BACKGROUND: Evidence-based guidelines can assist critical care nurses in promoting best practices, including those related to endotracheal tube cuff pressure management. However, these guidelines require tailored strategies to enhance their implementation, uptake, and sustained use in practice OBJECTIVES: To evaluate Malawian critical care nurses' views on the implementation of an endotracheal tube cuff pressure management guideline to enhance sustained guideline use METHODS: An explorative-descriptive survey design was employed, using a questionnaire with closed- and open-ended questions that was distributed after implementation of an educational intervention based on an endotracheal tube cuff pressure management guideline. The questionnaire had a Cronbach's alpha score of 0.85 RESULTS: A total of 47 nurses working in four public and two private hospital intensive care units in Malawi participated. Quantitative findings showed that the majority of the participants (92%) indicated that the strategies used for the group that received the full intervention including both active (monitoring visits) and passive (a half-day educational session using a PowerPoint presentation, and a printed guideline and algorithm) strategies (intervention 1 group) were useful, clear and applicable and enhanced implementation of the guideline. These results were statistically significant (mean (standard deviation) 1.86 (0.84); f=6.07; p<0.0005). Qualitative data revealed three major themes related to recommendations for uptake and sustained use of the guideline in nursing practice: the guideline needs to be translated, updated, and made available to ICU staff; implementation strategies (continuous supervision and follow-up); and facilitating factors for successful implementation (education and training on guideline content, resources, and commitment to best practices CONCLUSION: The study highlighted that although the implementation strategies used were positively received by participants, they need to be further tailored to their context to enhance guideline uptake and sustained use in practice. Further study is required to ensure that tailored implementation strategies facilitate guideline uptake and sustained use, specifically in resource-constrained contexts

Convalescent plasma is being considered as a potential therapy for COVID-19. We highlight and contextualise the findings of a recent Cochrane rapid review that evaluated the effectiveness and safety of convalescent plasma or hyperimmune immunoglobulin transfusion in the treatment of people with COVID-19. The review found low-certainty evidence of the therapeutic effectiveness and safety of convalescent plasma. As the novel coronavirus continues to spread in South Africa (SA), convalescent plasma may offer a therapeutic ray of hope for mitigating the morbidity and mortality burdens of the disease. Further investigation of the clinical benefits of the therapy in well-designed studies is needed to provide more evidence that will guide COVID-19 treatment decision-making in the SA context.

BACKGROUND. Evidence-based practices (EBPs) have been promoted to enhance the delivery of patient care, reduce cost, increase patient and family satisfaction and contribute to professional development. Individual and organisational barriers can hamper the implementation of EBP, which can be detrimental to healthcare delivery. OBJECTIVE. To determine the individual and organisational implementation barriers of EBP among nurses in a private intensive care unit (ICU). METHODS. A quantitative research design was used to collect data from nurses in a private ICU in the Eastern Cape Province, South Africa. The structured questionnaire (Cronbach's alpha: 0.72) was administered to 70 respondents, with a response rate of 93%. RESULTS. Barriers at individual level were identified, and include lack of familiarity with EBP, individual perceptions that underpin clinical decision-making, lack of access to information required for EBP, inadequate sources to access evidence, inability to synthesise the literature available, and resistance to change. Barriers related to organisational support, change and operations were identified. CONCLUSION. Although the findings were similar to other studies, this study showed that nurses younger than 40 years of age were more familiar with the concepts of EBP. Physicians were perceived as not being very supportive of EBP implementation. In order to enhance healthcare delivery in the ICUs, nurse managers need to take cognisance of the individual and organisational barriers that might hamper the implementation of EBP.

Pasture legumes provide critical nitrogen inputs but fail to persist in typical acidic low P fertility upland soils. Alternative legume species for these environments are urgently sought. Twelve novel legume species were grown for 42 weeks under glasshouse conditions in an acidic upland New Zealand soil. Phosphorus (P) was applied at eight rates (0, 10, 30, 60, 100, 250, 500, 1500 mg kg-1 soil) or lime (100% CaCO3) at five rates (0, 2, 5, 8, 15 t ha-1 equivalent). Annual species grew on average for 25 weeks, while perennial species grew for 42 weeks. Yield was measured and herbage was analysed for macro and micro elements and soils analysed for pH, exchangeable Al and Olsen P. P responses differed substantially between legume species which were likely driven by genetic adaptations to low phosphorus environments. Critical shoot P concentrations for optimum yield were identified and ranged from 0.23 (tagasaste) to 0.39 % P (falcata lucerne). Arrow leaf, subterranean and balansa clovers had the greatest yield increase at low P inputs (100 mg P kg-1) and show promise as alternatives to white clover. Lime treatments increased the yield of all species to a point beyond which yield decreased with further additions. Increased yield was primarily driven by decreased soil exchangeable aluminium (Al) concentrations and to a lesser extent by increased soil P and molybdenum (Mo) availability, while decreases were driven by lower soil P and boron (B) availability at high pH. Thresholds for soil exchangeable Al differed between legume species. Species with higher Al thresholds (7 - 8 mg Al kg-1) were tagasaste, lotus, persian and gland clovers and falcata lucerne. These species show promise for acid soil environments with soil Al issues and should now be investigated further in field experiments. For many of these legume species this represents new and critical information.

OBJECTIVE: To explore the methods that can be used to verify endotracheal tube (ETT) placement in adult mechanically ventilated patients. METHODS: An integrative literature search was conducted in 2012 - 2013 of research citations published in English on the topic of discussion. Electronic databases searched were: the Cumulative Index of Nursing and Allied Health (CINAHL), MEDLINE, PubMed, the Joanna Briggs Institute (JBI) systematic review library, the Cochrane Library and the National Guidelines Clearinghouse. In addition, reference lists of articles, conference summaries and hand searching was performed. Citations were selected based on the inclusion and exclusion criteria as decided upon by the researchers. The process of critical appraisal was done by the researchers as well as an independent reviewer, all skilled in the research methodology and subject matter related to the topic of discussion. A total of 45 articles were included for critical appraisal. On completion of the critical appraisal, which was done by two independent reviewers, 34 articles were excluded and 11 articles were included in the integrative review analyses. Data were extracted following the critical appraisal process. Owing to the heterogeneity of studies, a metasynthesis could not be done. RESULTS: Based on the reviewed studies, various methods have been identified to verify ETT placement in adult mechanically ventilated patients, namely ultrasonography, the use of centimetre scale printed on the ETT, manual cuff palpation, bilateral auscultation of chest and palpation of symmetrical chest movements, oesophageal detector devices, visualisation of the ETT, use of chest X-ray, pulse oximetry and capnography. Both ultrasonography and capnography had excellent sensitivity and specificity in verifying ETT placement. CONCLUSION: Although there are various methods reported for ETT verification, the review results recommended ultrasonography and capnography as the most accurate and reliable verification methods.

SYNOPSIS The practice of ilmenite smelting in electric arc furnaces has been researched and published over the last few decades. An issue that has not been addressed is the understanding of the properties of ilmenite smelting reductants, and linking these properties to the subsequent smelting behaviour in the furnace. The reduction mechanism of ilmenite smelting is not fully understood, but it is believed that the Boudouard reaction plays a role. This paper investigates the behaviour of a number of reductants when reacted with CO2 at different temperatures.