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Objective The objective of the proposed systematic review is to determine the barriers and enablers (or facilitators) to the implementation of pressure injury prevention among adults receiving care in the hospital setting. Introduction Hospital-acquired pressure injuries are preventable; however, they remain an ongoing safety and quality health care concern in many countries. There are various evidence-based preventative interventions for pressure injuries, but their implementation in clinical practice is limited. An understanding of the different factors that support (enablers or facilitators) and inhibit (barriers) the implementation of these interventions from different perspectives is important, so that targeted strategies can be incorporated into implementation plans. Inclusion criteria This review will include quantitative, qualitative, and mixed methods studies that investigate barriers and/or enablers in relation to hospital-acquired pressure injury prevention in hospitalized adults. Only English publications will be considered, with no publication date restrictions. Methods The systematic review will be conducted in accordance with the JBI methodology for mixed methods systematic review. Published studies will be searched in PubMed, CINAHL, Embase, PsycINFO and Scopus. Gray literature will also be considered. Critical appraisal and data extraction will be performed using standardized tools, followed by data transformation. Data synthesis will follow the convergent integrated approach.

Objective\ud Mixed methods systematic reviews (MMSR) combine quantitative and qualitative evidence within a single review. Since the revision of the JBI Methodology for MMSRs in 2020, there has been an increasing number of reviews published that claim to follow this approach. A preliminary examination of these indicated that authors frequently deviated from the methodology. This paper outlines five common ‘pitfalls’ associated with undertaking MMSR and provides direction for future reviewers attempting MMSR.\ud \ud Methods\ud Forward citation tracking identified 17 reviews published since the revision of the JBI mixed methods methodological guidance. Methods used in these reviews were then examined against the JBI methodology to identify deviations.\ud \ud Results\ud The issues identified related to the rationale for choosing the methodological approach; incorrect synthesis and integration approach chosen to answer the review question/s posed; the exclusion of primary mixed methods studies in the review; the lack of detail regarding the process of data transformation and a lack of ‘mixing’ of the quantitative and qualitative components.\ud \ud Conclusion\ud This exercise was undertaken to assist systematic reviewers considering conducting a MMSR as well as MMSR users to identify potential areas where authors tend to deviate from the methodological approach. Based on these findings a series of recommendations are provided.

Review objective/questions: The objective of this scoping review is to map the evidence relating to the reporting and evaluation of health technologies for the prevention and detection of falls in adult hospital in-patients. The following questions will guide this scoping review: i) What falls prevention and detection health technologies have been reported in the literature? ii) What outcomes have been reported that measure falls prevention and detection health technologies in terms of clinical effectiveness, cost-effectiveness, acceptability and feasibility of use?

Objective The objective of this scoping review was to examine and map the evidence relating to the reporting and evaluation of technologies for the prevention and detection of falls in adult hospital inpatients. Introduction Falls are a common cause of accidental injury, leading to significant safety issues in hospitals globally, and resulting in substantial human and economic costs. Previous research has focused on community settings with less emphasis on hospital settings. Inclusion criteria Participants included adult inpatients, aged 18 years and over; the concept included the use of fall-prevention or fall-detection technologies; the context included any hospital ward setting. Methods This scoping review was conducted according to JBI methodology for scoping reviews, guided by an a priori protocol. A wide selection of databases including MEDLINE, CINAHL, AMED, Embase, PEDro, Epistimonikos, and Science Direct were searched for records from inception to October 2019. Other sources included gray literature, trial registers, government health department websites, and websites of professional bodies. Only studies in the English language were included. A three-step search strategy was employed, with all records exported for subsequent title and abstract screening prior to full-text screening. Screening was performed by two independent reviewers and data extraction by one reviewer following agreement checks. Data are presented in narrative and tabular form. Results Over 13,000 records were identified with 404 included in the scoping review: 336 reported on fall-prevention technologies, 51 targeted detection, and 17 concerned both. The largest contributions of studies came from the USA (n=185), Australia (n=65), the UK (n=36), and Canada (n=18). There was a variety of study designs including 77 prospective cohort studies, 33 before-after studies, and 35 systematic reviews; however, relatively few randomized controlled trials were conducted (n = 25). The majority of records reported on multifactorial and multicomponent technologies (n = 178), followed by fall detection devices (n = 86). Few studies reported on the following interventions in isolation: fall risk assessment (n = 6), environment design (n = 8), sitters (n = 5), rounding (n = 3), exercise (n = 3), medical/pharmaceutical (n = 2), physiotherapy (n = 1), and nutritional (n = 1). The majority (57%) of studies reported clinical effectiveness outcomes, with smaller numbers (14%) reporting feasibility and/or acceptability outcomes, or cost-effectiveness outcomes (5%). Conclusions This review has mapped the literature on fall-prevention and fall-detection technology and outcomes for adults in the hospital setting. Despite the volume of available literature, there remains a need for further high-quality research on fall-prevention and fall-detection technologies.

