Search

The objective of this review is to determine the incidence and prevalence, clinical features, and outcomes of COVID-19 in persons with cystic fibrosis.Cystic fibrosis, predominantly a chronic respiratory illness, has long been known to be fatal with concomitant bacterial or viral infections. Consequently, the effects of COVID-19 on this protracted disease need to be understood, especially since the major manifestations affect the respiratory system. Hence, this review aims to examine the burden, clinical features, and outcomes of COVID-19 on individuals with cystic fibrosis.This review will consider studies of persons in all age groups with preexisting cystic fibrosis who are diagnosed with COVID-19 using either a polymerase chain reaction, serology, or point-of-care test for SARS-CoV-2. Eligible studies will report the incidence, prevalence, clinical features, or outcomes of COVID-19 in individuals with cystic fibrosis. Studies in community or health care settings from any geographic location will be considered.The JBI methodology for systematic reviews of prevalence and incidence will be used for this review. A methodical search for eligible studies in English (as well as available translations) in MEDLINE, Embase, Scopus, and CINAHL, and unpublished literature in Google Scholar, Dissertation Abstracts International, ProQuest Dissertations and Theses, and MedNar will be conducted from the year 2020 onwards. Studies meeting the inclusion criteria will be selected for appraisal and their methodological quality will be assessed by two independent reviewers based on study titles and abstracts, followed by full-text review focusing on sampling and statistical analysis. Data extraction will be accomplished using a standardized tool. If adequate synthesized data are obtained, a meta-analysis will be conducted; otherwise, the findings will be presented in narrative format, including tables and figures to aid in data presentation.PROSPERO CRD42021237792.

Rapid alterations to study environments during COVID-19 raised concerns for nursing students about their academic progression.The study aim was to investigate the psychometric properties of the Altered Student Study Environment Tool (ASSET) and the relationship between students' concerns, demographics, COVID-19-related knowledge, and communication received from the university.The 11-item ASSET and investigator-developed questions were administered to prelicensure nursing students using an anonymous online survey.Responses were obtained from 234 students. Exploratory factor analysis supported a three-factor structure, namely, attending clinical placement, completion of clinical placement, and grade attainment. Students with higher scores on knowledge had significantly lower concerns for the subscale attending clinical placement. Full-time students had significantly higher concerns for the subscale completion of clinical placement.The ASSET is a valid and reliable instrument that can be used to measure concerns relating to the effects of altered study environments on academic progression.

BACKGROUND Research about skin-to-skin care (SSC) experiences in early period after birth has focused on mothers and infants. PURPOSE The purpose of this study was to determine the outcomes of paternal skin-to-skin care (P-SSC) in both fathers and infants. METHODS The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed/MEDLINE, Embase, CINAHL, PsycInfo, Airiti Library, and Google Scholar were searched for randomized controlled trials (RCTs) that reported outcomes of P-SSC in both fathers and infants. We calculated pooled mean differences (MDs) and 95% confidence intervals (CIs) using RevMan 5.3 for the meta-analysis [PROSPERO: CRD42018106790]. RESULTS Seven RCTs including a total of 552 participants were eligible for inclusion. Compared to the maternal skin-to-skin care (M-SSC), fathers in the P-SSC exhibited no significant differences in salivary oxytocin levels (MD: -0.35 pg/mL; 95% CI: -0.75, 0.05), salivary cortisol levels (MD: 0.25 μg/dL; 95% CI: -0.82, 1.33), or anxiety scores (MD: -0.17; 95% CI: -0.57, 0.22) during the period of SSC. Similarly, there were no significant differences in the salivary cortisol levels (MD: -0.11 μg/dL; 95% CI: -0.05, 0.28) among preterm infants between the 2 groups. However, the crying time was less among full-term infants in the P-SSC group compared with infants in the incubator care or cot care groups. IMPLICATIONS FOR PRACTICE AND RESEARCH P-SSC had similar effects as M-SSC on stress-related outcomes during and after SSC among fathers and infants in the early stages after birth. We recommend that P-SSC be implemented in the early stages after birth. Further RCTs with a longitudinal design and large samples are needed to better understand the long-term effects of P-SSC on fathers and infants.

OBJECTIVE The objective of this review was to synthesize the best available research evidence regarding the effectiveness of tree nuts on glycemic outcomes in adults with type 2 diabetes mellitus. INTRODUCTION There has been an increase in the use of complementary therapy, particularly botanical products, for management of type 2 diabetes mellitus. It has been reported that increasing mono- and polyunsaturated fatty acids in diet effectively lowers the risk of development of type 2 diabetes mellitus. Hence, it was hypothesized that consumption of nuts, which are high in polyunsaturated fatty acids and mono-unsaturated fatty acids, may aid in preventing diabetes and reducing levels of blood glucose by reducing glycemic load by displacing dietary carbohydrates present in diet. INCLUSION CRITERIA This systematic review included randomized controlled trials that compared the consumption of any type and form of tree nut with a placebo or any other intervention in adults with type 2 diabetes mellitus. Trials were included if they measured fasting blood glucose, postprandial blood glucose, and/or glycated hemoglobin. Trials that assessed triglyceride levels and weight postintervention were also considered for inclusion. Trials were restricted to the English language. METHODS A three step search of PubMed, CINAHL, Embase, Trip database, and Cochrane Central Register of Controlled Trials (CENTRAL) was done in July 2019. To find unpublished studies, ClinicalTrials.gov and Google Scholar were searched. Studies from the search were reviewed against the inclusion criteria by two reviewers. The JBI critical appraisal checklist for randomized controlled trials was used to assess the potential studies for methodological quality. A meta-analysis and subgroup analysis was conducted among trials with the same type of intervention and outcome measures. Results are presented in a narrative format where statistical pooling was not possible. RESULTS Fifteen trials were included with a total sample size of 667. Consumption of pistachios demonstrated a significant reduction in triglyceride levels (mmol/L) at three month or earlier follow-up (mean difference [MD] -0.28; confidence interval -0.33, -0.23; P

OBJECTIVE The objective of this systematic review was to synthesize the best available evidence relating to the measurement properties of the multidimensional pain assessment tools used to assess postoperative pain in adults. INTRODUCTION Pain is a common and poorly managed occurrence in patients during the postoperative period. Currently, postoperative pain is usually evaluated with assessment tools that measure one dimension of pain, namely pain intensity, resulting in inadequate management of postoperative pain. It is important to understand the complex nature of pain by considering all dimensions for optimal postoperative pain management. Systematic, robust evidence is lacking regarding the most psychometrically reliable and valid multidimensional pain assessment tool for adult postoperative patients. INCLUSION CRITERIA This systematic review considered all study types for inclusion. Studies were considered if they assessed the measurement properties of a multidimensional pain assessment tool in adult postoperative patients within two weeks post-surgery. The outcomes included measurement of at least one of the psychometric properties, including reliability, validity, and responsiveness. METHODS A three-step search strategy was undertaken, including a search of the MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL databases performed in October 2019. We also searched Dissertation Abstracts International, ProQuest Dissertations and Theses, MedNar, and ClinicalTrials.gov to identify unpublished studies. The title and abstracts of the studies were reviewed by two independent reviewers against the inclusion/exclusion criteria. The methodological quality of the potential studies was assessed independently by three reviewers using the COSMIN checklist. RESULTS Seventeen studies involving five multidimensional postoperative pain assessment tools were included in the review: American Pain Society Pain Outcomes Questionnaire-Revised; Brief Pain Inventory; Houston Pain Outcome Instrument; McGill Pain Questionnaire; and the Quality Improvement in Postoperative Pain Management Postoperative Pain Questionnaire. The two most commonly used tools were the Brief Pain Inventory and the American Pain Society Pain Outcomes Questionnaire-Revised, which were assessed in six studies each. The included studies mainly reported internal consistency reliability, with four of the five identified tools demonstrating high Cronbach's alpha values ranging from 0.72 to 0.92. However, the Houston Pain Outcome Instrument demonstrated mixed findings, with eight of the nine subscales having moderate to high reliability while the expectations about pain subscale had poor reliability (α=0.003). CONCLUSIONS This review provides much needed information about the current tools used in many clinical, educational, and research settings. Of the five tools included in this review, the Brief Pain Inventory demonstrated strong evidence of psychometric validity and is recommended for use in assessing postoperative pain. Further psychometric validation of multidimensional postoperative pain assessment tools with emphasis on responsiveness and measurement error is required in order to accurately assess the minimal clinically important difference in postoperative pain outcomes.

