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To compare differences in recruitment and attrition between placebo control randomised trials of surgery, and trials of the same surgical interventions and conditions that used non-operative (non-placebo) controls.
Meta-epidemiological study.
Randomised controlled trials were identified from an electronic search of MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials from their inception date to 21 November 2018.
Placebo control trials evaluating efficacy of any surgical intervention and non-operative control trials of the same surgical intervention were included in this study. 25 730 records were retrieved from our systemic search, identifying 61 placebo control and 38 non-operative control trials for inclusion in analysis.
Primary outcome measures were recruitment and attrition. These were assessed in terms of recruitment rate (number of participants enrolled, as a proportion of those eligible) and overall attrition rate (composite of dropout, loss to follow-up and cross-overs, expressed as proportion of total sample size). Secondary outcome measures included participant cross-over rate, dropout and loss to follow-up.
Unadjusted pooled recruitment and attrition rates were similar between placebo and non-operative control trials. Study characteristics were not significantly different apart from time to primary timepoint which was shorter in studies with placebo controls (365 vs 274 days, p=0.006). After adjusting for covariates (follow-up duration and number of timepoints), the attrition rate of placebo control trials was almost twice as high compared with non-operative controlled-trials (incident rate ratio (IRR) (95% CI) 1.8 (1.1 to 3.0), p=0.032). The incorporation of one additional follow-up timepoint (regardless of follow-up duration) was associated with reduced attrition in placebo control surgical trials (IRR (95% CI) 0.64 (0.52 to 0.79), p
Placebo control trials of surgery have similar recruitment issues but higher attrition compared with non-operative (non-placebo) control trials. Study design should incorporate strategies such as increased timepoints for given follow-up duration to mitigate losses to follow-up and dropout.
CRD42019117364.
Carpal tunnel syndrome is a common disorder affecting a substantial portion of the general population. Surgical intervention is often deemed necessary, with the median nerve release being one of the most frequent operations. Optimising all the aspects of this procedure can enhance patient satisfaction with the treatment.
We aim to determine the differences in the aesthetic outcome of the scar as well as the pain experienced during the healing process between the use of absorbable and non-absorbable sutures. The primary outcome measure will be the patients’ subjective satisfaction with the aesthetic appearance of the scar 1 year after the operation. Secondary outcomes will include a similar evaluation of the aesthetics performed by a blinded outcome assessor, as well as pain experienced by the patients during the 2 weeks postoperatively. The severity and improvement of the patients’ symptoms will also be measured by a Finnish version of the Boston Carpal Tunnel Questionnaire. Costs will be evaluated for both groups. Safety of the wound closure will be followed and reported.
This protocol was approved by the Research Ethics Committee of the Northern Savo Hospital District (2319/2021). The trial will be conducted in accordance with the principles of Good Clinical Practice and the Declaration of Helsinki. The results will be disseminated through publication in peer-reviewed journals.
No abstract available Evidence-based healthcare (EBHC) enables consistent and effective healthcare that prioritises patient safety. The competencies of advanced practice nurses (APNs) are essential for implementing EBHC because their professional duties include promoting EBHC.
To identify, critically appraise, and synthesise the best available evidence concerning the EBHC competence of APNs and associated factors.
A systematic review.
CINAHL, PubMed, Scopus, Medic, ProQuest, and MedNar.
Databases were searched for studies (until 19 September 2023) that examined the EBHC competence and associated factors of APNs were included. Quantitative studies published in English, Swedish and Finnish were included. We followed the JBI methodology for systematic review and performed a narrative synthesis.
The review included 12 quantitative studies, using 15 different instruments, and involved 3163 participants. The quality of the studies was fair. The APNs' EBHC competence areas were categorised into five segments according to the JBI EBHC model. The strongest areas of competencies were in global health as a goal, transferring and implementing evidence, while the weakest were generating and synthesising evidence. Evidence on factors influencing APNs' EBHC competencies was contradictory, but higher levels of education and the presence of an organisational research council may be positively associated with APNs' EBHC competencies.
The development of EBHC competencies for APNs should prioritise evidence generation and synthesis. Elevating the education level of APNs and establishing a Research Council within the organisation can potentially enhance the EBHC competence of APNs.
We should consider weaknesses in EBHC competence when developing education and practical exercises for APNs. This approach will promote the development of APNs' EBHC competence and EBHC implementation in nursing practice.
