Can SBAR be implemented with high fidelity and does it improve communication between healthcare workers? A systematic review

ObjectiveTo characterise the extent to which health professionals perform SBAR (situation, background, assessment, recommendation) as intended (ie, with high fidelity) and the extent to which its use improves communication clarity or other quality measures.Data sourcesMedline, Healthstar, PsycINFO, Embase and CINAHL to October 2020 and handsearching selected journals.Study selection and outcome measuresEligible studies consisted of controlled trials and time series, including simple before-after design, assessing SBAR implementation fidelity or the effects of SBAR on communication clarity or other quality measures (eg, safety climate, patient outcomes).Data extraction and synthesisTwo reviewers independently abstracted data according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses on study features, intervention details and study outcomes. We characterised the magnitude of improvement in outcomes as small (<20% relative increase), moderate (20%–40%) or large (>40%).ResultsTwenty-eight studies (3 randomised controlled trials, 6 controlled before-after studies, and 19 uncontrolled before-after studies) met inclusion criteria. Of the nine studies assessing fidelity of SBAR use, four occurred in classroom settings and three of these studies reported large improvements. The five studies assessing fidelity in clinical settings reported small to moderate effects. Among eight studies measuring communication clarity, only three reported large improvements and two of these occurred in classroom settings. Among the 17 studies reporting impacts on quality measures beyond communication, over half reported moderate to large improvements. These improvements tended to involve measures of teamwork and culture. Improvements in patient outcomes occurred only with intensive multifaceted interventions (eg, early warning scores and rapid response systems).ConclusionsHigh fidelity uptake of SBAR and improvements in communication clarity occurred predominantly in classroom studies. Studies in clinical settings achieving impacts beyond communication typically involved broader, multifaceted interventions. Future efforts to improve communication using SBAR should first confirm high fidelity uptake in clinical settings rather than assuming this has occurred.PROSPERO registration numberCRD42018111377.

Unveiling Associations of COVID-19 Vaccine Acceptance, Hesitancy, and Resistance: A Cross-Sectional Community-Based Adult Survey

COVID-19 vaccines are essential to limit and eliminate the infectious disease. This research aims to identify strong vaccination resistance profiles and/or hesitation considering health, psychosocial, and COVID-related variables. A cross-sectional online survey (N = 300) was conducted in the context of strict COVID-related gathering and mobility restrictions (January–March 2021). Data collected were vaccine acceptance, hesitancy and resistance rates, general psychosocial status, and preventive practices and beliefs regarding COVID-19 and its vaccination, among other factors. Logistic regression was applied to a real-world data set and a significant model (χ2 (7, N = 278) = 124.548, p < 0.001) explaining 51.3% (R2 Nagelkerke) of attitudes towards vaccination was obtained, including the following predictors for acceptance: to have greater confidence in the COVID vaccine security (OR = 0.599) and effectiveness (OR = 0.683), older age (OR = 0.952), to be a healthcare professional (OR = 0.363), to have vulnerable individuals in charge (OR = 0.330), and sustain the belief that the vaccine will end the pandemic situation (OR = 0.346) or not being sure but give some credence to that belief (OR = 0.414). Findings could help understand the rate and determinants of COVID-19 vaccine resistance/hesitancy among a Spanish population sample and facilitate multifaceted interventions to enhance vaccine acceptance.

COVID-19 Stress and the Health of Black Americans in the Rural South

Black Americans have been disproportionately affected by the COVID-19 pandemic. To better understand changes in and predictors of their mental and physical health, in the current study, we used three waves of data (two prepandemic and a third during summer 2020) from 329 Black men and women in the rural South. Results indicated that health worsened after the onset of the pandemic, including increased depressive symptoms and sleep problems and decreased self-reported general health. Greater exposure to COVID-19-related stressors was significantly associated with poorer health. Prepandemic stressors (financial strain, racial discrimination, chronic stress) and prepandemic resources (marital quality, general support from family and friends) were significantly associated with exposure to COVID-19-related stressors and with health during the pandemic. Findings underscore how the pandemic posed the greatest threats to Black Americans with more prepandemic psychosocial risks and highlight the need for multifaceted interventions that address current and historical stressors among this population.