OBJECTIVE The objective of this review was to identify, appraise, and synthesize the best available evidence related to participation in outdoor nature-based therapeutic recreation programs for adults with a mental illness living in the community. INTRODUCTION Therapeutic recreation is posited to be beneficial for persons living with a mental illness. Research evidence indicates that therapeutic recreation programs can foster mental health recovery. It is important to understand the effectiveness of this from the perspective of persons living with mental illness how outdoor nature-based therapeutic recreation programs are meaningful and helpful for recovery. INCLUSION CRITERIA This review considered studies that collected qualitative data on the experiences and perspectives of adults with a mental illness regarding their participation in outdoor nature-based therapeutic recreation programs. METHODS The databases PsycINFO, CINAHL, MEDLINE, Scopus, and Informit, as well as unpublished sources in gray literature (Google Scholar, OpenGrey), were searched and reference lists were checked to locate any additional studies. Studies published in English were considered, with a date range from inception to 2019. Three reviewers independently assessed the methodological quality of the studies that met the inclusion criteria using the JBI critical appraisal approach for qualitative research. Data were extracted by one reviewer using the standardized qualitative extraction tool and checked for accuracy by three other reviewers. The qualitative research findings were pooled using JBI methodology. The JBI process of meta-aggregation was used to identify categories and synthesized findings, and a level of confidence was assigned to both synthesized findings. RESULTS Eighteen papers met the inclusion criteria and were included in the data extraction phase. A total of 84 findings were extracted and aggregated into six categories based on similarity of meaning and two synthesized findings. The methodological quality of the studies varied, and the overall level of confidence of the synthesized findings was determined to be moderate. CONCLUSIONS This review identified that persons living with mental illness perceive outdoor nature-based therapeutic recreation as enjoyable and that therapeutic recreation makes a positive contribution to mental health. Congruent with the literature, therapeutic recreation offers a socially inclusive and psychologically safe environment. The intentionally structured social milieu enhances the formation of social relationships and meaningful connections for persons with mental illness. Elements linked with psychological well-being, such as intrinsic motivation, overcoming perceived challenges, and finding purpose and meaning, are enhanced through participation in therapeutic recreation in outdoor nature-based settings. Increased levels of physical activity, greater self-esteem, and enhanced sense of identity were some of the perceived positive changes. This review provides important insights into the subjective needs of persons with mental illness who undertake therapeutic recreation in outdoor nature-based settings. The qualitative findings can inform health care providers, or those interested in therapeutic recreation programming, to use alongside quantitative evidence of effectiveness to design nature-based therapeutic recreation activities that are meaningful for persons with mental illness. Limitations of the research were that papers published in languages other than English were not searched, and papers not located may have influenced the findings of this review.

Objective The objective of this systematic review was to synthesize the best available research evidence on the effectiveness of flavonoid-rich fruits in the treatment of hypertension. Introduction Hypertension is a serious public health concern as it contributes to a significant burden of disease, leading to millions of deaths globally. Complementary therapies including flavonoids have generated interest in assisting the treatment of hypertension. Flavonoids are a type of polyphenol abundant in fruits and a growing body of evidence suggests antihypertensive effects of the flavonoids due to their antioxidant properties. To date, no systematic review has been performed to collate the evidence on the effects of flavonoid-rich fruits on hypertension in adults. Inclusion criteria This systematic review included randomized controlled trials (RCTs) that compared the administration of any type of flavonoid-rich fruit or equivalent supplement with a placebo or other intervention in adults with hypertension. Trials that measured blood pressure using objective outcome measures such as a manual mercury sphygmomanometer were included. Studies that did not specify the flavonoid component of the fruit or fruit supplement were excluded from the review. Secondary outcomes, including change in weight, blood glucose level, triglycerides and total blood cholesterol levels, were also assessed. Methods A three-step search was undertaken, including a comprehensive search of the MEDLINE, Embase, Cochrane Trials (CENTRAL) and CINAHL databases, in September 2018. We also searched Dissertation Abstracts International, ProQuest Dissertations and Theses, MedNar and ClinicalTrials.gov to identify unpublished studies. The title and abstracts of the studies were reviewed by two independent reviewers against the inclusion/exclusion criteria. The methodological quality of the potential studies for inclusion were assessed using the critical appraisal checklist for randomized controlled trials as recommended by JBI. Data were pooled in a statistical meta-analysis model. Subgroup-analysis according to type of intervention and length of intervention period was performed. Where statistical pooling was not possible, the findings have been presented in a narrative form. Results Fifteen randomized controlled trials involving 572 participants were included in the review. The subclasses of flavonoids assessed included: anthocyanins, naringin, narirutin and flavan-3-ols. The overall methodological quality of the trials was high. Six trials investigated the effect of the flavonoid intervention on blood pressure within four weeks. Meta-analysis of four of the trials demonstrated no effect of flavonoids on systolic or diastolic blood pressure when compared to placebo (systolic mean difference = -1.02, 95% confidence interval [CI] -3.12, 1.07; p = 0.34, I = 0%; diastolic mean difference = -0.90, 95% CI -2.10, 0.31; p = 0.15, I = 0%). Similarly, pooled results from two crossover RCTs with two-timed dosed interventions in a 24-hour period demonstrated no effect on a reduction in diastolic blood pressure (p = 0.38) but did reveal evidence of a reduction in systolic blood pressure (p = 0). Six trials assessed blood pressure following the flavonoid intervention at more than four weeks follow-up. Meta-analysis of five of the trials demonstrated evidence of no effect on either systolic blood pressure (mean difference = -0.95, 95%CI -3.58, 1.68; p = 0.478, I = 0%) or diastolic blood pressure (mean difference = 0.86, 95%CI -1.11, 2.82; p = 0.393, I = 0%). Conclusions The findings of this systematic review should be interpreted with caution, given that the results are obtained from single-center trials with small sample sizes. Flavonoids have no effect on systolic and diastolic blood pressure. Further robust RCTs using sample sizes based on power calculations are needed to provide evidence for the use of flavonoid-rich fruits for the management of hypertension.

Objective The objective of this review was to identify the effectiveness of topical medications on radial artery spasm (RAS) in patients undergoing transradial percutaneous coronary procedures. Introduction Percutaneous coronary procedures were traditionally carried out via the femoral artery; however, over the last 20 years there has been a global increase in the number of proceduralists carrying out percutaneous coronary procedures via the transradial approach. Radial artery spasm remains an issue for the transradial approach, potentially leading to procedural failure. Topical medications have been suggested to reduce the occurrence of RAS during transradial percutaneous coronary procedures. Inclusion criteria This review considered papers that included participants aged 18 years and over undergoing non-emergency transradial percutaneous coronary procedures. This review considered papers on the utilization of topical medications prior to commencing the transradial approach for percutaneous coronary procedures to reduce RAS. Topical medications were compared to other medications. The primary outcome was the incidence of RAS as assessed by angiography or ultrasound or resistance felt by the operator while manipulating the catheter. Other outcomes of interest included change in radial artery diameter, measured by angiography or ultrasound, change in radial artery patency and side effects of medications administered. Randomized and quasi-randomized controlled trials were considered. Methods A three-step search strategy was utilized in this review. A search of various databases was carried out followed by a search for unpublished literature between 1989 to January 2017. Only papers published in English were included in the review. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instrument from the Joanna Briggs Institute (JBI). There was no need for a third reviewer. Quantitative data was extracted from papers included in the review using the JBI data extraction instrument and entered in to RevMan5 (Copenhagen: The Nordic Cochrane Centre, Cochrane). All results were subject to double data entry. Effect sizes were expressed as odds ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals were calculated for analysis. Results Only three studies involving 697 participants met the inclusion criteria. There was a statistically significant reduction in the incidence of RAS in patients treated with a eutectic mixture of local anesthetics compared to subcutaneous lidocaine (OR 0.26; 95%CI 0.07,0.96). However there were no significant differences in RAS in studies that compared eutectic mixture of local anesthetics and placebo or a combinations of lidocaine with nitroglycerine compared to placebo. Conclusions It is difficult to draw a valid conclusion, given the low number of studies, small sample sizes and heterogeneity between the studies.