The review was registered in PROSPERO (CRD42021226578), and reporting followed the PRISMA checklist.
None.
This study evaluated the effectiveness of a multi-disciplinary diabetic limb salvage programme in improving clinical outcomes and optimising healthcare utilisation in 406 patients aged ≥80 years with diabetic foot ulcers (DFUs), compared to 2392 younger patients enrolled from June 2020 to June 2021 and against 1716 historical controls using one-to-one propensity score matching. Results showed that elderly programme patients had lower odds of amputation-free survival (odds ratio: 0.64, 95% CI: 0.47, 0.88) and shorter cumulative length of stay (LOS) compared to younger programme patients (incidence rate ratio: 0.45, 95% CI: 0.29, 0.69). Compared to the matched controls, participating in the programme was associated with 5% higher probability of minor lower extremity amputation, reduced inpatient admissions and emergency visits, shorter LOS but increased specialist and primary care visits (all p-values <0.05). The findings suggest that the programme yielded favourable impacts on the clinical outcomes of patients aged≥80 years with DFUs. Further research is needed to develop specific interventions tailoring to the needs of the elderly population and to determine their effectiveness on patient outcomes while accounting for potential confounding factors.
by Daiane Rubinato Fernandes, Bruna Nogueira dos Santos, Carolina Scoqui Guimarães, Elaine Barros Ferreira, Amanda Salles Margatho, Paula Elaine Diniz dos Reis, Didier Pittet, Renata Cristina de Campos Pereira Silveira
AimTo gather available scientific evidence on technologies used to teach hand hygiene to professional populations and lays involved in health care in the hospital setting. This systematic review was designed as proposed by Preferred Reporting Items for Systematic Reviews and Meta-Analysis, included studies reporting primary, original, quantitative research findings with no date limit and written in English, Spanish or Portuguese. The search was performed in the following electronic databases: Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, Excerpta Medica dataBASE, Literatura Latino-Americana e do Caribe em Ciências da Saúde, US National Library of Medicine, Scopus, Web of Science, Google Scholar and ProQuest. The eligibility criteria were applied independently by two reviewers to select the studies, first by reading the titles and abstracts on the Rayyan platform and then by full text reading of the eligible studies. After a descriptive analysis, the studies were subjected to critical evaluation of their methodological quality using JBI tools.
ResultsSeven studies were included, addressing various methods for teaching hand hygiene using different technological resources, such as audiovisual electronic devices, videos, virtual reality, and gamification using tablets and smartphones, in different populations.
ConclusionUsing technologies to teach hand hygiene considerably helps patients, visitors, and relatives in learning the procedures and efficiently improves hand hygiene compliance rates among healthcare professionals, creating evidence-based repetitive learning opportunities for patients and caregivers.
Evidence on the effectiveness of prostate cancer screening based on prostate-specific antigen is inconclusive and suggests a questionable balance between benefits and harms due to overdiagnosis, and complications from biopsies and overtreatment. However, diagnostic accuracy studies have shown that detection of clinically insignificant prostate cancer can be reduced by MRI combined with targeted biopsies.
The aim of the paper is to describe the analysis of the ProScreen randomised trial to assess the performance of the novel screening algorithm in terms of the primary outcome, prostate cancer mortality and secondary outcomes as intermediate indicators of screening benefits and harms of screening.
The trial aims to recruit at least 111 000 men to achieve sufficient statistical power for the primary outcome. Men will be allocated in a 1:3 ratio to the screening and control arms. Interim analysis is planned at 10 years of follow-up, and the final analysis at 15 years. Difference between the trial arms in prostate cancer mortality will be assessed by Gray’s test using intention-to-screen analysis of randomised men. Secondary outcomes will be the incidence of prostate cancer by disease aggressiveness, progression to advanced prostate cancer, death due to any cause and cost-effectiveness of screening.
The trial protocol was reviewed by the ethical committee of the Helsinki University Hospital (2910/2017). Results will be disseminated through publications in international peer-reviewed journals and at scientific meetings.
The cumulative stress toll on nurses increased during the COVID-19 pandemic. An evidence-based practice (EBP) project was conducted to understand what is known about the impacts of cumulative stress within nursing and if there are ways to mitigate stress during a nurse's shift.