Objective The objective of this paper is to outline the updated methodological approach for conducting a JBI mixed methods systematic review with a focus on data synthesis, specifically, methods related to how data are combined and the overall integration of the quantitative and qualitative evidence. Introduction Mixed methods systematic reviews provide a more complete basis for complex decision-making than that currently offered by single method reviews, thereby maximizing their usefulness to clinical and policy decision-makers. Although mixed methods systematic reviews are gaining traction, guidance regarding the methodology of combining quantitative and qualitative data is limited. In 2014, the JBI Mixed Methods Review Methodology Group developed guidance for mixed methods systematic reviews; however, since the introduction of this guidance, there have been significant developments in mixed methods synthesis. As such, the methodology group recognized the need to revise the guidance to align it with the current state of knowledge on evidence synthesis methodology. Methods Between 2015 and 2019, the JBI Mixed Methods Review Methodology Group undertook an extensive review of the literature, held annual face-to-face meetings (which were supplemented by teleconferences and regular email correspondence), sought advice from experts in the field, and presented at scientific conferences. This process led to the development of guidance in the form of a chapter in the JBI Manual for Evidence Synthesis, the official guidance for conducting JBI systematic reviews. In 2019, the guidance was ratified by the JBI International Scientific Committee. Results The updated JBI methodological guidance for conducting a mixed methods systematic review recommends that reviewers take a convergent approach to synthesis and integration whereby the specific method utilized is dependent on the nature/type of questions that are posed in the systematic review. The JBI guidance is primarily based on Hong et al. and Sandelowski's typology on mixed methods systematic reviews. If the review question can be addressed by both quantitative and qualitative research designs, the convergent integrated approach should be followed, which involves data transformation and allows reviewers to combine quantitative and qualitative data. If the focus of the review is on different aspects or dimensions of a particular phenomenon of interest, the convergent segregated approach is undertaken, which involves independent synthesis of quantitative and qualitative data leading to the generation of quantitative and qualitative evidence, which are then integrated together. Conclusions The updated guidance on JBI mixed methods systematic reviews provides foundational work to a rapidly evolving methodology and aligns with other seminal work undertaken in the field of mixed methods synthesis. Limitations to the current guidance are acknowledged, and a series of methodological projects identified by the JBI Mixed Methods Review Methodology Group to further refine the methodology are proposed. Mixed methods reviews offer an innovative framework for generating unique insights related to the complexities associated with health care quality and safety.

The objective of this review is to synthesize and integrate the best available evidence on the impact of canine-assisted interventions on the health and well-being of older people residing in long-term care.Canine-assisted interventions are commonly used as an adjunct therapy to enhance health and well-being, and are often implemented in long-term care facilities. The number of studies undertaken in this area has increased substantially over the previous five years; therefore, an update of two previous systematic reviews is warranted.This review will consider older people who reside in long-term care facilities and who receive canine-assisted interventions. For the quantitative component, canine-assisted interventions will be compared to usual care, alternative therapeutic interventions, or no interventions, and outcomes will be grouped under the following headings: biological, psychological, and social. For the qualitative component, the experiences of older people receiving canine-assisted interventions, as well as the views of people directly or indirectly involved in delivering canine-assisted interventions, will be explored. Quantitative, qualitative, and mixed methods studies published from 2009 to the present will be considered.A search of 10 bibliographic databases and other resources for published and unpublished English language studies will be undertaken. Study selection, critical appraisal, data extraction, and data synthesis will be undertaken by two independent reviewers following the segregated JBI approach to mixed methods reviews.PROSPERO CRD42020161235.

The current article provides an overview of an approach to incorporating a range of evidence, including qualitative research findings, which the authors piloted when developing a clinical guideline on epilepsies in children and young people. We describe methods used for incorporating literature types not usually included in Scottish Intercollegiate Guidelines Network guidelines, including critical appraisal, and establishing dependability and credibility of qualitative findings. We highlight limitations encountered and make suggestions for future work.

OBJECTIVE:To synthesize and integrate the best available evidence on the experiences and effectiveness of canine-assisted interventions (CAIs) on the health and well-being of older people residing in long-term care. INTRODUCTION:Canine-assisted interventions (CAIs) are commonly used as an adjunct therapy to enhance health and well-being and are often implemented in long-term care facilities. The number of studies undertaken in this area has increased substantially over the last five years; therefore, an update of two previous systematic reviews is warranted. INCLUSION CRITERIA:This review will consider older people who reside in long-term care facilities and who receive CAIs. For the quantitative component, CAIs will be compared to usual care, alternative therapeutic interventions or no interventions, and outcomes will be grouped under the following headings: biological, psychological and social. For the qualitative component, the experiences of older people receiving CAIs, as well as the views of people directly or indirectly involved in delivering CAIs, will be explored. Quantitative, qualitative and mixed methods studies published from 2009 to the present will be considered. METHODS:A search of 10 bibliographic databases and other various resources for published and unpublished English language studies will be undertaken. Study selection, critical appraisal, data extraction and data synthesis will be undertaken following the segregated JBI approach to mixed methods reviews.

Purpose To synthesise the quantitative and qualitative evidence on the views and experiences of children and young people with epilepsy (CYPwE), their family members/caregivers and healthcare professionals on conversations between healthcare professionals and CYPwE/caregivers about the possibility of sudden unexplained death in epilepsy (SUDEP). Methods Mixed methods systematic review in accordance with Joanna Briggs Institute methodology, PRISMA guidelines and guided by an a-priori protocol. Results 656 potentially relevant studies were identified, 11 of which fulfilled the inclusion criteria for the review: 6 quantitative studies, 4 qualitative studies and 1 opinion/text article. Data synthesis resulted in the following 2 integrated findings: (i) Caregivers, and where appropriate CYPwE, should be provided with information on SUDEP and how it relates to them; (ii) Information on SUDEP should be delivered face-to-face, with supporting written information, by a suitably knowledgeable healthcare professional whom the caregiver/CYPwE feels comfortable with, at an appropriate time at or close to diagnosis. Conclusion This review confirms that healthcare professionals should discus SUDEP with CYPwE and/or their caregivers at or around the time of diagnosis and that the discussion should include prevalence of SUDEP, risk factors and risk reduction methods relative to the individual concerned. Apart from delivering SUDEP information face-to-face, with written or online information provided to reinforce messages, there is a lack of evidence on “how” to impart this sensitive information. Further research exploring the most acceptable and effective methods of discussing SUDEP with CYPwE and their caregivers is therefore indicated.

