Search

Objective Depressive and anxiety symptoms are associated with Ischemic Heart Disease (IHD). Exercise interventions might improve both depressive and anxiety symptoms, but an overview of the evidence is lacking. Therefore, we systematically reviewed the existing literature on the effectiveness of exercise therapy to reduce depression and anxiety symptoms specifically in patients with IHD. Methods MEDLINE, EMBASE, PsycINFO and the Cochrane Central Register of Controlled Trials were searched until January 2016. The effectiveness of exercise was assessed within two groups: a) patients selected for study with severe depression or anxiety; and b) studies that did not exclusively targeted patients with increased levels of depression or anxiety. Secondary outcomes were mortality, cardiac events, re-hospitalizations and cardiovascular risk factors. Results We included fourteen studies. Clinical and methodological heterogeneity precluded meta-analysis. Three studies specifically included patients with high levels of depression or anxiety and eleven studies selected patients with unclear levels of depression or anxiety. Some RCTs showed that exercise was effective in lowering severe depressive symptoms (short and long term follow-up), but for the group with unclear depressive symptoms the results were non-conclusive. In the group with elevated anxiety symptoms, exercise had a positive effect on the short term follow-up. In the group with unclear anxiety symptoms the results were inconsistent (short and long term follow-up). No differences were found regarding the secondary outcomes. Conclusions There is a general paucity of data on the effect of exercise, precluding firm conclusions about the effectiveness of exercise for depressive and anxiety symptoms in IHD patients.

In deze serie beschrijven wij op een korte en overzichtelijke manier de highlights van verschillende onderzoeksdesigns. Dit keer: integrative reviews.

Er is steeds meer bewijs dat verpleegkundige zorg een grote invloed heeft op zowel gezondheid als maatschappij. Om veilige, doelmatige en persoonsgerichte zorg te kunnen blijven leveren, is het belangrijk te investeren in academische carrieres van verpleegkundigen.

Contains fulltext : 182667.pdf (Publisher’s version ) (Closed access) Background: An effective and tolerable bowel preparation is important to secure quality of colonoscopies. It remains unclear if sodium picosulphate with magnesium citrate (SPMC), which is considered a tolerable bowel preparation agent, is also an effective alternative for polyethylene glycol (PEG) and sodium phosphate (NaP). Aim: The aim of this article is to compare effectiveness of SPMC to PEG and NaP through assessment of quality of bowel cleansing measured by validated tools. Methods: We searched electronic databases up to January 2015. Only randomised controlled trials (RCTs) were included. Two authors independently performed selection of studies, risk of bias assessment and data extraction. Results: Thirteen RCTs were included, with overall good quality, but large heterogeneity. SPMC had slightly better quality of bowel cleansing than PEG (pooled RR 1.06; 95% CI 1.02 to 1.11). In most trials SPMC was significantly better tolerated than PEG. There were no significant differences in effectiveness or tolerability between SPMC and NaP. Side effects were similar between agents, except for dizziness (pooled RR 1.71; 95% CI 1.32 to 2.21 in favour of PEG vs. SPMC) and vomiting (pooled RR 0.35; 95% CI 0.13 to 0.95 in favour of single-dose SPMC vs. split-dose). Conclusions: SPMC is equally effective to NaP and little superior to PEG in terms of bowel cleansing. SPMC preparations were better tolerated than PEG preparations. SPMC may be considered as standard bowel preparation for colonoscopy.

Je werkt op een verpleegafdeling. Meerdere keren per dag meet je de vitale functies van de patienten. Tegenwoordig liggen er in het ziekenhuis ziekere patienten dan vroeger. Dat komt door de toegenomen vergrijzing met comorbiditeit en de uitvoering van complexere behandelingen. Deze patienten hebben een hoog risico om klinisch achteruit te gaan.

Binnen de randvoorwaarde visie en leiderschap hebben lokale opinieleiders en interdisciplinaire teams een belangrijke rol voor een succesvolle implementatie van het EBP-gedachtegoed of evidence-based handelingen. De eerste paragraaf betreft het kritisch bekeken artikel Interventions aimed at increasing research use in nursing: a systematic review. Voor een succesvolle implementatie van het EBP-gedachtegoed of evidence-based handelingen is het, binnen de randvoorwaarde visie en leiderschap, ook van belang een professionele organisatie te hebben en strategie hiervoor te bepalen. De tweede paragraaf betreft het kritisch bekeken artikel Effectiveness of organisational infrastructures to promote evidence-based nursing practice.

Voor de implementatie van het EBP-gedachtegoed en evidence-based handelingen is het beschikbaar zijn en kunnen gebruiken van informatietechnologie van belang. Hiervoor is het artikel The role of organizational context and individual nurse characteristics in explaining variation in use of information technologies in evidence based practice kritisch bekeken. Middelen dienen beschikbaar te zijn voor een succesvolle implementatie van het EBP-gedachtegoed of evidence-based handelingen. Beschermde tijd voor educatie of het opdoen van vaardigheden in het kritisch beoordelen van wetenschappelijke artikelen is daar een van. Hiervoor is artikel Are Journal Clubs effective in supporting evidence-based decision making? A systematic review kritisch bekeken

Persoonlijke kenmerken en gedrag van verpleegkundigen zijn onderdeel van drijfveren en motivatie voor de implementatie van het EBP-gedachtegoed of evidence-based handelingen. Daarom bevat dit onderdeel het kritisch bekeken artikel Individual determinants of research utilization by nurses: a systematic review update.

