Pub Date : 2004-02-27DOI: 10.1111/j.1479-6988.2004.00008.x
Alan Pearson RN PhD FRCNA FAAG FRCN
Techniques for the systematic review of evidence of effectiveness are now well established. Health-care professionals argue, however, for a need to recognise evidence of appropriateness and feasibility and for the development of methodologies to appraise and synthesise the results of qualitative research. This paper describes a participatory project designed to develop systems to systematically review qualitative evidence. The Qualitative Assessment and Review Instrument is described in detail, and a suite of programs designed to conduct comprehensive reviews of evidence for health-care practice is outlined. As evidence-based practice increases in sophistication, and its influence in health service delivery expands, the need for broadening the view of what constitutes legitimate evidence is advanced by clinicians and the approach described attempts to achieve a balance in evidence review that recognises the value of quantitative and qualitative evidence.
{"title":"Balancing the evidence: incorporating the synthesis of qualitative data into systematic reviews","authors":"Alan Pearson RN PhD FRCNA FAAG FRCN","doi":"10.1111/j.1479-6988.2004.00008.x","DOIUrl":"https://doi.org/10.1111/j.1479-6988.2004.00008.x","url":null,"abstract":"<p>Techniques for the systematic review of evidence of effectiveness are now well established. Health-care professionals argue, however, for a need to recognise evidence of appropriateness and feasibility and for the development of methodologies to appraise and synthesise the results of qualitative research. This paper describes a participatory project designed to develop systems to systematically review qualitative evidence. The Qualitative Assessment and Review Instrument is described in detail, and a suite of programs designed to conduct comprehensive reviews of evidence for health-care practice is outlined. As evidence-based practice increases in sophistication, and its influence in health service delivery expands, the need for broadening the view of what constitutes legitimate evidence is advanced by clinicians and the approach described attempts to achieve a balance in evidence review that recognises the value of quantitative and qualitative evidence.</p>","PeriodicalId":100738,"journal":{"name":"JBI Reports","volume":"2 2","pages":"45-64"},"PeriodicalIF":0.0,"publicationDate":"2004-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1479-6988.2004.00008.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71983746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2004-01-16DOI: 10.1111/j.1479-697X.2004.00007.x
Rhonda D Griffiths, Ritin S Fernandez, Maria S Mostacchi, Venita Evans
Background One in four people globally will be affected by mental disorders at some point in their life. Currently approximately 450 million people worldwide suffer from this condition thereby placing mental health disorders among the leading cause of illness. Although treatment with psychotropic medication for specific psychological interventions has been demonstrated to be beneficial, it is also associated with relapse due to non-adherence to the medication regime. Factors associated with non-compliance include inadequate knowledge of the condition and the side-effects of the drugs. However, there is still some debate amongst psychiatrists as to the relative benefits of informing consumers about the side-effects.
Objectives The objective of this review was to systematically assess the literature and present the best available evidence that investigated the efficacy of educational interventions, relating to psychotropic medications, for consumers with a mental health disorder.
Search strategy A literature search was performed using the following databases Medline (1966–2000), CINAHL (1982–2002), EMBASE (1980–2002) ProQuest, Psychlit and the Cochrane Controlled Trials Register (Issue 2, 2002 of Cochrane Library). In addition, the reference lists of relevant trials and conference proceedings were also scrutinised. No language restrictions were applied. Experts and investigators were contacted to elicit further information.
Selection criteria All relevant randomised controlled trials that investigated the effectiveness of providing education and the methods to provide education to adult consumers with a mental illness were eligible for inclusion in the study.
Data collection and analysis Eligibility of the trials for inclusion in the review, details of eligible trials and the methodological quality of the trials was assessed jointly by two reviewers. All information was verified by a third reviewer. Odds ratio for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals. Where synthesis was inappropriate a narrative overview was undertaken.