Long-term breastfeeding, including exclusive breastfeeding for six months and continuation of breastfeeding with complementary food until two years of age, has been recommended by the World Health Organization. However, despite the clear benefits of long-term breastfeeding (six months and beyond), the rates of breastfeeding still continue to remain low. Although there are some individual interventional studies that aimed to increase prolonged breastfeeding rates among both multiparous and primiparous women, there is no systematic review or meta-analysis to examine the effectiveness of those interventions among primiparous women who had no previous breastfeeding experience.The aim of this review was to identify the effects of professional educational and support interventions on breastfeeding rates at six months and up to two years postpartum compared to the standard care among primiparous women.Studies that included primiparous women aged 18 and over who intended to breastfeed.Studies that investigated the effect of educational and support interventions provided by health professionals during the antenatal, postnatal period or both.Randomized controlled trials.Studies with reported breastfeeding rates at six months or up to two years postpartum.A three-step search strategy was utilized in this review. The search was conducted in Cochrane, MEDLINE and CINAHL databases. Only trials that met the inclusion criteria and published in English were considered for this review. Databases were searched from their commencement year to May 2016.Two independent reviewers selected the papers using the standardized critical appraisal tool from the Joanna Briggs Institute.Data was extracted using the standardized Joanna Briggs Institute data extraction instrument. Quantitative data were, where possible, pooled in statistical meta-analysis using RevMan v5.3 (Copenhagen: The Nordic Cochrane Centre, Cochrane). In the absence of trials comparing the same outcomes, meta-analysis could not be performed; the findings have therefore been presented in a narrative form, including tables and figures to aid in data presentation where appropriate.Ten randomized controlled trials were included in this review. Interventions with only one antenatal or postnatal component were not effective in increasing breastfeeding rates at six months. However, based on one trial, an intervention that included antenatal education and support in combination with postnatal education and support doubled the rate of breastfeeding at six months among primiparous women randomized to the intervention group compared to the control group (p = 0.28).Despite the good methodological quality of the trials, due to the heterogeneity of the interventions and outcome measures (types of breastfeeding) it was not possible to identify any specific effective intervention. However, based on a single trial, it appears that a combination of antenatal and postnatal education interventions may be useful in increasing breastfeeding rates at six months.

Background The uptake of percutaneous coronary procedures via the radial artery has increased internationally due to the decreased risk of complications and increased patient satisfaction. The increased susceptibility of the radial artery to spasm however presents a potential risk for procedural failure. Although most experts agree on the need for prophylactic medications to reduce radial artery spasm, currently there is inconsistency in literature regarding the most effective vasodilatory medication or combination of medications. Review objective The objective of this study is to identify the effectiveness of vasodilatory medications on radial artery spasm in patients undergoing transradial coronary artery procedures. Inclusion criteria types of participants This review considered studies that included participants aged 18 years and over undergoing non-emergent transradial percutaneous coronary artery procedures. Types of intervention(s) This review considered studies that used vasodilating intravenous and intra-arterial medications or combinations of medications prior to commencing and during transradial coronary approaches to reduce radial artery spasm. Outcomes The outcomes of interest were the incidence of radial artery spasm during percutaneous coronary procedure using objective and/or subjective measures and its effect on the successful completion of the procedure. Types of studies Randomized controlled trials published in the English language between 1989 to date were considered for inclusion. Search strategy The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in this review. An initial search of MEDLINE, CINAHL and Scopus was undertaken, followed by a search for unpublished studies. Assessment of methodological quality Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments. Any disagreements that arose between the reviewers were resolved through discussion. Data extraction Quantitative data was extracted from papers included in the review using the standardized data extraction tool from RevMan5 (Copenhagen: The Nordic Cochrane Centre, Cochrane). Data synthesis Quantitative data, where possible, was pooled in statistical meta-analysis using RevMan5. All results were subject to double data entry. Effect sizes expressed as risk ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals were calculated for analysis. Results Nine trials involving 3614 patients were included in the final review. Pooled data involving 992 patients on the effect of calcium channel blockers demonstrated a statistically significant reduction in the incidence of vasospasm in patients who received verapamil 5 mg compared to those who received a placebo (OR 0.33; 95%CI 0.19, 0.58). Similarly patients who received verapamil 2.5 mg or 1.25 mg had significantly fewer incidences of vasospasm when compared to those who received a placebo. Nitroglycerine 100mcg was demonstrated to be associated with a statistically significant reduction in the incidence of vasospasm. Conclusion The evidence demonstrates a benefit in the use of vasodilatory medications for the reduction of vasospasm in patients having radial coronary procedures. Further large-scale multi-center trials are needed to determine the preferred medication.

Transradial access to percutaneous coronary procedures is becoming the preferred access route, and it is being increasingly used for emergent and elective procedures. However, radial artery occlusion (RAO) continues to remain an adverse occurrence following sheath removal or in the first 24 hours following sheath removal due to the smaller diameter of the artery.The overall objective of this study was to synthesize the best available research evidence related to the effects of methods used to achieve hemostasis on RAO rates after percutaneous coronary procedures.The current review considered trials that included adult patients (18 years and over) who have had a coronary angiography or coronary re-vascularization intervention via the radial artery.The interventions of interest were the use of various hemostatic methods compared to traditional interventions to prevent RAO.All randomized and quasi-randomized controlled trials evaluating the effect of various hemostatic methods on RAO rates after percutaneous coronary procedures were included in the review.The primary outcome of interest was the incidence of RAO at the time of discharge and persistent occlusion at the time of follow-up.The search aimed to find published and unpublished trials through electronic databases, reference lists and key reports. An extensive search was undertaken for the following databases - CINAHL, Embase, PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL). Databases were searched up to May 2016. The search for unpublished trials included Dissertation Abstracts International, World Cat, Clinicaltrials.gov, ProQuest Dissertation and Theses and MedNar.Methodological quality was assessed independently by two reviewers using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) checklist. Disagreements that arose between the reviewers were resolved through discussion.Quantitative data were extracted from papers included in the review by one reviewer using the standardized data extraction tool from JBI-MAStARI. The data extracted were checked by a second reviewer. Disagreements that arose between the reviewers were resolved through discussion. All results were subject to double data entry in Review Manager.Statistical pooling of the data was not possible due to the heterogeneity of the trials; therefore, the findings are presented in narrative form. However, figures have been used to illustrate the results.A total of seven trials were included in the review. One trial demonstrated a significant reduction in RAO rates in patients who had a mean arterial pressure (MAP)-guided TR band to a standard TR band (odds ratio [OR] 0.08; 95% confidence interval [CI] 0.02, 0.37). A statistically significant reduction in the incidence of RAO was observed among patients who received a biopolymer dressing (Chitosen) compared to those who received the TR band (OR 2.20; 95% CI 1.20, 4.02). No statistically significant difference in the incidence of RAO was reported between those who received the TR band and those who received either the elastic bandage (P = 0.08) or T band (P = 0.76). Similarly, no statistically significant difference in rates of RAO among patients was reported among those who had pro-coagulant dressings compared to those who had short or long manual compression. One trial that compared the TR band to a MAP-guided TR band demonstrated no statistically significant difference in the time taken to obtain hemostasis between the two groups (P = 0.61). A statistically significant reduction in the time taken to obtain hemostasis was observed among patients who received the hemostatic biopolymer dressing compared to the TR band. No statistically significant difference in the incidence of hematoma was identified among patients who received pneumatic compression or traditional compression to achieve hemostasis.There is limited evidence to support the use of any single hemostatic method to prevent RAO rates after percutaneous coronary procedures. Although used extensively, there is evidence of no effect of the pneumatic compression method using the TR band on the incidence of RAO at discharge or follow-up, the time taken to obtain hemostasis and the incidence of hematoma. The MAP-guided compression method and the Biopolymer dressing (Chitosen) were superior to the TR band compression method, and patent hemostasis was superior to hemoband in the prevention of RAO. However, these results are based on single trials and should be interpreted with caution. The evidence obtained from the review does not provide a concrete base for the development of practice guidelines. Until more robust evidence is available, practices will continue to be dictated by local preferences and available resources.

The objective of this systematic review is to synthesize the best available research evidence related to the effects of methods used to achieve hemostasis on radial artery occlusion (RAO) rates, following the radial artery approach for percutaneous coronary procedures.The specific review question is as follows: What is the effect of methods used to achieve hemostasis post sheath removal on RAO rates in adult patients, following the radial artery approach for percutaneous coronary procedures?