A project team from three clinical units completed an extensive literature review and identified the need to promote detachment while supporting parasympathetic recovery. Based on this review, leaders from three pediatric clinical units (neonatal intensive care unit, cardiovascular intensive care unit, and acute pulmonary floor) implemented respite rooms.
Follow-up outcomes showed a statistically significant stress reduction. For all shifts combined, the Wilcoxon Signed-Rank Test revealed that perceived stress scores from an 11-point Likert scale (0 = no stress and 10 = maximum perceived stress) were significantly lower in the post-respite room (Md = 3, n = 68) compared to in the pre-respite room (Md = 6, n = 68), Z = −7.059, p < .001, with a large effect size, r = .605. Nurses and other staff frequently utilized respite rooms during shifts.
Clinical inquiry and evidence-based practice processes can mitigate cumulative stress and support staff wellbeing. Respite rooms within the hospital can promote a healthy work environment among nurses and promote a self-care culture change. Evidence-based strategies to mitigate cumulative stress using respite rooms are a best practice to promote nurse wellbeing and mitigate cumulative stress.
by Marcos Antonio Matiucci, Iza Catarini dos Santos, Natallya Marques da Silva, Patricia Daniele Silva dos Santos, Gislaine Gonçalves Oliveira, Stefane Santos Corrêa, Elder dos Santos Araujo, Rafaela Said, Jaqueline Ferreira Silva, Ana Paula Sartório Chambó, Talita Aparecida Ferreira de Campos, Oscar Oliveira Santos, Claudete Regina Alcalde, Maria Luiza Rodrigues de Souza, Andresa Carla Feihrmann
The effect of the use of Nilo tilapia filleting residues in the production of pâtés with the addition of oregano essential oil stored for 90 days at 4 °C was evaluated. For that, 5 treatments were performed as follows: TSA—control treatment; TES with the addition of sodium erythorbate; and formulation TOE1 with 600 ppm oregano essential oil; TOE2 with 1000 ppm essential oil; and TOE3 with 1400 ppm essential oil. The pâtés showed adequate technological and physicochemical characteristics and microbiological counts within the legislation standards. No significant differences were observed in the luminosity of the pâté formulations during storage, and the addition of oil contributed to the increase in a* values and stability of b* values. Regarding the lipid and protein oxidation, TOE3 showed lower values at the end of the shelf-life. The addition of essential oil did not affect the hardness and cohesiveness of the products. The fatty acids in greater amounts in the samples were linoleic, oleic, palmitic, and stearic acids. The analysis of biogenic amines indicated that only the treatments with the highest amounts of sodium erythorbate (TES and TOE1) showed losses of spermidine. It was observed that decreasing the inclusion of sodium erythorbate and increasing the inclusion of oregano essential oil resulted in a drop in cadaverine values. A total of 46 volatile compounds were detected in the samples with the highest amount of free fatty acids and all the formulations were well accepted sensorially.by Elaine Cristina Teixeira, Lucas Freires Abreu, Fernando Antônio de Souza, Walter José Rodrigues Matrangolo, Karina Toledo da Silva, Luciano Soares de Lima, Hemilly Cristina Menezes de Sa, Ângela Maria Quintão Lana
Legumes shrubs such as Cratylia argentea have an ability to thrive in environments with low water availability and poor soil. On the other hand, forage grasses such as Tifton 85 have a greater demand for inputs to be productive. The objective of this study was to evaluate the performance of growing and finishing Lacaune lambs fed Cratylia argentea hay as an alternative to Tifton 85 (Cynodon spp). Twenty-four Lacaune lambs aged between five and six months (average body weight [BW] 21.50 ± 3.38 kg) were arranged in a split-plot randomized block design. The plots consisted of different Cratylia to Tifton 85 hay proportions (0, 20%, 40%, or 100%, dry matter [DM] basis) as a roughage replacement in the total diet. The subplots represented two evaluation times, entitled “initial period” and “final period”, which consisted of the early seven days of total feces and urine collection, and the last seven days of the experiment, respectively. The lambs were blocked by weight with six replicates per treatment. The results show that the level of Tifton 85 replacement for Cratylia hay in the roughage portion of the lamb diet did not influence (P > 0.05) weight gain (WG), dry matter intake or dry matter digestibility; feed conversion, feed efficiency; and the evaluated nitrogen balance variables. The digestibility coefficient of neutral detergent fiber decreased linearly as Tifton 85 replacement for Cratylia level was increased, which probably happened due to the presence of highly lignified material within the Cratylia hay. However, the alternative legume maintained animal performance of Tifton 85. In conclusion, Cratylia hay can be recommended as a potential substitute for Tifton 85 hay, which requires greater inputs for the production. Cratylia may be considered a feeding strategy for livestock production, especially for smallholder livestock systems and regions with unfavorable soil and climate.To identify evidence on frontline nurse leaders' competences in evidence-based healthcare (EBHC) and the instruments measuring these competences.