Results Twenty-one studies were included in this review. Knowledge was assessed in 15 studies. Compliance was assessed in 13 studies. Relapse was assessed in five studies and insight was assessed in six studies. Those patients who were provided with education demonstrated a significant increase in the level of knowledge and compliance compared to those who were not. However, there was no difference in the incidence of relapse and insight in those who were provided education. A structured education session using both written and verbal methods followed by discussion was demonstrated to be effective. The evidence suggests that consumers who were provided multiple education sessions had greater knowledge g
{"title":"Comparison of educational interventions for mental health consumers receiving psychotropic medication","authors":"Rhonda D Griffiths, Ritin S Fernandez, Maria S Mostacchi, Venita Evans","doi":"10.1111/j.1479-697X.2004.00007.x","DOIUrl":"https://doi.org/10.1111/j.1479-697X.2004.00007.x","url":null,"abstract":"<div>\u0000 \u0000 <p><b>Background </b> One in four people globally will be affected by mental disorders at some point in their life. Currently approximately 450 million people worldwide suffer from this condition thereby placing mental health disorders among the leading cause of illness. Although treatment with psychotropic medication for specific psychological interventions has been demonstrated to be beneficial, it is also associated with relapse due to non-adherence to the medication regime. Factors associated with non-compliance include inadequate knowledge of the condition and the side-effects of the drugs. However, there is still some debate amongst psychiatrists as to the relative benefits of informing consumers about the side-effects.</p>\u0000 <p><b>Objectives </b> The objective of this review was to systematically assess the literature and present the best available evidence that investigated the efficacy of educational interventions, relating to psychotropic medications, for consumers with a mental health disorder.</p>\u0000 <p><b>Search strategy </b> A literature search was performed using the following databases Medline (1966–2000), CINAHL (1982–2002), EMBASE (1980–2002) ProQuest, Psychlit and the Cochrane Controlled Trials Register (Issue 2, 2002 of Cochrane Library). In addition, the reference lists of relevant trials and conference proceedings were also scrutinised. No language restrictions were applied. Experts and investigators were contacted to elicit further information.</p>\u0000 <p><b>Selection criteria </b> All relevant randomised controlled trials that investigated the effectiveness of providing education and the methods to provide education to adult consumers with a mental illness were eligible for inclusion in the study.</p>\u0000 <p><b>Data collection and analysis </b> Eligibility of the trials for inclusion in the review, details of eligible trials and the methodological quality of the trials was assessed jointly by two reviewers. All information was verified by a third reviewer. Odds ratio for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals. Where synthesis was inappropriate a narrative overview was undertaken.</p>\u0000 <p><b>Results </b> Twenty-one studies were included in this review. Knowledge was assessed in 15 studies. Compliance was assessed in 13 studies. Relapse was assessed in five studies and insight was assessed in six studies. Those patients who were provided with education demonstrated a significant increase in the level of knowledge and compliance compared to those who were not. However, there was no difference in the incidence of relapse and insight in those who were provided education. A structured education session using both written and verbal methods followed by discussion was demonstrated to be effective. The evidence suggests that consumers who were provided multiple education sessions had greater knowledge g","PeriodicalId":100738,"journal":{"name":"JBI Reports","volume":"2 1","pages":"1-44"},"PeriodicalIF":0.0,"publicationDate":"2004-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71966352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background This systematic review updates a previous review published in 2000. The objective of this review was to present the best available evidence relating to the prevention of catheter‐associated urinary tract infections (UTI). Selection criteria This review considered randomised controlled trials (RCTs) of adult patients with short‐term urethral catheters. In the absence of RCTs, other research designs such as non‐randomised controlled trials and before and after studies were considered for inclusion. Interventions of interest were those related to the prevention of catheter‐related UTI and included: sterile versus non‐sterile insertion technique, special coatings to catheters versus standard non‐coated catheters, the use of flush solutions, the use of solutions added to urinary drainage bag, maintenance of a closed urinary drainage circuit, the use of antireflux valves, antibiotic creams applied to the external meatus‐catheter interface, meatal care regimens, education programs, and changed care delivery practices. This review was limited to short‐term urethral catheters, and so studies evaluating long‐term or suprapubic catheters were excluded. The primary outcome of interest was the difference in the rates of UTI between experimental intervention and the control. Search strategy The search included both published and unpublished studies with an initial limited search of MEDLINE and CINAHL databases undertaken to identify key words contained in the title or abstract, and index terms used to describe relevant interventions. A second extensive search used all identified key words and index terms. The third step included a search of the reference lists and bibliographies of relevant articles. The databases searched included: CINAHL, MEDLINE, Current Contents, Cochrane Library, Expanded Academic Index, and Embase. The Dissertation Abstracts International database was searched for unpublished studies. Assessment of methodological quality Methodological quality was assessed using a standardised checklist. Critical appraisal and data extraction were conducted by two independent reviewers; discrepancies were addressed through discussion with a third reviewer as required. Results There was no significant difference in infection rate using either sterile surgical or non‐sterile insertion technique. The use of water for cleansing prior to catheter insertion was recommended. There was no additional benefit from specific meatal care other than standard daily personal hygiene and removal of debris. Infection rates were similar for both latex and silicone catheters. Comparisons between silver and Teflon coating clearly favoured the silver alloy coating. The use of a complex closed drainage system in the intensive care environment did not confer any additional benefit. Studies comparing types of junction seals and use of junction seals either prior to or following catheterisation found no clear benefit from using either preconnected sealed systems or sea
{"title":"Management of short-term indwelling urethral catheters to prevent urinary tract infections†","authors":"Craig Lockwood RN BN GradDipNSc(ClinNurs) MNSc, Tamara Page RN BN HyperbaricNursCert GradDipNSc(HighDep) MNSc, Tiffany Conroy-Hiller RN BN DipBusFLM, Zuben Florence RN GradDipNSc(Cardiac)","doi":"10.1111/j.1365-2788.2004.00014.x","DOIUrl":"https://doi.org/10.1111/j.1365-2788.2004.00014.x","url":null,"abstract":"Background This systematic review updates a previous review published in 2000. The objective of this review was to present the best available evidence relating to the prevention of catheter‐associated urinary tract infections (UTI). Selection criteria This review considered randomised controlled trials (RCTs) of adult patients with short‐term urethral catheters. In the absence of RCTs, other research designs such as non‐randomised controlled trials and before and after studies were considered for inclusion. Interventions of interest were those related to the prevention of catheter‐related UTI and included: sterile versus non‐sterile insertion technique, special coatings to catheters versus standard non‐coated catheters, the use of flush solutions, the use of solutions added to urinary drainage bag, maintenance of a closed urinary drainage circuit, the use of antireflux valves, antibiotic creams applied to the external meatus‐catheter interface, meatal care regimens, education programs, and changed care delivery practices. This review was limited to short‐term urethral catheters, and so studies evaluating long‐term or suprapubic catheters were excluded. The primary outcome of interest was the difference in the rates of UTI between experimental intervention and the control. Search strategy The search included both published and unpublished studies with an initial limited search of MEDLINE and CINAHL databases undertaken to identify key words contained in the title or abstract, and index terms used to describe relevant interventions. A second extensive search used all identified key words and index terms. The third step included a search of the reference lists and bibliographies of relevant articles. The databases searched included: CINAHL, MEDLINE, Current Contents, Cochrane Library, Expanded Academic Index, and Embase. The Dissertation Abstracts International database was searched for unpublished studies. Assessment of methodological quality Methodological quality was assessed using a standardised checklist. Critical appraisal and data extraction were conducted by two independent reviewers; discrepancies were addressed through discussion with a third reviewer as required. Results There was no significant difference in infection rate using either sterile surgical or non‐sterile insertion technique. The use of water for cleansing prior to catheter insertion was recommended. There was no additional benefit from specific meatal care other than standard daily personal hygiene and removal of debris. Infection rates were similar for both latex and silicone catheters. Comparisons between silver and Teflon coating clearly favoured the silver alloy coating. The use of a complex closed drainage system in the intensive care environment did not confer any additional benefit. Studies comparing types of junction seals and use of junction seals either prior to or following catheterisation found no clear benefit from using either preconnected sealed systems or sea","PeriodicalId":100738,"journal":{"name":"JBI Reports","volume":"2 8","pages":"1–36"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1365-2788.2004.00014.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71959026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective The objective of this review was to appraise and synthesise the best available evidence on the clinical effectiveness of peritoneal dialysis catheter exit-site care.