BACKGROUND: Epilepsy is a global public health problem affecting people of all ages, sex, races, nations and social class. The majority of the 50 million people with epilepsy live in developing countries, with a prevalence rate of five to 10 people per 1000. The disease poses an enormous psychological, social and economic burden on patients. An estimated 90% of people with epilepsy in developing countries do not receive treatment due to sociocultural, economic and political factors. Current treatment interventions are limited to the clinical management of the disease and are largely driven by the healthcare provider's perspective, ignoring the experiences of people living with epilepsy (PLWE). Objective: The aim of this review was to identify, critically appraise, extract, synthesize and present the best and most current available evidence on the experiences of PLWE in developing countries. Review questions: • What are the experiences of PLWE regarding the causes of their condition? • What are the experiences of PLWE regarding treatment of epilepsy? • How has epilepsy shaped the social relationships of the affected persons? Inclusion criteria: Types of participants People living with epilepsy in developing countries (Africa, Asia, Eastern Europe and Latin America). Types of intervention(s)/phenomena of interest The experiences of PLWE in developing countries with particular attention on the causes, treatment and its impact on their social relationships. Types of studies Primary research studies with a qualitative design not limited to phenomenology, ethnography, grounded theory, ethnomethodology, phenomenography, critical theory, interpretative or feminist analysis, case study, narrative studies and action research. Context: Qualitative studies conducted in hospitals and community settings in developing countries. Search strategy: A three-step search strategy was used to identify published and unpublished studies in the English language from the 1990s to the present. Methodological quality: Identified studies that met the inclusion criteria were retrieved and critically appraised by two independent reviewers prior to their inclusion using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). Data extraction: Data were extracted from included papers using the recommended data extraction form embedded in the JBI-QARI. Data synthesis: Findings, where possible, were pooled using the JBI-QARI. It involved the meta-aggregation of findings to generate a set of statements that represented that aggregation, through assembling the findings rated according to their quality, and categorizing these findings on the basis of similarity in meaning. Results: From the 13 studies included in the review, 113 findings were extracted to create categories. Eight categories were created from which three synthesized findings were produced. The synthesized findings were: Synthesized finding 1: People living with epilepsy believed that the disease was caused by factors such as fever, demonic power, beatings, witchcraft, curses and God. Patients also had differing views as to whether the disease was contagious or hereditary. They indicated that the disease manifested as seizures, triggered by fever, stress, depression and anger. Synthesized finding 2: People living with epilepsy used biomedical and traditional methods to treat epilepsy and also developed strategies for coping with the disease beyond seeking treatment. Synthesized finding 3: People living with epilepsy had negative and positive experiences in their social relationships. The negative experiences were linked to the social, psychological and economic burden of the disease on patients, whereas the social support they got from friends, peers, family and community members were the positive aspects. Conclusion: People living with epilepsy attribute the cause of the disease to agents like fever, demonic power and witchcraft. Patients use biomedical and traditional methods to treat the disease and have also developed various coping strategies (like prayers and concealment) alongside treatment. Epilepsy has negative effects on the social relationships of patients and is a social, psychological and economic burden for patients. However, there are some positive effects like the social support they receive from family members, friends and the community. © 2016 by Lippincott williams & Wilkins, Inc. Language: en

With the increase in the number of systematic reviews available, a logical next step to provide decision makers in healthcare with the evidence they require has been the conduct of reviews of existing systematic reviews. Syntheses of existing systematic reviews are referred to by many different names, one of which is an umbrella review. An umbrella review allows the findings of reviews relevant to a review question to be compared and contrasted. An umbrella review's most characteristic feature is that this type of evidence synthesis only considers for inclusion the highest level of evidence, namely other systematic reviews and meta-analyses. A methodology working group was formed by the Joanna Briggs Institute to develop methodological guidance for the conduct of an umbrella review, including diverse types of evidence, both quantitative and qualitative. The aim of this study is to describe the development and guidance for the conduct of an umbrella review.Discussion and testing of the elements of methods for the conduct of an umbrella review were held over a 6-month period by members of a methodology working group. The working group comprised six participants who corresponded via teleconference, e-mail and face-to-face meeting during this development period. In October 2013, the methodology was presented in a workshop at the Joanna Briggs Institute Convention. Workshop participants, review authors and methodologists provided further testing, critique and feedback on the proposed methodology.This study describes the methodology and methods developed for the conduct of an umbrella review that includes published systematic reviews and meta-analyses as the analytical unit of the review. Details are provided regarding the essential elements of an umbrella review, including presentation of the review question in a Population, Intervention, Comparator, Outcome format, nuances of the inclusion criteria and search strategy. A critical appraisal tool with 10 questions to help assess risk of bias in systematic reviews and meta-analyses was also developed and tested. Relevant details to extract from included reviews and how to best present the findings of both quantitative and qualitative systematic reviews in a reader friendly format are provided.Umbrella reviews provide a ready means for decision makers in healthcare to gain a clear understanding of a broad topic area. The umbrella review methodology described here is the first to consider reviews that report other than quantitative evidence derived from randomized controlled trials. The methodology includes an easy to use and informative summary of evidence table to readily provide decision makers with the available, highest level of evidence relevant to the question posed.

Kidney transplantation has been recognized as the best renal replacement therapy option for people with end stage renal disease. With an estimated 170,000 people waiting for a kidney transplant around the world and a limited supply of donor organs, the waiting time is often prolonged for many years.The aim of this review was to examine the existing evidence of patients' experiences of living on dialysis and waiting for a renal transplant from a deceased donor.This review considered studies that included adult patients aged 18 years and over who had been on dialysis (hemodialysis or peritoneal dialysis) for up to 15 years and who were waiting for a renal transplant from a deceased donor. Types of intervention(s)/phenomena of interest: The phenomena of interest were the experiences of adults waiting for a renal transplant from a deceased donor and more specifically, the impact of waiting on their lifestyle and day to day living. Types of studies: This review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. Types of outcomes: This review considered studies that included the experiences of people who were waiting on dialysis for a kidney transplant from a deceased donor.The search strategy aimed to find both published and unpublished studies through electronic databases, reference list searches and the World Wide Web. Extensive searches were undertaken of the CINAHL, Embase, Medline and PsychInfo databases of published literature, the Cochrane Database of Systematic Reviews and the Virginia Henderson International Nursing Library, OpenGrey and the New York Academy of Medicine databases of unpublished literature.Each study was assessed for methodological quality by two independent reviewers using the Joanna Briggs Institute Qualitative Assessment and Review Instrument checklist. Disagreements between the reviewers were resolved through discussion or with a third reviewer.Qualitative data was extracted from papers included in the review using the standardized data extraction tool from JBI-Qualitative Assessment and Review Instrument.Qualitative research findings were pooled to generate a set of statements that represented the aggregation and categorizing of these findings on the basis of similarity in meaning. These categories were then subjected to a meta-synthesis in order to produce a comprehensive set of synthesized findings that can be used as a basis for evidence-based practice.A total of 12 studies were included in the final review. Thirty-seven findings from the 12 studies were extracted and aggregated into 11 categories and then into three synthesized findings. The three synthesized findings were: 1. People who are waiting for a kidney transplant from a deceased donor are affected by the experience of living on dialysis with end stage renal disease and its impact on their physical health and normal activities of living. 2. The experience of waiting for a kidney transplant from a deceased donor impacts a person's psychological wellbeing. 3. People who are waiting for a kidney transplant from a deceased donor place value on relationships and being part of a community. The experience of waiting for a renal transplant from a deceased donor while living on dialysis with end stage renal disease changes a person's relationships.Synthesized findings of the review conclude that people who are waiting for a kidney transplant from a deceased donor live with the physical effects of a life limiting chronic illness and dialysis therapy. Waiting for a kidney transplant is psychologically challenging. People waiting for a kidney transplant value knowledge, although the information they require to alleviate the uncertainty they feel is not available. The dynamics of relationships with family and friends are affected by the experience of waiting for a kidney transplant. People can feel isolated from others leading a 'normal' life, while new relationships are developed within the medical team and community of dialysis patients.There is limited evidence from the review to support the development of recommendations for clinical practice. Healthcare workers caring for people who are waiting for a kidney transplant from a deceased donor should be mindful of the physical and lifestyle effects of living on dialysis with end stage renal disease. Wherever possible, information should be provided to alleviate the stress and anxiety related to the uncertainty of waiting. The experience of waiting is stressful and people waiting for a kidney transplant may require support and reassurance. It is important to recognize that there are people within communities who may also benefit from receiving information and encouragement. Significant community members should be included in invitations to appointments and education sessions with the consent of the person being treated.Future studies should be undertaken exclusively with people waiting for a kidney transplant from a deceased donor. Qualitative research designs such phenomenology and grounded theory could be used to investigate the psychological experience of waiting and the relationship between hope, uncertainty and knowledge. Quantitative studies using validated tools could also be conducted. By producing more evidence relating to this significant specific patient population, interventions to improve the experience of waiting could be developed and trialed.