Introduction The World Health Organization estimates that 10% of the 35.6 million people worldwide with dementia are aged under 65 years. In an ageing workforce this has implications for employers, employees, and statutory and third sector services. Limited research has been conducted into this emerging global issue. Method This systematic review, employing the methodology of the Joanna Briggs Institute, aimed to identify and synthesise the best available qualitative evidence regarding the needs, experiences and perspectives of people with early onset dementia or mild cognitive impairment who were either in employment or wished to gain employment. Results Of 69 studies identified, eight met the inclusion criteria. From these, four themes emerged: disease progression and recognition; the emotional impact of change; the employer’s management of the worker; and changes to the worker role. Conclusion There are health benefits to the individual with dementia or mild cognitive impairment of continuing to engage in meaningful occupation. Retirement policy changes have resulted in an ageing workforce with concurrent risk factors for dementia. A lack of understanding of reasonable adjustments and sheltered employment opportunities was evident from the literature. This review highlights the potential for occupational therapists to engage this client group in vocational rehabilitation.

BACKGROUND: Effective nutritional screening, nutritional care planning and nutritional support are essential in all settings, and there is no doubt that a health service seeking to increase safety and clinical effectiveness must take nutritional care seriously. Screening and early detection of malnutrition is crucial in identifying patients at nutritional risk. There is a high prevalence of malnutrition in hospitalized patients undergoing treatment for colorectal cancer.OBJECTIVES: To synthesize the best available evidence regarding the diagnostic test accuracy of nutritional tools (sensitivity and specificity) used to identify malnutrition (specifically undernutrition) in patients with colorectal cancer (such as the Malnutrition Screening Tool and Nutritional Risk Index) compared to reference tests (such as the Subjective Global Assessment or Patient Generated Subjective Global Assessment).INCLUSION CRITERIA: TYPES OF PARTICIPANTS: Patients with colorectal cancer requiring either (or all) surgery, chemotherapy and/or radiotherapy in secondary care. Focus of the review: The diagnostic test accuracy of validated assessment tools/instruments (such as the Malnutrition Screening Tool and Nutritional Risk Index) in the diagnosis of malnutrition (specifically under-nutrition) in patients with colorectal cancer, relative to reference tests (Subjective Global Assessment or Patient Generated Subjective Global Assessment). Types of studies: Diagnostic test accuracy studies regardless of study design.SEARCH STRATEGY: Studies published in English, German, Danish, Swedish and Norwegian were considered for inclusion in this review. Databases were searched from their inception to April 2014.METHODOLOGICAL QUALITY: Methodological quality was determined using the Quality Assessment of Diagnostic Accuracy Studies checklist.DATA COLLECTION: Data was collected using the data extraction form: the Standards for Reporting Studies of Diagnostic Accuracy checklist for the reporting of studies of diagnostic accuracy.DATA SYNTHESIS: The accuracy of diagnostic tests is presented in terms of sensitivity, specificity, positive and negative predictive values. In addition, the positive likelihood ratio (sensitivity/ [1 - specificity]) and negative likelihood ratio (1 - sensitivity)/ specificity), were also calculated and presented in this review to provide information about the likelihood that a given test result would be expected when the target condition is present compared with the likelihood that the same result would be expected when the condition is absent. Not all trials reported true positive, true negative, false positive and false negative rates, therefore these rates were calculated based on the data in the published papers. A two-by-two truth table was reconstructed for each study, and sensitivity, specificity, positive predictive value, negative predictive value positive likelihood ratio and negative likelihood ratio were calculated for each study. A summary receiver operator characteristics curve was constructed to determine the relationship between sensitivity and specificity, and the area under the summary receiver operator characteristics curve which measured the usefulness of a test was calculated. Meta-analysis was not considered appropriate, therefore data was synthesized in a narrative summary.RESULTS: 1. One study evaluated the Malnutrition Screening Tool against the reference standard Patient-Generated Subjective Global Assessment. The sensitivity was 56% and the specificity 84%. The positive likelihood ratio was 3.100, negative likelihood ratio was 0.59, the diagnostic odds ratio (CI 95%) was 5.20 (1.09-24.90) and the Area Under the Curve (AUC) represents only a poor to fair diagnostic test accuracy. A total of two studies evaluated the diagnostic accuracy of Malnutrition Universal Screening Tool (MUST) (index test) compared to both Subjective Global Assessment (SGA) (reference standard) and PG-SGA (reference standard) in patients with colorectal cancer. In MUST vs SGA the sensitivity of the tool was 96%, specificity was 75%, LR+ 3.826, LR- 0.058, diagnostic OR (CI 95%) 66.00 (6.61-659.24) and AUC represented excellent diagnostic accuracy. In MUST vs PG-SGA the sensitivity of the tool was 72%, specificity 48.9%, LR+ 1.382, LR- 0.579, diagnostic OR (CI 95%) 2.39 (0.87-6.58) and AUC indicated that the tool failed as a diagnostic test to identify patients with colorectal cancer at nutritional risk,. The Nutrition Risk Index (NRI) was compared to SGA representing a sensitivity of 95.2%, specificity of 62.5%, LR+ 2.521, LR- 0.087, diagnostic OR (CI 95%) 28.89 (6.93-120.40) and AUC represented good diagnostic accuracy. In regard to NRI vs PG-SGA the sensitivity of the tool was 68%, specificity 64%, LR+ 1.947, LR- 0.487, diagnostic OR (CI 95%) 4.00 (1.23-13.01) and AUC indicated poor diagnostic test accuracy.CONCLUSIONS: There are no single, specific tools used to screen or assess the nutritional status of colorectal cancer patients. All tools showed varied diagnostic accuracies when compared to the reference standards SGA and PG-SGA. Hence clinical judgment combined with perhaps the SGA or PG-SGA should play a major role.IMPLICATIONS FOR PRACTICE: The PG-SGA offers several advantages over the SGA tool: 1) the patient completes the medical history component, thereby decreasing the amount of time involved; 2) it contains more nutrition impact symptoms, which are important to the patient with cancer; and 3) it has a scoring system that allows patients to be triaged for nutritional intervention. Therefore, the PG-SGA could be used as a nutrition assessment tool as it allows quick identification and prioritization of colorectal cancer patients with malnutrition in combination with other parameters.IMPLICATIONS FOR RESEARCH: This systematic review highlights the need for the following: Further studies needs to investigate the diagnostic accuracy of already existing nutritional screening tools in the context of colorectal cancer patients. If new screenings tools are developed, they should be developed and validated in the specific clinical context within the same patient population (colorectal cancer patients).