Inclusion criteria This review considered all randomised controlled trials that evaluated the effectiveness of peritoneal exit-site care. In the absence of randomised controlled trials, other controlled research designs such as non-randomised controlled trials were considered for inclusion in a narrative summary to enable the identification of current approaches and possible future strategies. Participants of interest were adults with chronic renal failure on maintenance peritoneal dialysis. Interventions of interest were those used to manage peritoneal catheter exit sites, and included types of dressings, frequency of dressings, types of skin care, and use of topical antiseptic or antimicrobial agents.
Search strategy The search sought to find both published and unpublished studies. An initial limited search of MEDLINE and CINAHL databases was undertaken to identify key words contained in the title or abstract, and index terms used to describe relevant articles. A second extensive search was undertaken using all identified key words and index terms. The third step was a search of the reference lists and bibliographies of all relevant articles.
Methodological quality All identified studies that met the inclusion criteria were assessed for methodological validity by two reviewers prior to inclusion in the review. Critical appraisal of studies focused on identifying bias in selection, performance, attrition and detection.
Results This review found few studies of sufficient quality to meet the inclusion criteria. The included studies often utilised historical control groups, potentially confounding measurement of their outcomes. The outcome measures varied considerably, thus meta-analysis was not possible.
Conclusions This review suggests topical mupirocin may reduce the risk of exit-site infection; however, the clinical effectiveness of any one antibiotic, antiseptic or dressing procedure was not established for the prevention or reduction of exit-site infection rates or peritonitis. This review has underlined large gaps in the existing knowledge on the care of exit sites in patients on peritoneal dialysis.
{"title":"Clinical effectiveness of different approaches to peritoneal dialysis catheter exit-site care","authors":"Craig Lockwood RN BN GradDip (ClinNurs) MNSC, Brent Hodgkinson MSc, Tamara Page RN BN HyperbaricNursCert GradDipNSc(HighDep)","doi":"10.1046/j.1479-697X.2003.00006.x","DOIUrl":"10.1046/j.1479-697X.2003.00006.x","url":null,"abstract":"<div>\u0000 \u0000 <p><b>Objective</b> The objective of this review was to appraise and synthesise the best available evidence on the clinical effectiveness of peritoneal dialysis catheter exit-site care.</p>\u0000 <p><b>Inclusion criteria</b> This review considered all randomised controlled trials that evaluated the effectiveness of peritoneal exit-site care. In the absence of randomised controlled trials, other controlled research designs such as non-randomised controlled trials were considered for inclusion in a narrative summary to enable the identification of current approaches and possible future strategies. Participants of interest were adults with chronic renal failure on maintenance peritoneal dialysis. Interventions of interest were those used to manage peritoneal catheter exit sites, and included types of dressings, frequency of dressings, types of skin care, and use of topical antiseptic or antimicrobial agents.</p>\u0000 <p><b>Search strategy</b> The search sought to find both published and unpublished studies. An initial limited search of MEDLINE and CINAHL databases was undertaken to identify key words contained in the title or abstract, and index terms used to describe relevant articles. A second extensive search was undertaken using all identified key words and index terms. The third step was a search of the reference lists and bibliographies of all relevant articles.</p>\u0000 <p><b>Methodological quality</b> All identified studies that met the inclusion criteria were assessed for methodological validity by two reviewers prior to inclusion in the review. Critical appraisal of studies focused on identifying bias in selection, performance, attrition and detection.</p>\u0000 <p><b>Results</b> This review found few studies of sufficient quality to meet the inclusion criteria. The included studies often utilised historical control groups, potentially confounding measurement of their outcomes. The outcome measures varied considerably, thus meta-analysis was not possible.</p>\u0000 <p><b>Conclusions</b> This review suggests topical mupirocin may reduce the risk of exit-site infection; however, the clinical effectiveness of any one antibiotic, antiseptic or dressing procedure was not established for the prevention or reduction of exit-site infection rates or peritonitis. This review has underlined large gaps in the existing knowledge on the care of exit sites in patients on peritoneal dialysis.</p>\u0000 </div>","PeriodicalId":100738,"journal":{"name":"JBI Reports","volume":"1 6","pages":"167-201"},"PeriodicalIF":0.0,"publicationDate":"2003-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1046/j.1479-697X.2003.00006.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77284017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective The objective of this review was to summarise the best available research related to the prevention and management of shoulder pain in the hemiplegic patient.
