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The management of severe traumatic brain injury (sTBI) in the intensive care unit (ICU) is focused on preventing secondary brain insults, by ensuring adequate cerebral perfusion, oxygenation and substrate delivery. Despite optimisation of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) using evidence-based guidelines, brain tissue hypoxia can still occur and is strongly associated with adverse functional outcomes post sTBI.
The Brain Oxygen Neuromonitoring in Australia and New Zealand Assessment – Global Trial (BONANZA-GT) is an international, two-arm, open-label, parallel group, randomised controlled trial comparing sTBI management incorporating early brain tissue oxygen (PbtO2) monitoring and optimisation, with ICP/CPP-based management alone. A total of 860 adults admitted to participating institutions with non-penetrating sTBI and requiring insertion of an ICP monitor (as determined by the treating neurosurgeon) will be enrolled. The primary outcome is the proportion of patients with favourable neurological outcomes, as defined by a Glasgow Outcome Score-Extended (GOS-E) >4, at 6 months following injury. Key secondary outcomes include all-cause mortality at ICU discharge, hospital discharge, adverse events, as well as hospital and ICU length of stay and GOS-E at 12 months. The BONANZA-GT will determine whether a protocolised therapeutic strategy guided by continuous PbtO2 monitoring in addition to ICP/CPP targets results in improved neurological outcomes when compared with standard care using ICP/CPP-guided management alone.
Approval has been obtained from relevant ethics boards in every jurisdiction that is participating in the trial. Inclusion of adults who lack capacity for informed consent will be governed in accordance with the legal requirements of each participating site. Study findings will be presented at scientific meetings and disseminated via peer-review publications.
Australian and New Zealand Clinical Trials Registry (ACTRN 12619001328167).
Evidence-based practice (EBP) should be implemented in clinical settings and practiced by registered nurses as it improves healthcare quality, safety, costs, and patient outcomes. For this to occur, nurses need to be skilled and acculturated. An EBP culture needs to be developed and sustained, both in initial academic programs and in clinical settings. Implementation models already exist and are being used, but outcomes are not consistently measured.
The aim of this scoping review was to gather and map the use of EBP implementation models as well as their implementation strategies and outcomes.
The methodology for the JBI Scoping Reviews was applied. The databases queried were PubMed, CINAHL, EMBASE, EMCARE, AMED, BNI, HMIC, PsycInfo. Inclusion criteria were as follows: Any primary study that describes the implementation of EBP in nursing, clinical, or academic settings. Studies using the following EBP implementation models were included: the ARCC Model, ARCC-E Model, IOWA Model, Stetler Model, Johns Hopkins Nursing EBP Model, ACE Star Model as well as PARIHS and i-PARIHS. They must have used Proctor's taxonomy for implementation outcomes as well as described implementation strategies according to the ERIC classification. Data extraction was performed by four independent reviewers in February 2024. There was no language or date limitation. Three independent reviewers performed an initial selection on titles and abstracts. Reading of the full texts was carried out by two independent reviewers using the JBI SUMARI.
A total of 2244 articles were retrieved. After removing duplicates and applying the inclusion criteria, 26 articles were reviewed, and data extracted. The most used implementation model was the PARiHS or i-PARiHS model followed by the IOWA model, the ARCC model combined with the JHNEBP model and the Stetler model. Nearly all studies used the implementation strategy domain “Use evaluative and iterative strategies” of ERIC classification. Overall, the selected studies used between 1 and 2 outcomes from Proctor's eight available.
The underuse of existing taxonomies (Proctor, ERIC) prevents an exhaustive mapping of the use of implementation models. The vocabulary used is too vague, and the implementation strategies are sometimes poorly described. An effort needs to be made to report on all work done to transfer the results to other settings and thus improve health care practices.
Evidence-based practice (EBP) is an approach that integrates the best evidence from research. It combines four concepts: patient preferences and values, clinical expertise, available resources, and the best evidence. Models exist and allow for its implementation, and the mentor appears as a facilitator.
To explore the mentor's role and its impact on nursing staff.
Inclusion criteria included sources that report clinical setting, EBP context, nurse, mentor, and related terms. We searched for published and unpublished studies and reports without any language and date limit. The search was conducted on January 25, 2024. Databases searched included MEDLINE, CINAHL, COCHRANE Library, Embase, Emcare, Google Scholar, Web of science, JBI EBP Database, and ProQuest Dissertations and Theses. The search strategy identified a total of 3195 studies and reports. The relevant data were extracted by two reviewers as recommended by the JBI Manual for Evidence Synthesis.