A scoping review.
The search was conducted in June 2021 and complemented in June 2022. The CINAHL, ProQuest, Medline (Ovid), Scopus, Web of Science databases and MedNar along with the Finnish database Medic were searched.
The scoping review was conducted in accordance with the Joanna Briggs institute methodology for scoping reviews. Titles, abstracts and full-text versions were screened independently by two reviewers according to the inclusion criteria. Deductive-inductive content analysis was used to synthesize data.
A total of 3211 articles published between 1997 and 2022 were screened, which resulted in the inclusion of 16 articles. Although frontline nurse leaders had a positive attitude towards EBHC, they had a lack of implementing EBHC competence into practice. Part of the instruments were used in the studies, and only one focused especially on leaders. None of instruments systematically covered all segments of EBHC.
There is a limited understanding of frontline nurse leaders' competence in EBHC. It is important to understand the importance of EBHC in healthcare and invest in the development of its competence at all levels of leaders. Frontline nurse leaders' support is essential for direct care nurses to use EBHC to ensure the quality of care and benefits to patients. Leaders must enhance their own EBHC competence to become role models for direct care nurses. It is also essential to develop valid and reliable instruments to measure leaders' competence covering all EBHC segments. The results can be utilized in the assessment and development of frontline nurse leaders' EBHC competence by planning and producing education and other competence development methods.
To describe health and social care managers' perceptions of the factors affecting the competence of managers in knowledge management.
A qualitative descriptive study.
A semi-structured interview was conducted with 15 managers from three public health and social care organizations in Finland. Data were collected in the spring of 2022 and analysed using inductive content analysis.
Health and social care managers perceived that the competence of managers working in knowledge management is affected by managers' behavioural and attitudinal characteristics, their interactive network competence in knowledge management, the dimensions of their competence in knowledge management, the knowledge management infrastructure with which they work and the organizational learning culture within which they work.
The competence of health and social managers in knowledge management is influenced by various factors, including their personal characteristics, management competence and the infrastructure and culture of the organization for which they work. However, their competence is constrained by an absence of clear processes, structures and resources in knowledge management as well as a lack of systematic support and training for managers working in knowledge management.
The study provides valuable information for improving the competence of managers working in knowledge management in health and social care organizations. The competence of managers working in knowledge management is instrumental for successful implementation and sustaining of knowledge management practices and thus, such competence has a positive impact on the overall performance of an organization.
Clarifying the roles and responsibilities of health and social care managers, as well as establishing organizational structures, is essential for effective knowledge management in organizations.
Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist has been used in the reporting.
No patient or public contribution.
To understand advanced nurse and midwife practitioners' experience of interprofessional collaboration in implementing evidence-based practice into routine care.
A qualitative interpretative phenomenological analysis.
A purposeful sample of 10 Registered Advanced Nurse and Midwife Practitioners from a range of practice settings in the Republic of Ireland participated in semi-structured interviews over a 10-month timeframe. Interviews were transcribed verbatim and data were analysed using a multi-stage approach in line with guidance for interpretative phenomenological analysis.
Six superordinate themes emerged: Understanding of advanced practice; ‘Treated as an equal and as a “nurse”’; Nursing management support; ‘A voice to implement anything new’; Confidence and Emotional intelligence. These factors impacted interprofessional relationships and the extent to which advanced practitioners could implement evidence-based practice.
There is scope to improve advanced practitioners' ability to collaborate with the interprofessional team in implementing evidence-based practice into routine care.
The study findings demonstrate that enhancing understanding of the advanced practice role; increasing organizational support for advanced practitioners and augmenting specific practitioner skills and attributes will increase their ability to collaborate effectively and implement evidence-based practice. Supporting advanced practitioners in this important aspect of their role will positively influence health outcomes for patients.