Review questions/objectives: The objective of this scoping review is to examine and map absolute clinical skill decay in the medical, nursing and allied health professions and to map the range of approaches used to address decay of clinical skills in these professions. Review questions/objectives: Specifically, the review questions are: which clinical skills, performed by which professional groups, are reported to be most susceptible to absolute clinical skill decay, and what approaches have been reported for addressing absolute clinical skill decay in the medical, nursing and allied health professions? Review questions/objectives: In addressing the review questions, the following sub-questions will also be addressed: Review questions/objectives: It is anticipated that this scoping review will inform further systematic review/s on the topic of addressing clinical skill decay in the medical, nursing and allied health professions, as well as identify gaps in the research knowledge base that will inform further primary research.

Review question/objective The objective of this review is to synthesize the best available qualitative evidence on the perceived competencies and skills required by members of a multidisciplinary bariatric care team to provide safe, meaningful and appropriate care for severely obese patients undergoing bariatric surgery. Inclusion criteria Types of participants The review will focus on specialist surgical services for patients with severe and complex obesity (BMI ≥40), provided internationally within public, independent or private sectors. Study participants of interest are members of the MDT providing the specialist services. The review will initially concentrate on four key roles within the MDT; all identified as key contributors to the best possible provision of care for bariatric patients: a) specialist bariatric surgeon; b) specialist bariatric nurse; c) specialist bariatric dietitian; d) psychologist and/or psychiatrist. Where available, literature pertaining to other practitioners with the key roles listed below will be included: e) physiotherapists; f) specialist physicians; g) anesthetists; h) radiographers and radiologists. The particular competencies of the individual MDT members to be explored pertain to the specialist knowledge, skills, and understanding required in order to provide a high quality service. Phenomena of interest The phenomena of interest for the review are the competencies and skills required by multidisciplinary team members to provide care for severely obese patients undergoing bariatric surgery. All types of bariatric procedures are of relevance to the review.

Background Breast-feeding is considered the optimum method of infant nutrition conveying health and psychological benefits for mother and baby. Women from disadvantaged groups are less likely to initiate or successfully establish breast-feeding and with the current emphasis on addressing health inequalities there is an identified need to tailor breast-feeding strategies towards this population. Objectives To appraise and synthesize the best available evidence on effectiveness and maternal satisfaction of interventions supporting the establishment of breast-feeding in the early postnatal period, up to seven days following delivery, for women from disadvantaged groups. Inclusion criteria Types of participants Women from disadvantaged groups, defined as those from socio-economically deprived areas; low income; under 20 years or substance dependent. Types of intervention(s)/phenomena of interest Any study exploring practical, motivational, informative and/or educational interventions supporting disadvantaged women to establish breast-feeding. Types of studies Quantitative and qualitative studies. Types of outcomes The establishment of breast-feeding/lactation within the postnatal period; perceived usefulness and acceptability of the intervention to support breast-feeding establishment in the postnatal period. Search strategy Searches were conducted for any published or unpublished material, in the English language, between 1992 and March 2013. A three-step search of databases including ASSIA; Campbell Collaboration; CINAHL, Cochrane Database; EBSCO; EThOS; Journals @OVID; Medline and SAGE journals was conducted. Methodological quality Each paper was assessed by two independent reviewers for methodological quality using the appropriate critical appraisal instrument from Joanna Briggs Institute. Data collection Data was collected using standardized extraction tools developed by Joanna Briggs Institute. Data synthesis Data was synthesized according to their methodological approach using instruments from the Joanna Briggs Institute. Where this was not possible, findings are presented in a narrative form. Results A total of 10 studies were included in the review. Two were quantitative studies (prospective cohort studies) and eight were qualitative studies (qualitative components of a mixed methodology study and seven qualitative studies). Forty-five findings were extracted from the qualitative components of the studies. Findings were synthesized into 12 categories. Categories were synthesized into three findings. The quantitative review demonstrated that technical assistance and information provision resulted in greater awareness of breast-feeding physiology, increased rates and a longer duration of breast-feeding. The qualitative synthesized findings suggested that maternal satisfaction was enhanced when proactive practical assistance was given within the confines of a collaborative relationship. Professional support offering positive encouragement and delivering socio-culturally appropriate strategies were considered by mothers as helping to meet their breast-feeding objectives. Disempowering practices included inaccessible information, conflicting advice and judgmental attitudes from health care providers. Conclusions The review identified interventions aimed at enhancing technical skill and knowledge as clinically effective in establishing successful breast-feeding. Disadvantaged women considered support strategies offering culturally relevant advice and specific to their individualized needs as the most acceptable and effective in meeting their breast-feeding intentions.