Inclusion criteria This review considered all studies that included hemiplegic patients post-cerebral vascular accident (CVA). Interventions of interest were any treatments or programs used to manage or prevent shoulder pain secondary to hemiplegia. The primary outcomes of interest were those related to pain. This review considered any randomised controlled trials (RCT) that evaluated the effectiveness of interventions that addressed shoulder pain in hemiplegic patients. In the absence of RCT, other research designs such as non-randomised controlled trials, time series and case series were also considered for inclusion in a narrative summary.
Search strategy The search sought to find both published and unpublished studies. Databases were searched up to February 2002 and included Medline, CINAHL, Current Contents, Cochrane Library, Expanded Academic Index, Electronic Collections Online, Turning Research Into Practice (TRIP), Dissertation Abstracts and Proceedings First. The reference lists of all studies identified were searched for additional studies.
Assessment of methodological quality All studies were checked for methodological quality by two reviewers and data was extracted using a data extraction tool.
Results Current research evaluating the effectiveness of treatment interventions on hemiplegic shoulder pain is very limited. The studies were very diverse in their nature of research. There has been no replication of studies, with the studies found using different populations, interventions or outcome measures. Not one study could be compared with another. Meta-analysis was unable to be performed not only because of inadequate reporting of results, but more often due to differences between the studies’ participants and the range of interventions used. The diversity in interval post-CVA also makes it difficult to make any comparisons between studies. For this reason the review is in narrative form.
Conclusions With this limited evidence, no single intervention has been identified that offers a dramatic effect in terms of treating pain in the hemiplegic shoulder. There is potential for some benefits for the patient's functional and comfort status, thereby improving their quality of life and maximising their social participation.
Preventive interventions demonstrated that a shoulder positioning policy had no statistically significant effect on pain. Strapping within 48 h significantly delayed the onset of pain and current research evaluating exercise is not limited to just one area of exercise, but a diverse range, making it difficult to make any comparisons. Some studies did suggest evidence of improvement, al
目的本综述的目的是总结有关预防和治疗偏瘫患者肩痛的最佳研究。纳入标准:本综述纳入了所有涉及脑血管意外(CVA)后偏瘫患者的研究。感兴趣的干预措施是用于管理或预防偏瘫继发肩痛的任何治疗或计划。主要关注的结果是与疼痛相关的结果。本综述纳入了所有评估偏瘫患者肩部疼痛干预措施有效性的随机对照试验(RCT)。在没有随机对照试验的情况下，其他研究设计，如非随机对照试验、时间序列和病例序列，也被考虑纳入叙述性总结。搜索策略搜索旨在找到已发表和未发表的研究。检索到2002年2月的数据库，包括Medline、CINAHL、Current Contents、Cochrane Library、Expanded Academic Index、Electronic Collections Online、Turning Research Into Practice (TRIP)、Dissertation Abstracts and Proceedings First。检索所有研究的参考文献列表以寻找其他研究。所有研究的方法学质量均由两名审稿人进行检查，并使用数据提取工具提取数据。结果目前评价偏瘫肩痛治疗干预措施有效性的研究非常有限。这些研究在研究性质上是非常多样化的。由于这些研究使用了不同的人群、干预措施或结果衡量标准，因此没有重复的研究。没有一项研究可以与另一项进行比较。荟萃分析无法进行，不仅是因为结果报告不充分，更常见的是由于研究参与者和使用的干预措施范围之间的差异。cva后间隔的多样性也使得研究之间难以进行比较。由于这个原因，这篇评论是叙事性的。在有限的证据下，没有一种单一的干预措施能够在治疗偏瘫肩关节疼痛方面产生显著的效果。对患者的功能和舒适状况有潜在的好处，从而改善他们的生活质量，最大限度地提高他们的社会参与。预防性干预表明肩部定位策略对疼痛没有统计学上的显著影响。在48小时内捆扎可以显著延缓疼痛的发作，目前评估运动的研究并不局限于运动的一个领域，而是一个不同的范围，这使得很难进行任何比较。一些研究确实提出了改善的证据，尽管有限。然而，一些运动技巧加重了肩痛。治疗干预表明，肌电生物反馈不能作为一种单独的治疗进行评估，因为它与放松疗法一起使用。在一项小型随机对照试验中，关节内注射曲安奈德尚未被证明是有益的，并且与高副作用发生率相关。不同的运动技术可能会加重肩痛(例如，与冷冻疗法相比，Bobath技术)。对功能性电刺激用于预防和治疗的有效性进行了系统评价，结论是目前没有证据表明有效果。
{"title":"Prevention and management of shoulder pain in the hemiplegic patient","authors":"Tamara Page RN BN GradDipNSc(HighDep), Craig Lockwood RN BN GradDipClinNurs MNSc","doi":"10.1046/j.1479-6988.2003.00005.x","DOIUrl":"10.1046/j.1479-6988.2003.00005.x","url":null,"abstract":"<div>\u0000 \u0000 <p><b>Objective </b> The objective of this review was to summarise the best available research related to the prevention and management of shoulder pain in the hemiplegic patient.</p>\u0000 <p><b>Inclusion criteria </b> This review considered all studies that included hemiplegic patients post-cerebral vascular accident (CVA). Interventions of interest were any treatments or programs used to manage or prevent shoulder pain secondary to hemiplegia. The primary outcomes of interest were those related to pain. This review considered any randomised controlled trials (RCT) that evaluated the effectiveness of interventions that addressed shoulder pain in hemiplegic patients. In the absence of RCT, other research designs such as non-randomised controlled trials, time series and case series were also considered for inclusion in a narrative summary.</p>\u0000 <p><b>Search strategy </b> The search sought to find both published and unpublished studies. Databases were searched up to February 2002 and included Medline, CINAHL, Current Contents, Cochrane Library, Expanded Academic Index, Electronic Collections Online, Turning Research Into Practice (TRIP), Dissertation Abstracts and Proceedings First. The reference lists of all studies identified were searched for additional studies.</p>\u0000 <p><b>Assessment of methodological quality </b> All studies were checked for methodological quality by two reviewers and data was extracted using a data extraction tool.</p>\u0000 <p><b>Results </b> Current research evaluating the effectiveness of treatment interventions on hemiplegic shoulder pain is very limited. The studies were very diverse in their nature of research. There has been no replication of studies, with the studies found using different populations, interventions or outcome measures. Not one study could be compared with another. Meta-analysis was unable to be performed not only because of inadequate reporting of results, but more often due to differences between the studies’ participants and the range of interventions used. The diversity in interval post-CVA also makes it difficult to make any comparisons between studies. For this reason the review is in narrative form.