The current and projected nurse workforce shortage has created significant pressure on health care organizations to examine their approach to managing talent. This includes the need for strategic development of new formal leaders. This article reports on a succession planning program for prospective nursing unit managers. Eight prospective management candidates participated in a Future Nursing Unit Managers program. The effectiveness of the program was measured through a comparison of pre- and postprogram surveys relating to participants' perception of personal managerial and leadership skills. Significant differences in scores from baseline to 6-month follow-up surveys were observed in the participants' confidence in undertaking the nursing unit manager role and in their management skills. Investment in structured programs to prepare nurses for leadership roles is strongly recommended as a management workforce strategy.

BACKGROUND A range of studies found that spending time outdoors in daylight provided substantial benefits for the psychosocial well-being of older people. Good psychosocial well-being is essential in maintaining overall health as people age and often contributes to adequate physical functioning. OBJECTIVES The overall objective of this study was to undertake a systematic review on the effects of spending time outdoors in daylight on the psychosocial well-being of older people and their family carers. INCLUSION CRITERIA Types of participants: This review considered studies that included older people aged 55 years or more, including those living in a community or residential accommodation setting. In addition, this review considered family carers, who were defined as unpaid relatives or friends of an older person, who helped that individual with their activities of daily living. Types of intervention(s): The intervention of interest was spending time outdoors in daylight. Types of studies: All experimental and epidemiological study designs including randomized controlled trials and non-randomized controlled trials published in the English language were included in this review. Types of outcomes: This review considered studies that included objective and/or subjective measures of psychosocial well-being for older people and their family carers. SEARCH STRATEGY The search aimed to find published and unpublished studies through electronic databases, reference lists, key reports and the World Wide Web. An extensive search was undertaken for the following databases: MEDLINE, CINAHL, Wiley Online Library, ProQuest Central, Scopus, and the Cochrane Library. Databases were searched up to December 2013. METHODOLOGICAL QUALITY Methodological quality was assessed independently by three reviewers using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) checklists. Disagreements that arose between the reviewers were resolved through discussion. DATA COLLECTION Quantitative data were extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI. The data was individually extracted by two reviewers. Disagreements that arose between the reviewers were resolved through discussion. All results were subject to double data entry. DATA SYNTHESIS For this review statistical pooling of the data was not possible due to the heterogeneity of the studies; therefore, the findings are presented in narrative form. RESULTS A total of 13 studies were included in the final review. In the four studies that evaluated the effects of exposure to daylight on behavioral disturbances, there was no evidence of effect of daylight hours on physical and verbal aggression. There was some evidence to indicate that exposure to daylight for a period of time resulted in fewer depressive symptoms. Increasing the frequency of going outdoors was associated with better cognitive preservation over a one year period. Similarly exposure to daylight resulted in improved social functioning and improved quality of life. There were no studies that evaluated the effect of spending time outdoors in daylight on the psychosocial well-being of family carers, including carer satisfaction or carer stress. CONCLUSIONS There is insufficient high-quality evidence from which conclusions can be drawn for the effect of spending time outdoors in daylight on the psychosocial TRUNCATED AT 500 WORDS

Review question/objective What is the effect of doll therapy on challenging behaviors (including agitation and verbal or physical aggression) in patients with dementia? Inclusion criteria Types of participants Adults (age >18years) diagnosed with dementia and living in any care setting will be included. Adults with dementia receiving antipsychotics will also be included and analyzed separately. Types of intervention(s)/phenomena of interest This review will include studies that evaluate the effects of giving dolls to persons with dementia for the management of BPSD. The review will include doll therapy delivered by either health professionals or carers. Studies will be included irrespective of the number and duration of doll therapy sessions. Studies will be excluded if the approach to giving dolls is not described. The following comparisons will be made: Doll therapy versus no intervention Doll therapy versus other non-pharmacological interventions Doll therapy versus pharmacological interventions. Studies that use other toys such as teddy bears and mechanised pets will be excluded. Types of outcomes The primary outcomes of interest are changes in challenging behaviors measured using validated scales or through observation, and will include: Agitation Verbal aggression Physical aggression Secondary outcomes may include: Interaction with staff. Interaction with other patients/residents Level of activity Quality of life.

Review question/objective The objective of this systematic review is to synthesize qualitative evidence relating to experiences of adults with end stage renal failure who are on dialysis and waiting for a renal transplant from a deceased donor. Inclusion criteria Types of participants This review will consider studies that include adult patients who were aged 18 years and over when they started dialysis, in order to examine the experiences of adults rather than children or adolescents. It will only consider studies including people who are waiting for a renal transplant from a deceased donor and who have been on dialysis (hemodialysis or peritoneal dialysis) for up to 15 years. The development of erythropoietin in the mid-1980’s combatted the effects of the anemia associated with end stage renal failure and considerably improved the quality of life of people on dialysis.Around the same time, advances in immunosuppressive medication meant that transplantation became a feasible option with good outcomes for more people. Therefore studies of people who have been on dialysis for up to 15 years will be included, because people who have been on dialysis for longer than 15 years may have had experiences that are not typical today. This review will not consider patients under the age of 18 years, patients receiving dialysis for acute renal failure, patients waiting for a transplant from a living donor or people waiting for a pre-emptive transplant from a deceased donor. Phenomena of interest This review will consider studies that investigate the experiences of adults waiting for a renal transplant from a deceased donor. More specifically the impact of waiting for transplant on lifestyle, coping strategies and day to day living will be included. Context This systematic review will consider studies that involve adults with end stage renal failure who are on either hemodialysis in a hospital, a satellite unit or at home, or on peritoneal dialysis , and who are waiting for a kidney transplant from a deceased donor.

Review question/objective The objective of this review is to determine the best available evidence related to the effect of insulin therapy algorithms on blood glucose levels in patients in critical care environments following cardiac surgery. More specifically, the review question to be answered is: Among adults within critical care environments who are in the acute postoperative phase (5 days) following cardiac surgery, what is the effect of insulin therapy algorithms for the control of blood glucose levels? Inclusion criteria Types of participants This review will consider studies that include adult patients aged 18 years and over admitted to a critical care unit following cardiac surgery and who received insulin therapy for glycemic control during the acute postoperative phase (five days) of admission. In this review studies that include participants with a known diagnosis of Diabetic Ketoacidosis will be excluded. Types of intervention(s)/phenomena of interest This review will consider studies that evaluate the use of intravenous insulin therapy algorithms to control blood glucose levels in acute postoperative phase patients in critical care environments following cardiac surgery. In this review, studies will be included if they make one of the following comparisons: 1. Intravenous insulin therapy algorithm compared to another insulin therapy algorithm. 2. Intravenous insulin therapy algorithm compared to no treatment. 3. Intravenous insulin therapy algorithm compared to a placebo. In this review, studies that include a Glucose-Insulin-Potassium (GIK) infusion as an intervention or a comparator will be excluded. Types of outcomes This review will consider studies that include the following outcome measures: Primary outcome: •Overall control of blood glucose levels as measured by time to target BGL range, time spent in BGL target range and time above or below target BGL range. Secondary outcome: •Incidence of adverse events, including: - Hypo/hyper glycemia, measured by standard point of care glucometers, arterial blood analysis, or venous blood analysis, with hypoglycemia defined as a BGL reading 7.8mmol/L(140mg/dL).13 - Sternal wound infection, identified by a positive wound culture or a positive wound exudate culture.14 - Mortality rate measured by in-hospital mortality (from day of operation to day of discharge) and/or 30 day mortality.15

Research Question: What factors determine diabetes care outcomes for young adults with type 1 diabetes after transition from paediatric to adult health care services? Criteria for considering studies for this review: Types of participants: People aged 15-19 years inclusive with diagnosis of type 1 diabetes who have been transitioned from paediatric to adult health care services. Types of outcome measures: The primary outcomes are: Diabetes control as measured by HbA1c at follow-up Loss to follow-up Adherence to insulin therapy Incidence of hospital admission for acute complications Frequency and regularity of clinic attendance Secondary outcomes: Uptake of screening for long term diabetes complications Cost effectiveness of intervention Health related quality of life Patient satisfaction