Seventy studies and reports were included in this scoping review. The mentors are mostly advanced practice nurses (APNs) who have completed EBP training. Mentorship programs aim to instill a spirit of inquiry and improve EBP skills of future mentors. As interprofessionality appears as a facilitator, a lack of time and resources is the main barrier. Mentors help teams improve their research skills in different ways to develop a research culture in a sustainable way and significantly improve beliefs and implementation.
This study demonstrated the interest of the mentor l working in interprofessionality while establishing a close link between the clinical environment and the university to combine the skills and resources of the two fields. The implementation of a mentoring program appears to be a necessity to train nurses in EBP daily. An investment in mentoring makes it possible to improve the quality of care, but also the quality of the work environment. APNs and managers must take on this leadership role to drive this culture of research and practice improvement. Managers must free up time for mentors in order to be able to support and carry out EBP projects. As mentors, they are expected to communicate about ongoing research projects, whether through conferences, congresses, informal, or formal meetings.
The intent of the PICOT (i.e., Population, Intervention, Comparison, Outcome, Time) method is to formulate focused clinical questions to facilitate the discovery of relevant evidence through systematic searching, with the components of the question serving as the foundation for the search. Doctor of Nursing Practice (DNP) graduates use evidence-based practices to institute changes in their organizations' systems and policies, thereby yielding positive effects on both patient and system outcomes. Given that the clinical question is the foundation of the evidence-based practice process, DNP graduates' competence in the PICOT method needs to be better understood.
This analysis aimed to describe how DNP students used the PICOT method to ask clinical questions in their DNP projects.
Project questions were retrieved from a subset (n = 129, 60.56%) of an existing national random sample of publicly available DNP projects spanning the years 2010 to 2021 from Commission on Collegiate Nursing Education-accredited schools (n = 213). Project questions using the PICOT method were further evaluated with a scoring system of 0 = no and 1 = yes for missing elements, formatting, directional outcome, and project purpose. Possible scores ranged from 0 to 8, with higher scores indicating more errors. Discussion among five researchers, until agreement was achieved, yielded consensus.
Although the PICOT method was project author-identified in 66 (31.0%) projects, only four (6%) followed the PICOT method. All 66 (100%) were intervention questions. There were 2.74 (SD 1.55) mean errors, ranging from 0 to 6. No questions were missing P or O. Specific errors included missing I 3 (4.5%) or missing C 37 (56%), poor formatting 34 (51.5%), directional outcome 44 (66.7%), and project purpose 38 (57.6%). Thirty-three (50%) of the questions were missing T; however, T is not used for searching, so researchers recalculated the mean error without T (M = 2.24, SD = 1.28, range 0–5).
Gaps in the accurate use of the PICOT method to construct clinical questions can lead to biased searches, inaccurate clinical problem identification, and, when used as the project purpose, jumping to non-evidence-based solutions. Academic faculty and clinical educators can mitigate these skewed outcomes and enhance their impact on quality outcomes by helping DNP-prepared nurses shore up this foundational skill.
The purpose of the meta-analysis was to evaluate and compare the prevalence of surgical site infection (SSI) after spine surgery (SS) in nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA). The results of this meta-analysis were analysed, and the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were calculated using dichotomous or contentious random- or fixed-effect models. For the current meta-analysis, 14 examinations spanning from 2014 to 2022 were included, encompassing 18 410 people who were tested for nasal colonization after SS. MRSA-positive had a significantly higher SSI (OR, 3.65; 95% CI, 2.48–5.37, p < 0.001) compared with MRSA-negative in SS subjects. However, no significant difference was found between methicillin-susceptible Staphylococcus aureus and Staphylococcus aureus negative (OR, 0.94; 95% CI, 0.32–2.79, p = 0.91), and Staphylococcus aureus positive and negative (OR, 2.13; 95% CI, 0.26–17.41, p = 0.48) in SS subjects. The examined data revealed that MRSA colonization had a significant effect on SSI; however, methicillin-susceptible Staphylococcus aureus and Staphylococcus aureus had no significant effect on SSI in SS subjects. However, given that some comparisons included a small number of chosen studies, attention should be given to their values.
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