Transmission dynamics of SARS-CoV-2 in a mid-size city of China

Background An outbreak of pneumonia, COVID-19 associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan city and then rapidly spread to other cities. Wenzhou is located approximately 900 km from Wuhan, which was experiencing an outbreak that was severe at the time but is considered modest as the epidemic became a pandemic. We described the epidemiological characteristics of SARS-CoV-2 outside of the epicenter to help understand the transmission pattern in a mid-sized Chinese city. Methods To investigate the epidemiological and clinical characteristics of the COVID-19, we described case series of 473 patients with confirmed COVID-19 in Wenzhou, China from January 27 to March 16, 2020. We described the public health interventions of COVID-19 and evaluated the effect of interventions by the effective reproduction number (Rt). Results The median age of all patients was 47.6 years, 48.4% of whom were female. 33.8% of the patients had a history of residence in Wuhan. Fever (71.7%) and cough (43.1%) were the most common symptoms. In addition, three kinds of unconventional cases were observed, namely 4.9% asymptomatic patients, 7.6% confirmed patients who had no link to Wuhan city but contact with individuals from Wuhan without any symptoms at the time of contact, and 12.9% confirmed patients who had an unknown source of transmission. We estimated that the basic reproductive number (R0) was 2.75 (95% CI: 2.37–3.23). The Rt fluctuated within the range of 2.50 to 3.74 from January 11 to January 16 while gradually reached a peak of 3.74 on January 16. Rt gradually decreased after January 16 and decreased to 1.00 on January 30. Rt continually decreased and reached the lowest point (0.03) on February 21, 2020. Conclusion Our study presented the possibility of asymptomatic carriers affected with SARS-CoV-2, and transmission by these three kinds of unconventional patients in Wenzhou may be an important characteristic of SARS-CoV-2 transmission. The evaluation showed that a series of multifaceted interventions proved effective in controlling the epidemic of COVID-19. These findings might provide valuable examples of control policies for countries or areas in combatting the global pandemic of COVID-19.

Reducing Overuse of Proton Pump Inhibitors for Stress Ulcer Prophylaxis and Nonvariceal Gastrointestinal Bleeding in the Hospital: A Narrative Review and Implementation Guide

Proton pump inhibitors (PPIs) are among the most commonly used medications in the world; however, these drugs carry the risk of patient harm, including acute and chronic kidney disease, Clostridium difficile infection, hypomagnesemia, and fractures. In the hospital setting, PPIs are overused for stress ulcer prophylaxis and gastrointestinal bleeding, and PPI use often continues after discharge. Numerous multifaceted interventions have demonstrated safe and effective reduction of PPI use in the inpatient setting. This narrative review and the resulting implementation guide summarize published interventions to reduce inappropriate PPI use and provide a strategy for quality improvement teams.

Haptic-Enabled Hand Rehabilitation in Stroke Patients: A Scoping Review

There is a plethora of technology-assisted interventions for hand therapy, however, less is known about the effectiveness of these interventions. This scoping review aims to explore studies about technology-assisted interventions targeting hand rehabilitation to identify the most effective interventions. It is expected that multifaceted interventions targeting hand rehabilitation are more efficient therapeutic approaches than mono-interventions. The scoping review will aim to map the existing haptic-enabled interventions for upper limb rehabilitation and investigates their effects on motor and functional recovery in patients with stroke. The methodology used in this review is based on the Arksey and O’Malley framework, which includes the following stages: identifying the research question, identifying relevant studies, study selection, charting the data, and collating, summarizing, and reporting the results. Results show that using three or four different technologies was more positive than using two technologies (one technology + haptics). In particular, when standardized as a percentage of outcomes, the combination of three technologies showed better results than the combination of haptics with one technology or with three other technologies. To conclude, this study portrayed haptic-enabled rehabilitation approaches that could help therapists decide which technology-enabled hand therapy approach is best suited to their needs. Those seeking to undertake research and development anticipate further opportunities to develop haptic-enabled hand telerehabilitation platforms.

Oncology Clinicians’ Challenges to Providing Palliative Cancer Care—A Theoretical Domains Framework, Pan-Cancer System Survey