Educatie ontvangen en vaardigheden opdoen is van belang om onzekerheid bij de implementatie van het Evidence Based Practice (EBP) gedachtegoed of evidence-based handelingen te voorkomen. Dit overzichtsartikel geeft een aansprekend gebleken mogelijkheid om EBP op praktische wijze aan te leren. Cruciaal is de leersituaties zo dicht mogelijk bij de praktijk te zoeken en vragen uit de dagelijkse praktijk op te halen.

Hyperbaric oxygen therapy (HBOT) is used as a treatment for acute wounds (such as those arising from surgery and trauma) however the effects of HBOT on wound healing are unclear. To determine the effects of HBOT on the healing of acute surgical and traumatic wounds.We searched the Cochrane Wounds Group Specialised Register (25 August 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 3), Ovid MEDLINE (1950 to August Week 2 2010 ), Ovid MEDLINE (In-ProcessOther Non-Indexed Citations August 24, 2010), Ovid EMBASE (1980 to 2010, Week 33) and EBSCO CINAHL (1982 to 20 August 2010).Randomised controlled trials (RCTs) comparing HBOT with other interventions or comparisons between alternative HBOT regimens.Two review authors conducted selection of trials, risk of bias assessment, data extraction and data synthesis independently. Any disagreements were referred to a third review author. Three trials involving 219 participants were included. The studies were clinically heterogeneous, therefore a meta-analysis was inappropriate.One trial (48 participants with burn wounds undergoing split skin grafts) compared HBOT with usual care and reported a significantly higher complete graft survival associated with HBOT (95% healthy graft area risk ratio (RR) 3.50; 95% confidence interval (CI) 1.35 to 9.11). A second trial (36 participants with crush injuries) reported significantly more wounds healed with HBOT than with sham HBOT (RR 1.70; 95% CI 1.11 to 2.61) and fewer additional surgical procedures required with HBOT: RR 0.25; 95% CI 0.06 to 1.02 and significantly less tissue necrosis: RR 0.13; 95% CI 0.02 to 0.90). A third trial (135 people undergoing flap grafting) reported no significant differences in complete graft survival with HBOT compared with dexamethasone (RR 1.14; 95% CI 0.95 to 1.38) or heparin (RR 1.21; 95% CI 0.99 to 1.49).Many of the predefined secondary outcomes of the review, including mortality, pain scores, quality of life, patient satisfaction, activities daily living, increase in transcutaneous oxygen pressure (TcpO(2)), amputation, length of hospital stay and costs, were not reported. All three trials were at unclear or high risk of bias.There is a lack of high quality, valid research evidence regarding the effects of HBOT on wound healing. Whilst two small trials suggested that HBOT may improve the outcomes of skin grafting and trauma these trials were at risk of bias. Further evaluation by means of high quality RCTs is needed.

Hyperbaric oxygen therapy (HBOT) is used as a treatment for acute wounds (such as those arising from surgery and trauma) however the effects of HBOT on wound healing are unclear. To determine the effects of HBOT on the healing of acute surgical and traumatic wounds. We searched the Cochrane Wounds Group Specialised Register (25 August 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 3), Ovid MEDLINE (1950 to August Week 2 2010 ), Ovid MEDLINE (In-Process & Other Non-Indexed Citations August 24, 2010), Ovid EMBASE (1980 to 2010, Week 33) and EBSCO CINAHL (1982 to 20 August 2010). Randomised controlled trials (RCTs) comparing HBOT with other interventions or comparisons between alternative HBOT regimens. Two review authors conducted selection of trials, risk of bias assessment, data extraction and data synthesis independently. Any disagreements were referred to a third review author. Three trials involving 219 participants were included. The studies were clinically heterogeneous, therefore a meta-analysis was inappropriate.One trial (48 participants with burn wounds undergoing split skin grafts) compared HBOT with usual care and reported a significantly higher complete graft survival associated with HBOT (95% healthy graft area risk ratio (RR) 3.50; 95% confidence interval (CI) 1.35 to 9.11). A second trial (36 participants with crush injuries) reported significantly more wounds healed with HBOT than with sham HBOT (RR 1.70; 95% CI 1.11 to 2.61) and fewer additional surgical procedures required with HBOT: RR 0.25; 95% CI 0.06 to 1.02 and significantly less tissue necrosis: RR 0.13; 95% CI 0.02 to 0.90). A third trial (135 people undergoing flap grafting) reported no significant differences in complete graft survival with HBOT compared with dexamethasone (RR 1.14; 95% CI 0.95 to 1.38) or heparin (RR 1.21; 95% CI 0.99 to 1.49).Many of the predefined secondary outcomes of the review, including mortality, pain scores, quality of life, patient satisfaction, activities daily living, increase in transcutaneous oxygen pressure (TcpO(2)), amputation, length of hospital stay and costs, were not reported. All three trials were at unclear or high risk of bias. There is a lack of high quality, valid research evidence regarding the effects of HBOT on wound healing. Whilst two small trials suggested that HBOT may improve the outcomes of skin grafting and trauma these trials were at risk of bias. Further evaluation by means of high quality RCTs is needed

Dit artikel is besproken tijdens een van de Journal Clubs (JC) met de verpleegkundige docenten van de Amsterdam School of Health Professionals of gebruikt bij het EBP-onderwijs aan verpleegkundestudenten, zoals u kunt lezen in het interview met Wilma Scholte op Reimer in dit nummer (vanaf p. 17). Om de week wordt een JC gehouden over een artikel dat aansluit bij een recent probleem, dilemma of onzekerheid uit de dagelijkse verpleegkundige praktijk. Hoe u een dergelijke bespreking op de afdeling of instelling kunt starten, kunt u lezen in NTvEBP 2-2009.