Review question/objective The overall objective of this research is to undertake a systematic review of the effects of spending time outdoors in daylight on the physical health of older adults and family carers. The specific questions to be addressed are: Which aspects of physical health are affected by spending time outdoors in daylight for older adults and family carers? To what extent is spending time outdoors in daylight effective for improving aspects of physical health in older adults and family carers? Inclusion criteria Types of participants This review will consider studies that include all older adults aged 55 years or more, including those living in a community setting or a residential aged care facility. In addition, this review will consider family carers, who are defined as unpaid relatives or friends of an older person, who help that individual with their activities of daily living. No further inclusion criteria will be applied. Types of intervention(s)/phenomena of interest The intervention or phenomenon of interest is spending time outdoors in daylight. ‘Outdoors in daylight’ is a broad term that encompasses all outdoor environments where participants are exposed, directly or indirectly, to daylight in a natural setting while participating in any type of outdoor activity. For our review, the definition of outdoor activity is simply ‘being outdoors’ in order to capture all types of engagement with outdoor environments. Studies will be excluded if they utilise artificial ‘bright’ light sources or modify the indoor environment to improve light exposure. An absence of activity or indoors activity with no exposure to daylight will be used as a comparator. Types of outcomes This review will consider studies that include objective and/ or subjective measures of the following outcomes: Older adults: • physical health: o bio-makers: - melatonin levels. - serotonin levels; and - vitamin D levels; o functional ability; o physical activity levels; and o sleep patterns; Family carer health: o physical health.

Review question/objective The overall objective of this research is to undertake a systematic review of the effects of spending time outdoors in daylight on the psychosocial wellbeing of older adults and family carers. The specific objectives to be addressed are: Which aspects of psychosocial wellbeing are affected by spending time outdoors in daylight in older adults and family carers? To what extent is spending time outdoors in the daylight effective for improving aspects of psychosocial wellbeing in older adults and family carers? Inclusion criteria Types of participants This review will consider studies that include all older adults aged 55 years or more, including those living in a community setting or a residential aged care facility. In addition, this review will consider family carers, who are defined as unpaid relatives or friends of an older person, who help that individual with their activities of daily living. No further inclusion criteria will be applied. Types of intervention(s)/phenomena of interest The intervention or phenomenon of interest is spending time outdoors in daylight. ‘Outdoors in daylight’ is a broad term that encompasses all outdoor environments where participants are exposed, directly or indirectly, to daylight in a natural setting while participating in any type of outdoor activity. For our review, the definition of outdoor activity is simply ‘being outdoors’ in order to capture all types of engagement with outdoor environments. Studies will be excluded if they utilise artificial ‘bright’ light sources or modify the indoor environment to improve light exposure. An absence of activity or indoors activity with no exposure to daylight will be used as a comparator. Types of outcomes This review will consider studies that include objective and/ or subjective measures of the following outcomes: Older adults: • psychosocial well-being: o behavioural disturbances; o cognition; o mood levels; o quality of life; o satisfaction with service provision; and o social interaction. Family carer health: o carer satisfaction; and o carer stress.

Objective This review investigated the effect of the various models of nursing care delivery using the diverse levels of nurses on patient and nursing outcomes. Methods All published studies that investigated patient and nursing outcomes were considered. Studies were included if the nursing delivery models only included nurses with varying skill levels. A literature search was performed using the following databases: Medline (1985–2011), CINAHL (1985–2011), EMBASE (1985 to current) and the Cochrane Controlled Studies Register (Issue 3, 2011 of Cochrane Library). In addition, the reference lists of relevant studies and conference proceedings were also scrutinised. Two reviewers independently assessed the eligibility of the studies for inclusion in the review, the methodological quality and extracted details of eligible studies. Data were analysed using the RevMan software (Nordic Cochrane Centre, Copenhagen, Denmark). Results Fourteen studies were included in this review. The results reveal that implementation of the team nursing model of care resulted in significantly decreased incidence of medication errors and adverse intravenous outcomes, as well as lower pain scores among patients; however, there was no effect of this model of care on the incidence of falls. Wards that used a hybrid model demonstrated significant improvement in quality of patient care, but no difference in incidence of pressure areas or infection rates. There were no significant differences in nursing outcomes relating to role clarity, job satisfaction and nurse absenteeism rates between any of the models of care. Conclusions Based on the available evidence, a predominance of team nursing within the comparisons is suggestive of its popularity. Patient outcomes, nurse satisfaction, absenteeism and role clarity/confusion did not differ across model comparisons. Little benefit was found within primary nursing comparisons and the cost effectiveness of team nursing over other models remains debatable. Nonetheless, team nursing does present a better model for inexperienced staff to develop, a key aspect in units where skill mix or experience is diverse.

OBJECTIVE: The objective of this review was to investigate the prevalence of obesity among migrant Asian Indians globally. The primary outcomes of interest included the incidence of obesity as measured objectively by body mass index (BMI), waist circumference, waist-to-hip ratio and body fat. METHODS: All published studies that investigated obesity rates in migrant Asian Indians were considered for inclusion in the review. Studies were included if they had more than 100 participants and reported objective measures of obesity. A literature search was performed using the following databases Medline (2000-10), Cumulative Index to Nursing and Allied Health Literature (2000-11), Excerpta Medica Database (2000-current) and the Cochrane Controlled Studies Register (Issue 1, 2011 of Cochrane Library). In addition, the reference lists of relevant studies and conference proceedings were also scrutinised. Two reviewers independently assessed the eligibility of the studies for inclusion in the review, the methodological quality and then extracted details of eligible studies. Data were analysed using the Review Manager software. RESULTS: Ten studies investigating the obesity indices in Asian Indians were eligible for this review. All ten trials that reported on BMI values demonstrated significantly higher BMI values among migrant Asian Indians when compared with other migrants and the native population (standardised mean difference 0.36; 95% confidence interval 0.30, 0.41). A greater proportion of Asian Indians had BMIs greater than or equal to 30 when compared with other ethnic groups. Up to 80% of the Asian Indian women had a waist circumference greater than the recommended value of 88 cm. CONCLUSIONS: Based on the available evidence, the obesity indices among migrant Asian Indians are significantly greater when compared with the native population and those living in India, particularly among women. This is likely to contribute to the high levels of diabetes and coronary heart disease in this population. Culturally appropriate strategies to reduce obesity, particularly abdominal obesity, in this ethnic group are urgently needed.

Background Cardiac catheterisation plays a vital role in the diagnosis and evaluation of cardiac conditions. The goal of management of patients after cardiac catheterisation is to reduce the risk of development of any local or prolonged vascular complications, in particular bleeding and haematoma formation at the puncture site. Bed rest and immobilisation of the affected leg are recommended practices to ensure adequate haemostasis at the femoral arterial puncture site and prevent complications. Objectives The objective of this review was to present the best available evidence for the optimal length of bed rest after trans-femoral diagnostic cardiac catheterisation. The main outcome of interest was the incidence of bleeding and haematoma formation following varying periods of bed rest. Search strategy We searched the following databases: CINAHL, Medline, Cochrane Library, Current Contents, EBSCO, Web of Science, Embase, British Nursing Index, Controlled clinical trials database, Google Scholar. Reference lists of relevant articles and conference proceedings were searched. We also contacted key organisations and researchers in the field. Selection criteria All randomised and quasi-randomised controlled trials that compared the effects of different lengths of bed rest following trans-femoral diagnostic cardiac catheterisation on patient outcomes were 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 were assessed independently by two reviewers. Odds ratios (OR) for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals (CI). Where synthesis was inappropriate, trials were considered separately. Main results Eighteen trials involving a total of 4294 participants were included in the review. One trial included three treatment groups. In seven trials among 747 people there was no significant difference in the incidence of bleeding following six or less than 6 h of bed rest (OR 1.47; 95% CI 0.60, 3.64). Likewise, there was no significant difference in the incidence of bleeding following bed rest at other time periods. In eight trials involving 2272 patients there was no significant difference in the incidence of haematoma formation following 6 or less than 6 h of bed rest (OR 0.82; 95% CI 0.59, 1.16). Significantly fewer patients randomised to less than 6 h of bed rest complained of back pain. The odds of developing back pain at 4 (OR 24.60; 95% CI 1.29, 469) and 24 h (OR 2.47; 95% CI 1.16, 5.23) following coronary catheterisation was significantly higher among patients randomised to 6 compared with 3 h of bed rest. Authors' conclusions There is evidence of no benefit relating to bleeding and haematoma formation in patients who have more than 3 h of bed rest following trans-femoral diagnostic cardiac catheterisation. However, there is evidence of benefit relating to decreased incidence and severity of back pain and cost-effectiveness following 3 h of bed rest. There is suggestive but inconclusive evidence of a benefit from bed rest for 2 h following trans-femoral cardiac catheterisation. Clinicians should consider a balance between avoiding increased risk of haematoma formation following 2-2.5 h of bed rest and circumventing back pain following more than 4 h of bed rest.

