Fall prevention in a pediatric unit: a best practice implementation project

INTRODUCTION

Inpatient falls account for 6% to 24% of pediatric safety incidents and can lead to increased length of hospital stay, increased cost of care, and decreased satisfaction with care. A review of a pediatric hematology, oncology, neurology, and rehabilitation unit in a hospital in the southern United States revealed an average of one to two falls monthly.

OBJECTIVE

This project aimed to promote evidence-based practices (EBPs) regarding fall prevention in the pediatric unit.

METHODS

This project used the JBI Evidence Implementation Framework to promote EBPs regarding pediatric fall prevention. A baseline audit was conducted to identify gaps between evidence and current practice. Barriers to EBPs were identified, strategies were implemented to promote EBPs, and a follow-up audit was conducted to measure the effectiveness of the improvement strategies.

RESULTS

The baseline audit revealed 100% compliance with all criteria except for Criterion 1 (using a validated assessment tool), which scored 0%, and Criterion 5 (communication between nurses at shift handover), which scored 69%. In the follow-up audit, Criterion 1 remained at 0%, but Criterion 5 rose to 82%.

CONCLUSIONS

This project identified areas of non-compliance with best practice recommendations for the prevention and assessment of pediatric fall risk. Interventions were implemented, with positive results. Further investigation is needed to assess the long-term effectiveness of the interventions.

SPANISH ABSTRACT

http://links.lww.com/IJEBH/A196.

Reproductive justice in pediatric health care: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to identify the barriers and facilitators of reproductive justice in pediatric health care.

INTRODUCTION

Reproductive justice is defined as the right to maintain personal bodily autonomy, to have or not have children, and to parent children in safe and sustainable communities. The reproductive justice framework is often applied to adult women in conventional care settings; however, the need for health care guided by the framework should extend to all females of reproductive age in all care settings, including pediatric settings.

INCLUSION CRITERIA

This review will consider studies from 1994 to the present that report on the barriers and facilitators of reproductive justice in pediatric health care. Studies from any setting or geographic location will be included. This scoping review will include pediatric patients up to 21 years of age of any gender identity or sexual orientation who may birth a child, and their health care providers.

METHODS

Database searches will include CINAHL (EBSCOhost), MEDLINE (PubMed), Embase (Elsevier), and Web of Science Core Collection. Sources of unpublished studies and gray literature to be searched include MedNar and ProQuest Dissertation and Theses Science and Engineering Collection (ProQuest). The JBI methodology for scoping reviews will be followed. Data extracted will include details about the title, authors, year of publication, type of evidence, participants, context, and concept. The extracted data will be presented in diagrammatic or tabular format in a manner that aligns with the objective and questions of the scoping review.

REVIEW REGISTRATION

Open Science Framework https://osf.io/d5vf9.

Vaccinations in patients diagnosed with an autoimmune disorder receiving an immunosuppressive agent: a best practice implementation project

INTRODUCTION

Immunosuppressed patients face increased health risks due to infections such as influenza or COVID-19. Scientific evidence supports improved health-related outcomes in this patient population, such as reduced hospitalizations, with up-to-date vaccinations. The project setting, a community-based rheumatology clinic, did not have a vaccination record specific to the needs of immunosuppressed patients, which may lead to a suboptimal immunization status in these patients.

OBJECTIVE

This project aimed to promote evidence-based practices regarding the use of vaccinations in patients diagnosed with autoimmune disorders receiving immunosuppressive agents.

METHODS

This project used the JBI evidence implementation framework to promote best practices regarding vaccination. Two audit criteria were identified using a JBI Evidence Summary. Baseline audits identified gaps between the evidence and current practice. Barriers to best practice were then identified, and strategies implemented. Post-implementation audits measured changes in compliance.

RESULTS

Baseline audits revealed 67% compliance with the two best practices. Barriers included a lack of provider awareness of the current vaccination recommendations for immunosuppressed patients and a lack of customizable vaccine records. Strategies to address these barriers included educating providers about current national vaccination recommendations and implementing a new patient vaccination history intake form. Post-implementation audits revealed 83% compliance, with a 16% increase from baseline.

CONCLUSIONS

This evidence-based implementation project enhanced best practices by educating providers and implementing an updated patient vaccination history form. Recommendations include the improved compliance with the use of the new form and to assess the effectiveness and usability of a customizable electronic form that interfaces with the clinic's electronic medical records.

Effectiveness of implementation strategies to improve nutrition education interventions in adults living in rural and/or low-income communities

OBJECTIVE

The objective of this project was to promote evidence-based practice and identify how to best implement nutrition education interventions for adults living in rural and/or low-income communities.