</p>\u0000 <p><b>Conclusions </b> With this limited evidence, no single intervention has been identified that offers a dramatic effect in terms of treating pain in the hemiplegic shoulder. There is potential for some benefits for the patient's functional and comfort status, thereby improving their quality of life and maximising their social participation.</p>\u0000 <p>Preventive interventions demonstrated that a shoulder positioning policy had no statistically significant effect on pain. Strapping within 48 h significantly delayed the onset of pain and current research evaluating exercise is not limited to just one area of exercise, but a diverse range, making it difficult to make any comparisons. Some studies did suggest evidence of improvement, al","PeriodicalId":100738,"journal":{"name":"JBI Reports","volume":"1 5","pages":"149-165"},"PeriodicalIF":0.0,"publicationDate":"2003-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1046/j.1479-6988.2003.00005.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75677337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The objective of this systematic review was to present the best available evidence related to the management of nipple pain, post childbirth in breast-feeding women. The specific objective of the review was to determine the effectiveness of interventions used by and for breast-feeding women to prevent and/or reduce nipple pain and trauma.
Selection criteria
The review considered all studies that included women who breast-fed with or without painful or traumatised nipples of any aetiology post childbirth.
Interventions of interest were: (i) interventions aimed to prevent or reduce pain and/or trauma to nipples post commencement of breast-feeding; and (ii) treatments for painful or traumatised nipples post commencement of breast-feeding.
The primary outcomes of interest were those related to the prevention and treatment of nipple pain and/or trauma in women post childbirth, in terms of:
•Incidence and prevalence of nipple pain
•Pain intensity
•Incidence and prevalence of nipple trauma
•Healing rates of traumatised nipples
•Breast-feeding duration.
This review considered randomised-controlled trials (RCT) that evaluated the effectiveness of interventions and treatments associated with breast-feeding practices. In the absence of RCTs other research designs such as non-randomised controlled trials and before and after studies were considered for inclusion in a narrative summary to enable the identification of current practices and possible future strategies.
Search strategy
The search sought to find both published and unpublished studies in the English language. Databases were searched up to and including August 2002 and included MEDLINE, CINAHL, Current Contents, Cochrane Library, Expanded Academic Index, Electronic
{"title":"Management of nipple pain and/or trauma associated with breast-feeding","authors":"Tamara Page RN BN GradDipNSc(HighDep), Craig Lockwood RN BN GradDipClinNurs MNSc, Kylie Guest RN BN GradDipNSc(Cardiac)","doi":"10.1046/j.1479-697x.2003.00004.x","DOIUrl":"10.1046/j.1479-697x.2003.00004.x","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Executive summary</h3>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective </h3>\u0000 \u0000 <p>The objective of this systematic review was to present the best available evidence related to the management of nipple pain, post childbirth in breast-feeding women. The specific objective of the review was to determine the effectiveness of interventions used by and for breast-feeding women to prevent and/or reduce nipple pain and trauma.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection criteria</h3>\u0000 \u0000 <p> The review considered all studies that included women who breast-fed with or without painful or traumatised nipples of any aetiology post childbirth.</p>\u0000 \u0000 <p>Interventions of interest were: (i) interventions aimed to prevent or reduce pain and/or trauma to nipples post commencement of breast-feeding; and (ii) treatments for painful or traumatised nipples post commencement of breast-feeding.</p>\u0000 \u0000 <p>The primary outcomes of interest were those related to the prevention and treatment of nipple pain and/or trauma in women post childbirth, in terms of:</p>\u0000 \u0000 <div>\u0000 \u0000 <ul>\u0000 \u0000 <li>\u0000 \u0000 <p>•Incidence and prevalence of nipple pain</p>\u0000 </li>\u0000 \u0000 <li>\u0000 \u0000 <p>•Pain intensity</p>\u0000 </li>\u0000 \u0000 <li>\u0000 \u0000 <p>•Incidence and prevalence of nipple trauma</p>\u0000 </li>\u0000 \u0000 <li>\u0000 \u0000 <p>•Healing rates of traumatised nipples</p>\u0000 </li>\u0000 \u0000 <li>\u0000 \u0000 <p>•Breast-feeding duration.</p>\u0000 </li>\u0000 </ul>\u0000 </div>\u0000 \u0000 <p>This review considered randomised-controlled trials (RCT) that evaluated the effectiveness of interventions and treatments associated with breast-feeding practices. In the absence of RCTs other research designs such as non-randomised controlled trials and before and after studies were considered for inclusion in a narrative summary to enable the identification of current practices and possible future strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search strategy </h3>\u0000 \u0000 <p>The search sought to find both published and unpublished studies in the English language. Databases were searched up to and including August 2002 and included MEDLINE, CINAHL, Current Contents, Cochrane Library, Expanded Academic Index, Electronic ","PeriodicalId":100738,"journal":{"name":"JBI Reports","volume":"1 4","pages":"127-147"},"PeriodicalIF":0.0,"publicationDate":"2003-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1046/j.1479-697x.2003.00004.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85710562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2003-07-07DOI: 10.1046/j.1479-6988.2003.00003.x
Andrea Averis RN RM BSc MSc(PHC) PhD FRCNA FGLF, Alan Pearson RN PhD FRCNA FRCN