Review question/objective The objective is to identify the effectiveness of peer support interventions in community-dwelling adults with chronic non-cancer pain. More specifically, the objectives are to identify: The effectiveness of peer support interventions in function, pain, quality of life, self-efficacy and health service utilization for adults with chronic non-cancer pain dwelling in the community, compared to those receiving usual care or other self-management interventions. The specific review question is therefore: Is peer support more effective than usual care or other self-management interventions in reducing pain and health service utilization, and enhancing function, self-efficacy and quality of life in community-dwelling older adults with chronic non-cancer pain? Inclusion criteria Types of participants Since chronic pain affects adults of all ages there will be no upper limit set; we will include participants aged 18 or over. Chronic pain in children is often managed differently than in adults, with specific guidelines, 11 therefore participants under 18 are outwith the scope of this review. Cancer pain is also considered outwith the scope of this review due to its specific nature and management 14 which often differs from non-cancer related causes of chronic pain. Adults who are hospitalized or living in residential care will also be excluded from this review. Peer support interventions in these settings are likely to differ greatly from those designed for community dwelling adults; the focus of this review is on interventions designed for community-dwelling adults. Types of intervention(s)/phenomena of interest The review will consider studies that evaluate any peer support intervention or any intervention that includes a defined element of peer support. Peer support interventions can be aimed at individuals or groups, therefore both will be included in this review. Interventions will include support groups or clubs, email discussion groups, telephone calls, home visits, and any other intervention that can be considered to be peer support. Peers will have knowledge of chronic pain. They may be self-selected or selected by health professionals, and will have received a moderate amount of training to deliver an intervention, in keeping with the definition presented above. 2 People with no training are considered natural lay helpers and are excluded from this review. People who have undergone extensive training are considered paraprofessionals and are likewise excluded from this review. In cases where it is not possible to determine whether the support was provided by a natural lay helper, peer or paraprofessional, studies will be included in order to minimize the risk of omitting relevant data. Types of comparator This review will consider studies that have compared peer support interventions to other self-management interventions that are not delivered by peers. These will include one-on-one or group interventions delivered by paraprofessionals or by health professionals. This review will also consider studies that have compared peer support to usual care. Since there is no one agreed definition of usual care for long term management of adults with chronic pain, any study that provides a description of usual care as their comparator will be included. There may also be studies in which the self-management intervention is the same in the experimental and comparison group, the only difference being the addition of a peer support element to the experimental group; these studies will also be considered. Types of outcomes This review will consider studies that include the following quantitative measures: function, pain, quality of life, self-efficacy and health service utilization. This is in keeping with recommendations for outcome measurement in chronic pain and self-management research, 13,16-17 therefore these measures should be available for consideration. Measures of function may be specific to the region of chronic pain, eg Roland Morris Low Back Pain Disability Questionnaire and Oswestry Low Back Pain Disability Questionnaire, or more general measures, eg Pain Disability Index. In addition to these measures of physical function, measures of emotional function will also be considered, eg scales that measure depression, anxiety and loneliness. Any measure of pain will be included, eg Visual Analogue Scale and Multidimensional Pain Inventory. Any quality of life measure will be included eg SF-36, Euroqol. Any measure of self-efficacy will be included, eg self-care of chronic pain and self-efficacy questionnaires. In addition, where self-management knowledge and skills have been measured these will likewise be considered (eg Health Education Impact Questionnaire) Any measure of health service utilization will be considered, such as emergency room and physician visits. Economic evaluation is however outwith the scope of this review. Where possible, outcomes measured with similar scales will be pooled together.

The quantitative objective is to identify the known and/or potential health effects of working in the wind power generation industry. More specifically the objectives are to identify: 1. The musculoskeletal and other physical health risks to onshore wind technicians associated with the repeated climbing of vertical ladders; 2. The musculoskeletal and other physical health risks to onshore wind technicians associated with working in confined spaces within wind turbine structures. The qualitative objective is to identify onshore wind technicians' and/or related workers' perceptions and experiences of work-related musculoskeletal and other physical health disorders. The textual objective is to identify the issues related to musculoskeletal and other physical health risks of working in the wind power generation industry. Inclusion criteria Types of participants The quantitative and qualitative components of this review will consider studies that include adult onshore wind technicians. In the absence of studies directly relating to onshore wind technicians, participants from other related sectors (i.e. occupations that involve repeated vertical ladder climbing and/or confined space working similar to turbine structures) will be considered. These participants include, but are not restricted to, telecommunications workers, offshore oil and gas workers, construction and maintenance workers and electricians. The specific environmental health effects associated with offshore wind and marine developments are not within the scope of this review. The textual component of this review will consider the same participants as the quantitative and qualitative components, but will also include occupational health and safety experts, health professionals, employers and industry bodies. Types of intervention(s)/phenomena of interest The quantitative component of the review will consider studies that evaluate the musculoskeletal and other physical health risks to onshore wind technicians and related others associated with the repeated climbing of vertical ladders and working in confined spaces. The qualitative component of this review will consider studies that investigate onshore wind technicians' and related others' perceptions and experiences of work-related musculoskeletal and other physical health disorders. The textual component of this review will consider publications that describe the issues related to musculoskeletal and other physical health risks of working in the wind power generation and TRUNCATED AT 350 WORDS

Review question What are the experiences of acute mental health /psychiatric nurses of clinical supervision in promoting their well-being in their place of work? Objectives The objective of this review is to synthesise the best available qualitative evidence on the positive aspects of clinical supervision experiences of acute mental health /psychiatric nurses, such as a sense of individual well-being Inclusion criteria Types of participants This review will consider studies that include nurses working in acute mental health in-patient care settings, who have first hand experience of clinical supervision regardless of age, gender, ethnicity, length of time since registration as a mental health nurse, work experience, or country of origin. For this systematic review we will use the following definitions: •The term mental health or (psychiatric) nurse is used interchangeably to reflect international preferences and refers to nurses who have completed a recognised approved training in mental health nursing by the relevant professional body, and awarded a licence to practice, and to use the legal title of ‘nurse’. •The term acute mental health (psychiatric) in-patient care settings or environments refers to wards or units providing hospitalisation and care for patients with acute mental disorders. •The term clinical supervision refers to a formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and the safety of care in complex clinical situations. It is central to the process of learning and to the expansion of the scope of practice and should be seen as a means of encouraging self-assessment and analytical and reflective skills, and nurses’ well-being in the work place. Phenomena of interest The experiences of acute mental health/psychiatric nurses of clinical supervision in promoting their well-being in the work place.The types of data that include experiential accounts of acute mental health /psychiatric nurses of the contribution of CS to their well-being, for example reduced stress, less feelings of burn out and exhaustion, job satisfaction, and enhanced coping skills.