Background Nosocomial infection remains the most common complication of hospitalisation. Despite infection control efforts, nosocomial methicillin-resistant Staphylococcus aureus (MRSA) transmission continues to rise. The associated costs of increased hospital stay and patient mortality cause considerable burden to the health system. Objectives This review sought to evaluate the role of reservoirs, particularly the environment and equipment commonly found in the clinical area, in the transmission of MRSA within the acute hospital. This review updates a review previously completed by the authors and published by the Joanna Briggs Institute (2002). Search strategy A systematic search for relevant published or unpublished literature was undertaken using electronic databases, the reference lists of retrieved papers and the Internet. This extended the search published in the original review. Databases searched included Medline (1966–August Week 1 2005), CINAHL (1982–August Week 1 2005), EMBASE (1996–Week 33), as well as the Cochrane Library (Issue 3, 2005) and the Joanna Briggs Institute Evidence Library (August 2005). Selection criteria All research reports published between 1990 and August 2005 in the English language that focused on the role of the environment and equipment commonly found in the clinical area on the nosocomial MRSA transmission in adult, paediatric or neonatal acute care settings were considered. Data collection and analysis Two reviewers assessed each paper against the inclusion criteria and a validated quality scale. Studies that scored less than the mean quality score were excluded from the review. Data extraction was undertaken using a tool designed specifically for this review. Statistical comparisons of findings were not possible, so findings are presented in a narrative form. Results Forty-two papers met the review inclusion criteria, of which 18 obtained a quality score above the threshold and are included in this review. Seven studies reported general investigations of MRSA in the clinical environment and 11 studies explored specific environmental aspects. All studies used exploratory, descriptive or comparative designs. The evidence suggests that MRSA strains within the environment often match those found in patients within that environment. MRSA can be found in the air around MRSA colonised or infected patients. The degree of airborne contamination is significantly increased by activities that promote airflow. Although the site of MRSA colonisation or infection can influence the degree of environmental contamination, these data are inconsistent. Therefore, there is limited evidence for tailoring infection control interventions based on the sites of MRSA colonisation or infection. The evidence suggests that the type of materials used in clinical equipment can influence the effectiveness of cleaning techniques. Current routine cleaning practices, including conventional terminal cleaning, do not necessarily effectively eradicate MRSA from the environment. This review demonstrates that there is a link between the environment and hospital equipment and the transmission of MRSA within the acute hospital setting. Further well-designed research is urgently required to explore the efficacy of specific cleaning and decontamination methods, staff compliance with infection control practices and the range of factors that affect the incidence of MRSA contamination of the environment and equipment commonly found in the clinical area.

Review objectives: The overall objective is to determine the best available evidence concerning the non‐pharmacological management of fatigue in adults with multiple sclerosis (MS). Review Question: 1. What is the effect of non‐pharmacological interventions in managing fatigue in adults with MS? Criteria for considering studies for this review: Types of participants: Studies undertaken on adults (age >18 years), in hospitals or community settings, and who have been clinically diagnosed as having MS and reporting fatigue will be included in the review. No strict definition of fatigue will be required. Types of interventions: Studies evaluating the following non‐pharmacological interventions for the management of fatigue in adults with MS will be examined: • Exercise • Behavioural interventions • Physiological strategies • Nutritional supplements Types of outcome measures: The primary outcome measures to be considered are objective indicators of fatigue assessment. The literature demonstrates that differences of opinion exist regarding the most valid and reliable method of measuring MS‐related fatigue. Therefore, studies that used any validated scale for MS fatigue assessment will be included. Secondary outcomes that will be measured include: • quality of life (QOL) • activities of daily living (ADLs) • cost effectiveness • self‐esteem • self‐efficacy

Background Many acute care facilities report endemic methicillin-resistant Staphylococcus aureus (MRSA), while others describe the occurrence of sporadic disease outbreaks. The timely implementation of effective infection control measures is essential to minimise the incidence of MRSA cases and the magnitude of disease outbreaks. Management strategies for the containment and control of MRSA currently vary between facilities and demonstrate varying levels of effectiveness. Objectives This review sought to systematically review the best available research regarding the efficacy of infection control practices in controlling endemic MRSA or MRSA outbreaks in the acute hospital setting. It updates an original review published in 2002. Search strategy A systematic search for relevant published or unpublished English language literature was undertaken using electronic databases, the reference lists of retrieved papers and the Internet. This extended the search of the original review. Databases searched included: Medline, CINAHL, EMBASE, Cochrane Library and Joanna Briggs Institute Evidence Library. Selection criteria All research reports published between 1990 and August 2005 in the English language that focused upon the infection control strategies that were implemented in response to either a nosocomial outbreak of MRSA or endemic MRSA within an acute clinical setting were included. Only studies that reported interventions which were implemented following the collection of baseline data were included. Data collection and analysis Two reviewers assessed each paper against the inclusion criteria and a validated quality scale. Data extraction was undertaken using a purposely designed tool. Given the heterogeneity of the interventions and outcomes measures, statistical comparisons of findings were not possible, therefore, the findings of this review are presented in a narrative format. Results Fourteen papers met the inclusion criteria for this review. Of these, 11 papers achieved a quality score above the threshold and were included in the review. Of the included papers, five describe MRSA outbreaks, while the remaining six describe endemic MRSA. All included studies used either exploratory descriptive or comparative designs.The varying combinations of interventions described in the included studies make it impossible to differentiate the efficacy of individual or even groups of interventions.The fact that most studies reported positive findings may reflect the bias towards publication of effective interventions. Implications for clinical practice This review provides evidence that the use of multifaceted strategies can reduce nosocomial MRSA transmission in both outbreaks of MRSA and settings where MRSA is endemic. The heterogeneous nature of the topic, combinations of interventions implemented and methodological weaknesses of the studies impairs the ability to aggregate data and develop specific recommendations for practice.

Background The physical and psychosocial benefits of participation in cardiac rehabilitation following a coronary event have well been established. Despite these benefits there is strong evidence that participation in traditional cardiac rehabilitation programs remains low. Various models of cardiac rehabilitation have been implemented including the use of brief structured interventions to enable modification of coronary risk factors. Objectives The objective of this review was to determine the effect of brief structured interventions on risk factor modification in patients with coronary heart disease. Search strategy A literature search was performed using the following databases MEDLINE (1966-2006), CINAHL (1982-2006), EMBASE (1980-current) and up to the Cochrane Controlled Trials Register (Issue 2, 2006 of Cochrane Library). In addition, the reference lists of relevant trials and conference proceedings were also scrutinised. Company representatives, experts and investigators were contacted to elicit further information. Selection criteria All randomised and quasi-randomised controlled trials that compared the effects of brief structured interventions on risk factor modification in patients with coronary heart disease were 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 were assessed independently by two reviewers. Relative risks for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals. Where synthesis was inappropriate, trials were considered separately. Main results Seventeen trials involving a total of 4725 participants were included in the final review: three trials compared the effects of brief structured interventions on diet modification; seven on smoking cessation; and seven on multiple risk factors. Two trials involving 76 patients compared brief structured intervention versus usual care for dietary modification. Although there was a tendency for more participants in the intervention arm to lose weight at the 12-week follow up and achieve target cholesterol levels at the 6-month follow up, these results were not statistically significant. Only one small trial involving 36 patients compared brief structured intervention and extensive intervention for dietary modification and demonstrated a significant reduction in the percentage of energy obtained from fat and saturated fat intake among participants receiving extensive intervention. However, no difference in fish, fruit and vegetable intake between the groups was evident. Six trials involving 2020 patients compared brief structured intervention versus usual care for smoking cessation. There was no difference in the smoking cessation rates at the 3- and 6-week follow up, however, there was evidence of a benefit of brief structured interventions for smoking cessation at the 3-, 6- and 12-month follow up. In the only trial that and compared brief structured intervention and extensive intervention for smoking cessation in 254 participants there was no clear difference of a likelihood of smoking cessation between the two groups. In the seven trials that compared brief structured intervention and usual care for multiple risk factor modification there was evidence of a benefit of the intervention on behavioural changes such as fat intake, weight loss and consequently on reduction in the body mass index, smoking cessation and physical activity among the participants. The findings concerning the effect on blood pressure, blood glucose levels and the lipid profile, however, remain inconclusive. Conclusions There is suggestive but inconclusive evidence from the trials of a benefit in the use of brief interventions for risk factor modification in patients with coronary heart disease. This review, however, supports the concept that brief interventions for patients with coronary heart disease can have beneficial effects on risk factor modification and consequently on progression of coronary heart disease. Further trials using larger sample sizes need to be undertaken to demonstrate the benefits of brief structured intervention targeted at the modification of single or multiple risk factors.