Background This report describes the results of a study designed to identify research priorities in nursing arising out of the analysis of 22 systematic review reports published by the Joanna Briggs Institute (JBI) from 1998 to 2002. A feature of the systematic review of evidence is the noticeable lack of high-quality evidence to support a large proportion of nursing interventions and activities. Systematic review topics are selected as areas of concern about practice by nurses comprising the individual and corporate membership of JBI at Professional Advisory Forums and meetings held annually throughout Australia and internationally in conjunction with JBI's collaborating centres. Such selection prioritises nurses’ views about what ‘matters in their daily practice’.
Objective and Methods The study comprised a content analysis of the 22 systematic review reports and set out to:
• identify any striking gaps in evidence for frequently used practices;
• generate research questions to address the gaps; and
• suggest research approaches appropriate to the research questions generated.
Results The results of the analysis identified in excess of 200 important gaps in the evidence base available for nursing practice in relation to the 22 discrete areas of practice examined. Recommendations included the wide dissemination of this report to promote the results of systematic reviews as an important resource in setting research priorities. Policy makers, the Commonwealth Government, State and Territory Governments, research funding bodies, organisations and individuals involved in decision-making and the funding of research in health care have received little substantive direction in setting priorities for nursing research. This lack of well founded advice is evidenced by the incredibly low level of support for nursing research in Australia and the large number of gaps in evidence for nursing practice.
Conclusions Knowledge transfer – of evidence into practice – has the potential to improve health outcomes, but the delivery of ‘best practice’ care based on sound evidence is dependant upon the generation of evidence to fill systematically identified gaps.
{"title":"Filling the gaps: identifying nursing research priorities through the analysis of completed systematic reviews†","authors":"Andrea Averis RN RM BSc MSc(PHC) PhD FRCNA FGLF, Alan Pearson RN PhD FRCNA FRCN","doi":"10.1046/j.1479-6988.2003.00003.x","DOIUrl":"10.1046/j.1479-6988.2003.00003.x","url":null,"abstract":"<div>\u0000 \u0000 <p><b>Background </b> This report describes the results of a study designed to identify research priorities in nursing arising out of the analysis of 22 systematic review reports published by the Joanna Briggs Institute (JBI) from 1998 to 2002. A feature of the systematic review of evidence is the noticeable lack of high-quality evidence to support a large proportion of nursing interventions and activities. Systematic review topics are selected as areas of concern about practice by nurses comprising the individual and corporate membership of JBI at Professional Advisory Forums and meetings held annually throughout Australia and internationally in conjunction with JBI's collaborating centres. Such selection prioritises nurses’ views about what ‘matters in their daily practice’.</p>\u0000 <p><b>Objective and Methods </b> The study comprised a content analysis of the 22 systematic review reports and set out to:</p>\u0000 <p>\u0000 \u0000 </p><ul>\u0000 \u0000 <li><span> </span>\u0000 \u0000 <p>• identify any striking gaps in evidence for frequently used practices;</p>\u0000 </li>\u0000 \u0000 <li><span> </span>\u0000 \u0000 <p>• generate research questions to address the gaps; and</p>\u0000 </li>\u0000 \u0000 <li><span> </span>\u0000 \u0000 <p>• suggest research approaches appropriate to the research questions generated.</p>\u0000 </li>\u0000 </ul>\u0000 \u0000 <p><b>Results </b> The results of the analysis identified in excess of 200 important gaps in the evidence base available for nursing practice in relation to the 22 discrete areas of practice examined. Recommendations included the wide dissemination of this report to promote the results of systematic reviews as an important resource in setting research priorities. Policy makers, the Commonwealth Government, State and Territory Governments, research funding bodies, organisations and individuals involved in decision-making and the funding of research in health care have received little substantive direction in setting priorities for nursing research. This lack of well founded advice is evidenced by the incredibly low level of support for nursing research in Australia and the large number of gaps in evidence for nursing practice.</p>\u0000 <p><b>Conclusions </b> Knowledge transfer – of evidence into practice – has the potential to improve health outcomes, but the delivery of ‘best practice’ care based on sound evidence is dependant upon the generation of evidence to fill systematically identified gaps.</p>\u0000 </div>","PeriodicalId":100738,"journal":{"name":"JBI Reports","volume":"1 3","pages":"49-126"},"PeriodicalIF":0.0,"publicationDate":"2003-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1046/j.1479-6988.2003.00003.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78814908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Total parenteral nutrition (TPN) is a form of nutritional support that has become an essential adjunct to the management of patients who are unable to obtain adequate nutrition either via the oral or enteral route. Previous studies indicate that TPN can be administered safely and effectively to patients; however, there are associated risks with this form of nutritional support. Researchers have indicated that due to the complexity of TPN therapy a high level of knowledge and expertise is required in the management of these patients. The multidisciplinary team approach has been supported for its ability to assess the patients’ nutritional status, prescribe the nutritional requirements, and reduce the incidence of metabolic complications through regular monitoring. However, contradictory views on the effectiveness of multidisciplinary TPN teams in health-care facilities have also been reported.