The recent interest in wisdom in professional health care practice is explored in this article. Key features of wisdom are identified via consideration of certain classical, ancient and modern sources. Common themes are discussed in terms of their contribution to ‘clinical wisdom’ itself and this is reviewed against the nature of contemporary nursing education. The distinctive features of wisdom (recognition of contextual factors, the place of the person and timeliness) may enable their significance for practice to be promoted in more coherent ways in nursing education. Wisdom as practical knowledge (phronesis) is offered as a complementary perspective within the educational preparation and practice of students of nursing. Certain limitations within contemporary UK nursing education are identified that may inhibit development of clinical wisdom. These are: the modularization of programmes in higher education institutions, the division of pastoral and academic support and the relationship between theory and practice.

There are an estimated three million people affected by Chronic Obstructive Pulmonary Disease (COPD) in the UK with only about 900,000 of these being diagnosed according to the Healthcare Commission, and prevalence is increasing. Significant progress has been made in respect of treatment and management of the disease. However, there is limited evidence related to the perspective of those with COPD despite an acknowledgement that lung function, as determined by spirometry, does not necessarily equate with pulmonary disease and subsequent functional level or disability. The impact of COPD on patients, their family, carers and healthcare services demands that better ill health prevention and disease maintenance strategies be employed.The objective was to explore the common and shared experiences of those in caring partnership for patients with COPD receiving care and support in their community.For this review, the definition of support takes the view that support relates to 'any activity or intervention aimed at improving or maintaining the health status of a patient with COPD'.The review focused on the experiences of patients, carers, family members, nurses and doctors involved in providing support to patients with COPD in their own home. Patients aged 65 years and over were included.The review considered studies that represented patient, carer, nursing and medical staff experiences and perceptions of support relating to COPD.The review considered evidence from qualitative research including phenomenology, grounded theory, and descriptive studies, where support for COPD in a community context was the focus.The search set out to find published studies in English from 1990-2010.The studies were appraised and findings extracted using the JBI critical appraisal tool for qualitative research. Three reviewers appraised the studies independently. 72 studies were critically appraised and 39 met the inclusion criteria.Findings from included papers were aggregated, categorised and synthesised.If those with COPD received more consistent support in relation to information, rehabilitation, end of life care and other service provision then their quality of life could be enhanced.Better planned and more integrated support for home based care around self-care/management and in managing exacerbations can reduce patient and carer anxiety and distress related to COPD.Individualisation of care, which is not based on the patient's 'disease state' (i.e. physical parameters) but on assessed need, is a necessary part of care for those with COPD.

OBJECTIVE: To systematically review the literature of factors affecting adherence to Antiretroviral treatment (ART) in Asian developing countries. METHODS: Database searches in Medline/Ovid Cochrane library CINAHL Scopus and PsychINFO for studies published between 1996 and December 2010. The reference lists of included papers were also checked with citation searching on key papers. RESULTS: A total of 437 studies were identified and 18 articles met the inclusion criteria and were extracted and critically appraised representing in 12 quantitative four qualitative and two mixed-method studies. Twenty-two individual themes including financial difficulties side effects access stigma and discrimination simply forgetting and being too busy impeded adherence to ART and 11 themes including family support self-efficacy and desire to live longer facilitated adherence. CONCLUSION: Adherence to ART varies between individuals and over time. We need to redress impeding factors while promoting factors that reinforce adherence through financial support better accessible points for medicine refills consulting doctors for help with side effects social support and trusting relationships with care providers. (c) 2011 Blackwell Publishing Ltd.

Levels of medication administration error have been reported as accounting for 38% of all adverse drug events and have been calculated as occurring in 3-8% of all administrations. The majority of these will occur as part of "routine" administration.To undertake a systematic review of roles and systems for preventing medication error during routine medication administration in hospital-based acute care settings and of perceptions of causes of error.Types of participants- Participants were nurses, pharmacists, pharmacy technicians, medical and surgical staff and adult patients in hospital-based, acute care settings.Types of intervention/Phenomena of interest- Intervention related to administration systems and related to roles of those who administer medicines were considered. The perceptions of causes of error was the phenomena of interest.Types of outcomes- 1) Number of medication administration errors, and 2) Nurses and patients' perceptions of causes of medication errorTypes of studies- Quantitative studies of medication error rates for differing medication systems and roles of those administering medications. Qualitative and descriptive studies of perceived causes of errors.The review sought studies published in English from 1990 to December 2008. 23 databases, websites and search engines were searched.Critical appraisal tools from Joanna Briggs Institute were used. Two reviewers appraised studies independently. 35 studies out of 1004 identified papers were critically appraised. 19 studies met the inclusion criteria.Data were extracted using standardised extraction forms.It was not possible to undertake meta-analysis due to lack of studies in all categories and lack of similarity between studies. Quantitative results were combined in a narrative summary. Qualitative studies were synthesised accordingly using a meta-aggregative approach.Nurses perceptions of medication administration errors suggest that ineligible prescriptions and distractions/interruptions (external factors) are perceived as key causes of error. Limited evidence on patient perceptions, suggest that their inclusion in routine medication administration may reduce errors.Studies related to routine medication administration roles and systems are small and lack power and generalisability to all acute care contexts. What evidence exists suggests routine medication that is individualised to the patient and administered close to the bedside, reduces error.There is equivocal evidence related to differing roles of nurses. The use of dedicated medication nurses and primary administration (nurse administers "own" patient medications) are inconclusive. Equivocal evidence related to three system types was identified: self administration; trolley, bay and bedside systems; individualised and unit dose medications.There is no evidence of effectiveness related to one or two nurse checking or related to the use of devices to reduce distractions, such as signs or tabards.Administration from individually labelled medication, administered close to the patient, appear to be the most significant factors in reducing errors during routine medication rounds. Nurses' perspectives on causes of medication errors, may differ from those recorded. There is no conclusive evidence that manipulating the nursing role has any impact on errors.Implication for practice- Individual or patient dose systems used with administration occurring as close to the patient as possible. Including the patient more fully in the administration process through self administration or involvement in the checking process has some potential for reducing errors.Implication for research- The review identifies the need for rigorous large scale further research.