As numbers of both nurse and midwife practitioners increase globally, this study provides timely evidence from a range of practice settings to guide the design of education programmes and policies governing advanced practice.
Study recommendations have broad applicability to all healthcare professionals who are engaged in implementing evidence-based practice into routine care.
Consolidated criteria for reporting qualitative research (COREQ).
No patient or public contribution.
To examine (1) the association between healthcare workers' workplace ostracism and job satisfaction, stress and perceived health, and (2) whether this relationship is mediated by loneliness and self-esteem.
A cross-sectional study.
Healthcare (N = 569) managers and employees (nurses, practical nurses, doctors and social workers) in Finland responded to a semi-structured survey in January 2021 and evaluated their experiences of workplace ostracism, job satisfaction, stress, perceived health, loneliness and self-esteem during the last year. To examine the association of these variables, linear regression and mediator model tests were performed.
Workplace ostracism had a clear direct association with job satisfaction, stress and perceived health. Loneliness fully mediated the relationship between workplace ostracism, stress and perceived health, and partly mediated the association between workplace ostracism and job satisfaction. Self-esteem partly mediated the association between workplace ostracism, stress, job satisfaction and perceived health.
The experience of workplace ostracism in organizations is a significant factor in job satisfaction, stress and perceived health. Healthcare organizations could strengthen job satisfaction and increase workers' well-being by strengthening social relationships in the organization and, via that, reducing turnover intention.
This study gives understanding and information to the healthcare profession on how workplace ostracism affects work well-being and workplace relationships. Workplace ostracism decreases interaction, which can also endanger patient care if information is not openly exchanged.
This study indicated that workplace ostracism weakened job satisfaction more than loneliness. More commonality and consideration for others at work are needed because these factors may help increase work well-being and decrease exits from working life. Further research is needed on why workplace ostracism occurs in healthcare workplaces.
STROBE.
No patient or public contribution.
The aim of the study was to identify the nature and extent of scientific research addressing continuing education for advanced practice nurses.
A scoping review.
The Joanna Briggs Institute's methodology for scoping reviews.
Electronic search was conducted on 17 September 2023 via CINAHL, PsycINFO, PubMed, Scopus, Web of Science, Cochrane Library and the Joanna Briggs Institute's Evidence-Based Practice Database for research articles published between 2012 and 2023.
Nineteen papers were included in this review. Scientific research on continuing education for advanced practice nursing roles (i.e. nurse practitioner, clinical nurse specialist) has primarily been conducted in the United States and mostly addresses online-delivered continuing education interventions for clinical care competency. Most of the interventions targeted nurse practitioners.
Continuing education has a pivotal role in supporting advanced practice nursing competency development. In addition to clinical care, future continuing education research should focus on other advanced practice nursing competencies, such as education, leadership, supporting organizational strategies, research and evidence implementation.
Continuing education programmes for advanced practice nurses should be rigorously developed, implemented and evaluated to support the quality and effectiveness of patient care.
Continuing education for advanced practice nursing roles is an understudied phenomenon. This review highlights future research priorities and may inform the development of continuing education programmes.
PRISMA-ScR.
Objetive: analizar las percepciones, motivaciones y dificultades de los técnicos de enfermería titulados en enfermería. Metodología: Me-todología: Se trata de una investigación cualitativa, exploratoria descriptiva, la recolección de datos se realizó en un Hospital Municipal del Noroeste de Paraná, durante el primer semestre de 2020, mediante la aplicación de un guión semiestructurado con preguntas orien-tadoras y un cuestionario sociodemográfico. Resultados: El conocimiento adquirido en la graduación de enfermería fue uno de los facto-res facilitadores que contribuyó a una mejor ejecución de la atención brindada, y la mayor dificultad está relacionada con la aceptación de los colegas y supervisores, en relación a las opiniones y sugerencias sobre los procedimientos u organización de la Servicio. Las razones que llevaron a los técnicos de enfermería a cursar una carrera en el área en la que trabajan se deben a la necesidad de cono-cimientos y la búsqueda de un mejor futuro financiero. Conclusión: cuando el profesional tiene un título, se desarrolla con mayor destreza y eficacia en la asistencia proporcionada.
FreshRSS 