Aim The aim of this review was to critically analyse the literature and present the best available evidence that investigated the effectiveness of multidisciplinary TPN teams in the provision of TPN to adult hospitalised patients. The primary outcomes included: incidence of catheter-related complications, types of catheter-related complications, incidence of metabolic and electrolyte abnormalities, provision of nutritional requirements, estimated nutritional requirements, number of patients whose nutritional goals were met and the amount of energy and protein provided. Secondary outcomes included cost effectiveness of nutritional support teams and physician compliance with team recommendations.
Search strategy The literature search sought to identify both published and unpublished studies utilising various search strategies and the Internet. The Cochrane Library (2001, Issue 4) was initially searched to identify randomised controlled trials. The other electronic databases searched included CINAHL, Complete Medline, Complete Biomedical Collection, Complete Nursing Collection, and EMBASE. Experts and company representatives were contacted to identify published reports as well as research in progress relevant to this review. Professional bodies were contacted and included the British Association for Parenteral and Enteral Nutrition (BAPEN) and the Australasian Society for Parenteral and Enteral Nutrition (AuSPEN).
Selection criteria All randomised and non-randomised controlled trials comparing the effectiveness of multidisciplinary TPN teams, in the provision of TPN to adult hospitalised patients, were considered for inclusion in this review. Trials were included if they reported objective or subjective measures of nutritional, metabolic and catheter-related complications and cost effectiveness. To minimise publication bias studies reported in other languages were also considered for inclusion in the review.
{"title":"Effectiveness of a multidisciplinary total parenteral nutrition team in the hospital setting","authors":"Ritin Fernandez RN BSc(Nurs) MN(CritCare), Rhonda Griffiths RN CM BEd(Nurs) MSc(Hons) DrPH, Carlie-Jane Naylor BSc MNutrDiet MPH","doi":"10.1046/j.1479-6988.2003.00002.x","DOIUrl":"10.1046/j.1479-6988.2003.00002.x","url":null,"abstract":"<div>\u0000 \u0000 <p><b>Background </b> Total parenteral nutrition (TPN) is a form of nutritional support that has become an essential adjunct to the management of patients who are unable to obtain adequate nutrition either via the oral or enteral route. Previous studies indicate that TPN can be administered safely and effectively to patients; however, there are associated risks with this form of nutritional support. Researchers have indicated that due to the complexity of TPN therapy a high level of knowledge and expertise is required in the management of these patients. The multidisciplinary team approach has been supported for its ability to assess the patients’ nutritional status, prescribe the nutritional requirements, and reduce the incidence of metabolic complications through regular monitoring. However, contradictory views on the effectiveness of multidisciplinary TPN teams in health-care facilities have also been reported.</p>\u0000 <p><b>Aim </b> The aim of this review was to critically analyse the literature and present the best available evidence that investigated the effectiveness of multidisciplinary TPN teams in the provision of TPN to adult hospitalised patients. The primary outcomes included: incidence of catheter-related complications, types of catheter-related complications, incidence of metabolic and electrolyte abnormalities, provision of nutritional requirements, estimated nutritional requirements, number of patients whose nutritional goals were met and the amount of energy and protein provided. Secondary outcomes included cost effectiveness of nutritional support teams and physician compliance with team recommendations.</p>\u0000 <p><b>Search strategy </b> The literature search sought to identify both published and unpublished studies utilising various search strategies and the Internet. The Cochrane Library (2001, Issue 4) was initially searched to identify randomised controlled trials. The other electronic databases searched included CINAHL, Complete Medline, Complete Biomedical Collection, Complete Nursing Collection, and EMBASE. Experts and company representatives were contacted to identify published reports as well as research in progress relevant to this review. Professional bodies were contacted and included the British Association for Parenteral and Enteral Nutrition (BAPEN) and the Australasian Society for Parenteral and Enteral Nutrition (AuSPEN).</p>\u0000 <p><b>Selection criteria </b> All randomised and non-randomised controlled trials comparing the effectiveness of multidisciplinary TPN teams, in the provision of TPN to adult hospitalised patients, were considered for inclusion in this review. Trials were included if they reported objective or subjective measures of nutritional, metabolic and catheter-related complications and cost effectiveness. To minimise publication bias studies reported in other languages were also considered for inclusion in the review.</p>\u0000 <p><b>Data collection a","PeriodicalId":100738,"journal":{"name":"JBI Reports","volume":"1 2","pages":"17-48"},"PeriodicalIF":0.0,"publicationDate":"2003-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1046/j.1479-6988.2003.00002.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77817526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Indwelling urethral catheters (IUCs) are inserted in approximately 15–25% of all hospitalised patients mainly to assist clinicians to accurately monitor urine output during acute illness or following surgery, to treat urinary retention and for investigative purposes. However, this procedure is associated with significant morbidity. Although research has focused on the type and maintenance of urinary catheters and techniques for insertion, limited attention has been given to the procedures for their removal, in particular whether the time of day the IUC is removed influences patient outcomes. There is no consensus among clinicians about the optimal time for removal of IUCs, rather practices tend to be based on personal preference and tradition rather than on evidence from research.