Aim: This paper reflects on the language and translation challenges faced and interventions used whilst undertaking cross-cultural public health research in Nepal using translators.\ud \ud Background: The growth in cross-cultural studies and international research highlights the use of translators and the associated challenges for researchers with regard to cultural and linguistic issues when collecting data in one language and analysing and reporting in another. The specific challenges when using translators are frequently overlooked in the research literature and translators and the interpretation processes omitted from the research methodology and/or discussion.\ud \ud Methods: The experiences and challenges for an English-speaking nurse researcher working with a team of translators in a cross-cultural study on the sexual and reproductive health (SRH) of young people in Nepal, in 2006, is explored in this paper. The paper employs a case study approach.\ud \ud The Study: Data were collected over four weeks observing the settings, and the SRH knowledge and practices of participants in two villages in Kathmandu Valley were identified using a questionnaire, which was administered as a structured interview, and from the nurse researcher's field notes. This provided information on the translation and interpretation events. Stages in the research process where error could occur are identified in the researchers model and the interventions taken to minimise these are discussed which clarify perspectives and opinions when researching in the field.\ud \ud Findings and Conclusion: Reflecting on translation and interpretation challenges during the data collection process in a language which the nurse researcher does not speak, can help reduce (or avoid) potential mistakes and error. The paper reflects on a model of translation processes which emerged during fieldwork which helps understand what events happened and what actions were taken to obtain the most accurate data. Using a model such as this for cross cultural fieldwork may be useful for both novice and established researchers.

Objectives This review seeks to establish the nature of care and support in the community for those people who have one or more long term condition. The review will consider any qualitative research that describes or analyses the experiences of adult patients, families, carers and members of the community nursing team involved in managing long term conditions. Criteria for considering studies for this review Types of participants The review will consider older adult participants with one or more long term condition being supported by family, carers and members of the community nursing team. The perspectives of the family may be from a variety of points of view, for example, spousal support as differing from the support of offspring. The viewpoint of the community nursing team may be through, for example District Nurses, Family Health Nurses or Community Matrons. Phenomenon of Interest This review will examine the phenomenon of care and support in LTC whilst living at home. This will include the perspectives of the person with a LTC, the families and or carers and community nurses. The interventions may consider but not be limited to the following: o Support o Self-care o Symptom control o Communication o Quality of life o Activities o Spirituality Anticipated Outcomes The anticipated outcome will be a synthesis of themes/categories that relate to the perspectives of the main players (patient, carer or nurse) in the care and support of Long Term Conditions. Whilst at this stage it is not possible to identify differences between these, the review will seek to identify differences and similarities across the three groups.

Objectives The overall objective is to investigate what human roles and systems are most effective and feasible for preventing medication incidents during routine medication administration in hospital-based acute care settings. The review will consider the effectiveness and feasibility of the following interventions in preventing medication incidents: • Timing of administration • Type and dosage of drug • Route of administration • Type of patient • Type of staff Member, for example nurse • Type of acute care setting • Drug delivery and storage • Dispensing system Inclusion Criteria Types of participants The participants in this review will consist of: hospital- based acute care setting nurses, pharmacists, pharmacy technicians, medical and surgical staff in acute care settings and adult patients in acute care settings. Types of interventions This review examines two major types of intervention: Administration systems • Self administration • Trolley systems • Single unit systems • Pharmacy to ward systems Administration processes • Documentation/recording • Drug types • Prescribing • Single nurse administration • Multiple nurse administration • Level/role of nurse • Patient involvement Types of outcome measures There are three types of outcome measures: Medication incident rate Hospital staff and adult patient satisfaction with medication administration system and process Practicality/applicability of medication administration system and process

There are an increasing number of published single-method systematic reviews that focus on different types of evidence related to a particular topic. As policy makers and practitioners seek clear directions for decision-making from systematic reviews, it is likely that it will be increasingly difficult for them to identify 'what to do' if they are required to find and understand a plethora of syntheses related to a particular topic.Mixed-methods systematic reviews are designed to address this issue and have the potential to produce systematic reviews of direct relevance to policy makers and practitioners.On the basis of the recommendations of the Joanna Briggs Institute International Mixed Methods Reviews Methodology Group in 2012, the Institute adopted a segregated approach to mixed-methods synthesis as described by Sandelowski et al., which consists of separate syntheses of each component method of the review. Joanna Briggs Institute's mixed-methods synthesis of the findings of the separate syntheses uses a Bayesian approach to translate the findings of the initial quantitative synthesis into qualitative themes and pooling these with the findings of the initial qualitative synthesis.

Background Many women from socially disadvantaged groups discontinue breastfeeding in the early postnatal period before lactation is fully established. This suggests that existing health service practices do not adequately meet the breastfeeding support needs of this population. The aim of this meta-synthesis is to review the literature exploring how women from socioeconomically deprived backgrounds experience breastfeeding establishment and to identify factors associated with supportive practice. Methods The meta-synthesis includes qualitative studies exploring the perception of women from disadvantaged groups of in-hospital and professionally led interventions to support the establishment of breastfeeding. Searches were conducted for studies published between 1992 and 2013; after critical appraisal, eight studies were retained. Results Three overarching themes of the influences on maternal perception of the efficacy of breastfeeding support were identified. These included practical skill and knowledge of the breastfeeding process, the influence of psychological factors on perceived breastfeeding ability, and the provision of a person-centered approach to infant feeding support. Conclusions The findings illustrate that the factors associated with supportive breastfeeding practice are extensive, complex, and interrelated. Strategies which enable mothers to gain confidence in their ability to successfully breastfeed by acquiring technical expertise, which offer positive encouragement, and which are culturally specific are more likely to be perceived as supportive by women from socially disadvantaged groups.