Despite the known benefits, healthcare systems struggle to provide early, integrated palliative care (PC) for advanced cancer patients. Understanding the barriers to providing PC from the perspective of oncology clinicians is an important first step in improving care. A 33-item online survey was emailed to all oncology clinicians working with all cancer types in Alberta, Canada, from November 2017 to January 2018. Questions were informed by Michie’s Theoretical Domains Framework and Behaviour Change Wheel (BCW) and queried (a) PC provision in oncology clinics, (b) specialist PC consultation referrals, and (c) working with PC consultants and home care. Respondents (n = 263) were nurses (41%), physicians (25%), and allied healthcare professionals (18%). Barriers most frequently identified were “clinicians’ limited time/competing priorities” (64%), “patients’ negative perceptions of PC” (63%), and clinicians’ capability to manage patients’ social issues (63%). These factors mapped to all three BCW domains: motivation, opportunity, and capability. In contrast, the least frequently identified barriers were clinician motivation and perceived PC benefits. Oncology clinicians’ perceptions of barriers to early PC were comparable across tumour types and specialties but varied by professional role. The main challenges to early integrated PC include all three BCW domains. Notably, motivation is not a barrier for oncology clinicians; however, opportunity and capability barriers were identified. Multifaceted interventions using these findings have been developed, such as tip sheets to enhance capability, reframing PC with patients, and earlier specialist PC nursing access, to enhance clinicians’ use of and patients’ benefits from an early PC approach.

Effect of unifaceted and multifaceted interventions on antibiotic prescription control for respiratory diseases: a systematic review of randomised controlled trials

Background The global health system is improperly using antibiotics, particularly in the treatment of respiratory diseases. We aimed to examine the effectiveness of implementing a unifaceted and multifaceted intervention for unreasonable antibiotic prescriptions. Methods Relevant literature published in the databases of Pubmed, Embase, Science Direct, Cochrane Central Register of Controlled Trials (CENTRAL), Chinese Journal Full-text (CNKI) and Wanfang was searched. Data were independently filtered and extracted by two reviewers based on a pre-designed inclusion and exclusion criteria. The Cochrane collaborative bias risk tool was used to evaluate the quality of the included randomised controlled trials studies. Results A total of 1,074 studies were obtained of which 58 were included in the systematic review. Fifty-one studies reported positive results, that is, the primary results in the intervention groups were superior to those in the control groups. The remaining 7 studies had negative or partially negative results. In 19 studies the outcome variable was the antibiotic prescription rate with detailed reports of the number of prescriptions being further analyzed, of which 17 involved educational interventions for doctors, including: (1) Online training using email, web pages and webinar, (2) Antibiotic guidelines for information dissemination measures by email, postal or telephone reminder, (3) Training doctors in communication skills, (4) Short-term interactive educational seminars, and (5) Short-term field training sessions. Seventeen studies of interventions for health care workers also included: (6) Regular or irregular assessment/audit of antibiotic prescriptions, (7) Prescription recommendations from experts and peers delivered at a meeting or online, (8) Publicly reporting on doctors' antibiotic usage to patients, hospital administrators, and health authorities, (9) Monitoring/feedback prescribing behavior to general practices by email or poster, and (10) Studies involving patients and their families (n = 9). Seventeen randomised controlled trials were rated as having a low risk of bias while 2 randomised controlled trials were rated as having a high risk of bias. Conclusion The combination of education, prescription audit, prescription recommendations from experts, public reporting, prescription feedback and patient or family member multifaceted interventions can effectively reduce antibiotic prescription rates in health care institutions. Moreover, adding multifaceted interventions to educational interventions can control antibiotic prescription rates and may be a more reasonable method. Registrations: This systematic review was registered in PROSPERO, registration number: CRD42020192560.

Acceptability of a COVID-19 Vaccine among the Saudi Population

To investigate the associated factors underlying vaccination intentions for Coronavirus Disease 2019 (COVID-19), an online cross-sectional survey was conducted among adults 18 years or over in the Kingdom of Saudi Arabia. Data were collected between 8 and 14 December 2020. A logistic regression analysis was employed to examine and identify the variables associated with vaccination intentions for COVID-19, with the odds ratio (OR) and 95% confidence interval (CI) also calculated. A total of 2137 respondents completed the questionnaire. Overall, about 48% of Saudi adults were willing to receive the COVID-19 vaccine. Participants had stronger intentions to receive a vaccination if they resided in the southern region (OR: 1.95; 95% CI: 1.21–3.14), received the seasonal influenza vaccination in the past (OR: 1.52; 95% CI: 1.17–1.97), believed in mandatory COVID-19 vaccination (OR: 45.07; 95% CI: 31.91–63.65), or reported high levels of concern about contracting COVID-19 (OR: 1.91; 95% CI: 1.29–2.81). Participants were less likely to have an intention to be vaccinated if they had a history of vaccine refusal (OR: 0.28; 95% CI: 0.19–0.40). The low acceptance rate among the Saudi population should be targeted with multifaceted interventions aimed at raising awareness and emphasizing the safety and efficacy of the COVID-19 vaccine.