Objectives The objective of this review was to determine whether the timing of the removal of IUCs influences patient outcomes. The primary outcomes of interest included duration to and volume of first void; length of hospitalisation; number of patients developing urinary retention and number requiring recatheterisation. Secondary outcome measures included patient satisfaction and the percentage of IUCs removed according to the scheduled time for removal.
Search strategy A literature search was performed using the following databases Medline (1966–2000), CINAHL (1982–2002), Nursing Collection (1995–2002), EMBASE (1980-current) and the Cochrane Controlled Trials Register (Issue 2, 2002 of Cochrane Library). In addition, the reference lists of relevant trials and conference proceedings were also scrutinised. No language restrictions were applied. Company representatives, experts and investigators were contacted to elicit further information.
Selection criteria All published and unpublished randomised and quasi-randomised controlled trials that compared the effects of the timing of removal of short-term IUC on patient outcomes were considered for inclusion in the review. Trials were included if they reported objective measures of time to and volume of the first void, length of hospital stay (number of hours from removal of the IUC to discharge), the number of patients who developed urinary retention following the removal of the IUC and the incidence of recatheterisation. Trials that included subjective measures of patient satisfaction were also considered for inclusion in the review.
Data collection and analysis Eligibility of the trials for inclusion in the review, details of eligible trials and the methodological quality of the trials was assessed independently by two reviewers. All information was verified by a third reviewer. Odds ratios for dichotomous data and weighted mean differences for continuous data were calculated with 95% confidence intervals. Where synthesis was inappropriate a narrative overview was undertaken. Trial
{"title":"Comparison of late night and early morning removal of short-term urethral catheters","authors":"Ritin Fernandez RN MN(CritCare), Rhonda Griffiths RN CM BEd(Nurs) MSc(Hons) DrPH, Penny Murie RN","doi":"10.1046/j.1479-6988.2003.00001.x","DOIUrl":"10.1046/j.1479-6988.2003.00001.x","url":null,"abstract":"<div>\u0000 \u0000 <p><b>Background </b> Indwelling urethral catheters (IUCs) are inserted in approximately 15–25% of all hospitalised patients mainly to assist clinicians to accurately monitor urine output during acute illness or following surgery, to treat urinary retention and for investigative purposes. However, this procedure is associated with significant morbidity. Although research has focused on the type and maintenance of urinary catheters and techniques for insertion, limited attention has been given to the procedures for their removal, in particular whether the time of day the IUC is removed influences patient outcomes. There is no consensus among clinicians about the optimal time for removal of IUCs, rather practices tend to be based on personal preference and tradition rather than on evidence from research.</p>\u0000 <p><b>Objectives </b> The objective of this review was to determine whether the timing of the removal of IUCs influences patient outcomes. The primary outcomes of interest included duration to and volume of first void; length of hospitalisation; number of patients developing urinary retention and number requiring recatheterisation. Secondary outcome measures included patient satisfaction and the percentage of IUCs removed according to the scheduled time for removal.</p>\u0000 <p><b>Search strategy </b> A literature search was performed using the following databases Medline (1966–2000), CINAHL (1982–2002), Nursing Collection (1995–2002), EMBASE (1980-current) and the Cochrane Controlled Trials Register (Issue 2, 2002 of Cochrane Library). In addition, the reference lists of relevant trials and conference proceedings were also scrutinised. No language restrictions were applied. Company representatives, experts and investigators were contacted to elicit further information.</p>\u0000 <p><b>Selection criteria </b> All published and unpublished randomised and quasi-randomised controlled trials that compared the effects of the timing of removal of short-term IUC on patient outcomes were considered for inclusion in the review. Trials were included if they reported objective measures of time to and volume of the first void, length of hospital stay (number of hours from removal of the IUC to discharge), the number of patients who developed urinary retention following the removal of the IUC and the incidence of recatheterisation. Trials that included subjective measures of patient satisfaction were also considered for inclusion in the review.</p>\u0000 <p><b>Data collection and analysis </b> Eligibility of the trials for inclusion in the review, details of eligible trials and the methodological quality of the trials was assessed independently by two reviewers. All information was verified by a third reviewer. Odds ratios for dichotomous data and weighted mean differences for continuous data were calculated with 95% confidence intervals. Where synthesis was inappropriate a narrative overview was undertaken. Trial","PeriodicalId":100738,"journal":{"name":"JBI Reports","volume":"1 1","pages":"1-16"},"PeriodicalIF":0.0,"publicationDate":"2003-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1046/j.1479-6988.2003.00001.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72411770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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