Review question/objective The aim of the systematic review is to identify and synthesize the best available qualitative evidence regarding the needs, experiences and perspectives of people with dementia or mild cognitive impairment who are either in employment or wish to gain employment and other significant stakeholders. This is a review of qualitative evidence as qualitative studies are known to be the most effective in elucidating needs, experiences and perspectives and may permit the reviewers to address the following questions: What are the needs, experiences and perceptions of people with dementia or mild cognitive impairment who are in employment or seeking employment? What are the needs, experiences and perceptions of people who care for, partner or otherwise informally support people with dementia or mild cognitive impairment who are in employment or seeking employment? What are the needs, experiences and perceptions of employers and co-workers of people with dementia or mild cognitive impairment? What are the needs, experiences and perceptions of employees of statutory health, social care and other governmental and voluntary agencies on the employment of people with dementia or mild cognitive impairment? What are the needs, experiences and perspectives of people with dementia or mild cognitive impairment who are in employment or wish to gain employment and other significant stakeholders in regards to self and agency facilitated management strategies utilized to sustain people with dementia or mild cognitive impairment in employment? What are the needs, experiences and perspectives of people with dementia or mild cognitive impairment who are in employment or wish to gain employment and other significant stakeholders in regards to the factors that predict or facilitate the sustained employment of individuals with dementia or mild cognitive impairment? What are the needs, experiences and perspectives of people with dementia or mild cognitive impairment who are in employment or wish to gain employment and other significant stakeholders in regards to the factors that impede or preclude employment in individuals with dementia or mild cognitive impairment? Inclusion criteria Types of participants This review will consider people with dementia or mild cognitive impairment who are in employment or seeking TRUNCATED AT 350 WORDS

Review question/objective The aim of this systematic review is to comprehensively search the available literature and to synthesize the best available evidence to determine the diagnostic accuracy of currently available and published nutritional screening tools used to screen or assess the nutritional status of patients with colorectal cancer compared to Subjective Global Assessment (SGA) or Patient Generated Subjective Global Assessment (PG-SGA). The objective of this review is therefore to determine: How sensitive and specific are the screening tools used to assess malnutrition in patients with colorectal cancer? Review question: How sensitive and specific are screening tools compared to the scored Patient Generated-Subjective Global Assessment (PG-SGA) or the Subjective Global Assessment (SGA) when used to assess malnutrition in patients with colorectal cancer? Inclusion criteria Types of participants This review will consider studies that include adult participants with colorectal cancer requiring either (or all) surgery, chemotherapy and/or radiotherapy in secondary care. Focus of the review The following index tests for assessing nutritional status will be addressed: Assessment of nutritional status using a published and validated screening/assessment tool /instrument Reference test The diagnostic accuracy of the index tests will be compared against either PG-SGA or SGA. Types of outcomes This review will consider studies that include the following outcome measures: Diagnostic accuracy defined as how well the index test correctly gives positive results (sensitivity and specificity) in regard to identifying malnutrition in patients with colorectal cancer using the reference test. Where available, Positive Predictive Values (PPV), Negative Predictive Values (NPV) and likelihood ratios will also be included.

Evidence-based practice (EBP) is a requirement of nurses through the generation of evidence to implementing it, in a bid to to improve clinical practice. However, EBP is difficult to achieve. This paper highlights an approach to generating evidence for enhancing community nursing services for patients with chronic obstructive pulmonary disease (COPD) through a collaborative partnership. A district nurse and two nursing lecturers formed a partnership to devise a systematic review protocol and perform a systematic review to enhance COPD practice. This paper illustrates the Joanna Briggs Institute (JBI) systematic review process, the review outcomes and the practitioner learning. Collaborative partnerships between academics, researchers and clinicians are a potentially useful model to facilitate enhanced outcomes in evidence-based practice and evidence application.

To systematically review the literature of factors affecting adherence to Antiretroviral treatment (ART) in Asian developing countries.Database searches in Medline/Ovid, Cochrane library, CINAHL, Scopus and PsychINFO for studies published between 1996 and December 2010. The reference lists of included papers were also checked, with citation searching on key papers.A total of 437 studies were identified, and 18 articles met the inclusion criteria and were extracted and critically appraised, representing in 12 quantitative, four qualitative and two mixed-method studies. Twenty-two individual themes, including financial difficulties, side effects, access, stigma and discrimination, simply forgetting and being too busy, impeded adherence to ART, and 11 themes, including family support, self-efficacy and desire to live longer, facilitated adherence.Adherence to ART varies between individuals and over time. We need to redress impeding factors while promoting factors that reinforce adherence through financial support, better accessible points for medicine refills, consulting doctors for help with side effects, social support and trusting relationships with care providers.

Bariatric surgery is the only intervention leading to sustained weight reduction for severely obese individuals. However, there is variability across the UK in organisation of bariatric services, and perceptions of how to develop and deliver optimum care. This means lack of clarity on competencies and skills required for roles within the multidisciplinary bariatric surgical team. This systematic review was carried out to synthesise literature identifying the competencies required by members of the multidisciplinary team for provision of safe, meaningful and appropriate care for severely obese patients undergoing bariatric surgery. The databases CINAHL; Medline; ERIC; PsycINFO; IngentaConnect; The Knowledge Network, and Web of Knowledge were searched to identify key papers. Papers selected were independently appraised for methodological quality by two reviewers using Joanna Briggs Institute systems. Thirty-six papers were included in the review. The literature was poorly developed, largely consisting of text and opinion, and lacking evaluative content. Pooling of papers generated three synthesised findings: 1) Safe, meaningful and appropriate care may be delivered if staff in each role in the multidisciplinary team achieve a minimum set of competencies; 2) Safe, effective and meaningful care may require a minimum set of competencies for managing a bariatric surgery unit and the multidisciplinary team; 3) To achieve competencies for safe, effective and meaningful care certain approaches to education may be developed. Sensitive care, pre-operative psychological assessment, post-operative care and identification of complications, and team management may be areas in which educational interventions develop, but the conclusion remains tentative because of lack of empirical research in the area.