PURPOSE The purpose of this study was to describe the trajectory of cardiac patient's perceptions of health-related quality of life (HRQoL) during a 24-month period in a community-based population. METHODS After obtaining informed consent, a self-administered questionnaire was mailed to participants. Using the MacNew questionnaire, which assesses the emotional, physical, social, and global domains, HRQoL outcomes were assessed. RESULTS Completed questionnaires were received from 202 participants (75%). Improvements in the emotional, physical, social, and global HRQoL scores were observed until 15 to 17 months after the index percutaneous coronary intervention, after which a decline was observed. However, the scores in all HRQoL domains remained high when compared with the scores at 12 months. No clinical or sociodemographic predictors for HRQoL were identified. CONCLUSIONS The information obtained from this study will enable clinicians to further understand the process of recovery and adjustment of patients after percutaneous coronary intervention and the development of tailored strategies for patient management.

Question/Objectives This systematic review will be undertaken to answer the following question. For patients with CHD what is the effect of brief structured interventions for the modification of the following risk factors: smoking; physical inactivity, lipid profile, high blood pressure, high fat diet and diabetes? The objective of this review is to determine the effect of brief intervention on risk factor modification in patients with CHD. The following comparisons will be made: 1) Brief intervention versus usual care for single risk factor modification 2) Brief intervention versus extensive interventions for single risk factor modification. 3) Brief intervention versus usual care for multiple risk factor modification 4) Brief intervention versus extended intervention for multiple risk factor modification. Criteria for considering studies for this review Types of participants Adults (age >18years) with CHD and known risk factors will be included. Trials undertaken in children to promote healthy lifestyle will be excluded. Types of interventions The following comparisons will be made: 1) Brief intervention versus usual care for single risk factor modification 2) Brief intervention versus extensive interventions for single risk factor modification. 3) Brief intervention versus usual care for multiple risk factor modification 4) Brief intervention versus extensive interventions for multiple risk factor modification Trials that include the following methods for delivery of the brief intervention will be included: face to face interview; telephone; electronic and postal. Trials that included brief intervention as part of an extended program will be excluded. In addition trials that compare types of diets or exercises will be excluded. Population based trials and those undertaken for health promotion will also be excluded. Types of outcome measures The primary outcomes of interest will include a) Changes in self-monitoring or other-reports of smoking b) Changes in self- monitoring or other-reports of cholesterol level c) Changes in self- monitoring or other-reports of physical activity d) Changes in self- monitoring or other-reports of dietary habits including fat and fish intake e) Changes in self- monitoring or other-reports of blood sugar levels f) Changes in self- monitoring or other-reports of blood pressure levels g) Changes in BMI TRUNCATED AT 350 WORDS

OBJECTIVE The objective of this systematic review was to determine the effect of the timing of removal of indwelling urethral catheters (IUCs) on the duration to and volume of first void, length of hospitalization, number of patients developing urinary retention and requiring recatheterization, patient satisfaction, and the percentage of IUCs removed according to the scheduled time for removal. MATERIALS AND METHODS Published and unpublished literature in English and other languages between January 1966 and June 2002, which compared the effects of the timing of removal of short-term indwelling urethral catheters on patient outcomes, was systematically reviewed using multiple electronic databases. To determine eligibility of the trials for inclusion in the review, assessment of methodologic quality and data extraction was undertaken independently by 2 reviewers and verified by a third reviewer. Odds ratio (OR) for dichotomous data and a weighted mean difference for continuous data were calculated with 95% confidence intervals (CI). Where synthesis was inappropriate, a narrative overview has been undertaken. RESULTS Eight randomized controlled trials were eligible for this review. When IUCs were removed at midnight, the time to first void was significantly shorter (P = .012) after gynecologic surgery and significantly longer in patients after urologic surgery and procedures. Seven trials reported that the volume of the first void was greater in patients whose IUCs were removed late at night, and this was statistically significant in 4 trials. Patients who had their IUC removed at midnight were discharged from the hospital significantly (P < .00001) earlier than those who had their IUC removed in the morning, a finding that could result in potential cost savings for hospitals. CONCLUSION Based on the limited available evidence, this article suggests benefits in terms of patient outcomes and reduction in the length of hospitalization after midnight removal of the IUCs. Further trials should be undertaken in wider settings and on specific groups of patients to enhance generalizability.

Background This systematic review updates a previous review published in 2001. Cleansing is a vital component of wound management; however; little attention has been give to the solutions and techniques used for cleansing purposes. The objective of this review was to assess the effectiveness of different solutions, pressures and techniques used for wound cleansing to prevent infection and promote wound healing. Search strategy Randomised and clinical controlled trials were identified using the Cochrane Central Register of Controlled Trials (CENTRAL). Additional searches of other databases and hand searches of journals and bibliographies was undertaken to identify further trials. Selection criteria All randomised and clinical controlled trials involving adults and/or children whose wounds were cleaned with commercial cleansers, normal saline, water, chlorhexidine, hydrogen peroxide or povidone-iodine were eligible for inclusion. Studies that utilised solutions for preoperative skin cleansing, compared solutions for burns or dental procedures, and those that compared dressings for patients with ulcers were excluded from this review. Outcomes included rate of healing, incidence of infections or levels of bacterial count. Selection of potential articles, assessment of methodological quality and data abstraction was conducted independently by two reviewers. Trials with similar patients, comparisons, and outcomes were pooled. The data were analysed using Cochrane Review Manager 4.2. Where pooling was inappropriate, trials are discussed in a narrative review. Results Fourteen randomised controlled trials were included that compared various solutions for wound cleansing. The evidence indicates that there is no difference in the infection and healing rates in acute and chronic wounds cleansed with either tap water or normal saline. An irrigation pressure of 13 psi is effective for cleansing wounds and reducing infection without causing tissue trauma. There were no studies comparing common techniques for wound cleansing such as swabbing or scrubbing. Showering postoperative wounds did not demonstrate any difference in infection rates; however, it increased the morale of the patient. Whirlpool therapy was effective in reducing inflammation and pain in surgical wounds. Conclusions These conclusions are based on the best available clinical evidence. However, there is an urgent need to support these findings with rigorous research as some of the conclusions are based on single studies with limited sample sizes. Solutions for wound cleansing: • The evidence supports the use of potable tap water for cleansing lacerations in both adults and children and postoperative wounds in adults only. • Potable tap water as well as boiled and cooled water is also an effective wound cleansing solution. This finding, however, is based on a trial that had a small sample size. • The evidence to support the use of potable tap water is limited (only one study with low power); therefore, further studies are required to confirm that assumption. • Povidone-iodine is an effective cleansing solution for contaminated wounds. Pressure for wound cleansing: • A pressure of 13 psi is effective in reducing infection and inflammation in both adults and children with lacerations and traumatic wounds. Techniques for wound cleansing: • Evidence to support or refute swabbing and scrubbing to cleanse wounds is lacking. • The review demonstrated no evidence of a difference in the wound infection and healing rates between wounds that were showered and those that were not. • The evidence for showering ulcers and other chronic wounds is lacking; therefore, this technique of wound cleansing should be undertaken with caution. • Whirlpool therapy is effective to reduce pain and inflammation in surgical wounds and improve the healing rate in pressure ulcers. • The evidence to support the use of Sitz bath for patients following episiotomy is limited.