INTRODUCTION

Adults living in rural and/or low-income communities are at increased risk for poor nutrition and chronic health conditions. Patients are referred to the EversCare Clinic (ECC), an ambulatory clinic at an academic medical center in Mississippi, USA, to receive assistance with social needs. In addition to living in rural and/or low-income communities, over 90% of the patients seen at the ECC are food-insecure, yet nutrition education is inconsistently provided.

METHODS

The JBI Practical Application of Clinical Evidence System (PACES) and the Getting Research into Practice (GRiP) audit and feedback tools were used. The ECC team conducted a baseline audit of 30 patient electronic health records, designed and implemented best-practice nutrition education strategies, and completed a follow-up audit of 30 patient electronic health records. Four evidence-based criteria for nutrition education in adults living in rural and/or low-income communities were audited, and various interventions were used to address multiple levels.

RESULTS

The baseline audit revealed patients were not receiving recommended nutrition education interventions. Following the implementation, there was a 64.2% improvement in compliance with all four best practice criteria. Involving nursing students proved to be an effective method of improving compliance.

CONCLUSION

Adherence to best practices regarding implementing nutrition education interventions was satisfactory, with 80% of patients receiving interventions at individual, interpersonal, community, and societal levels. Future audits are planned to ensure sustainability.

Experiences of parents and prospective parents when receiving a diagnosis of Down syndrome for their child in the perinatal period: a qualitative systematic review protocol

OBJECTIVE

The objective of this review is to synthesize qualitative evidence regarding the experiences of parents and prospective parents when receiving a diagnosis of Down syndrome for their child in the perinatal period.

INTRODUCTION

Increased awareness of parental experiences when receiving a Down syndrome diagnosis for their child may help health care professionals provide the parental support needed to promote the best possible outcomes for these children.

INCLUSION CRITERIA

The participants for this review are the parents and prospective parents of a child with Down syndrome. The phenomenon of interest is parents' and prospective parents' experiences when receiving the diagnosis of Down syndrome for their child in the perinatal period. Experiences of prospective parents, parents whose children are living or deceased, and those who terminated a pregnancy because of the diagnosis will be included.

METHODS

This review will follow JBI methodology for qualitative reviews. The databases to be searched include Academic Search Premier, AccessPediatrics, Health Source: Nursing/Academic Edition, MEDLINE, CINAHL, Scopus, PsycINFO, and Web of Science. Sources of unpublished studies and gray literature will include ProQuest Dissertations and Theses Sciences and Engineering Collection, MedNar, National Association for Down Syndrome, Down Syndrome International, and WorldWideScience. Studies will be critically appraised by 2 independent reviewers. All studies, regardless of methodological quality, will be included. Data will be extracted by 2 independent reviewers. Findings will be pooled using the meta-aggregation approach. Where textual pooling is not possible, the findings will be presented narratively. The final synthesized findings will be graded according to the ConQual approach.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42021250813.

Barriers and facilitators for low-dose computed tomography lung cancer screening in rural populations in the United States: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to identify barriers and facilitators for low-dose computed tomography lung cancer screening uptake and adherence among rural populations in the United States.

INTRODUCTION

Lung cancer is the leading cause of cancer-related death in the United States, and cancer patients from rural areas have poorer outcomes than those from metropolitan areas. Evidence exists that lung cancer screening by low-dose computed tomography significantly increases survival time but is also significantly underutilized.

INCLUSION CRITERIA

Studies completed in the United States with adults who fit United States Preventive Services Task Force guidelines for lung cancer screening and who live in rural areas will be included. Studies published in English since 2013 that report on barriers and facilitators for low-dose computed tomography lung cancer screening uptake and adherence will be included in this review. Quantitative, qualitative, or mixed-methods studies will be included, along with opinion pieces published by government agencies or professional cancer-related organizations.

METHODS

The search strategy will locate published primary studies, reviews, and opinion papers, including those by government and nonprofit agencies focused on cancer. The databases to be searched include MEDLINE, CINAHL Complete, Embase, Web of Science, and Cochrane Library. Gray literature databases and sources of unpublished studies will also be searched. Independent reviewers will be used throughout the search and selection process.

JBI series paper 4: the role of collaborative evidence networks in promoting and supporting evidence-based health care globally: reflections from 25 years across 38 countries

Evidence-based health care (EBHC) is a worldwide movement with hundreds of organizations and thousands of individuals working to ensure that health care practice, policy, and decision-making are informed by rigorous research evidence, to improve health outcomes. The success of this global agenda, however, depends on individuals and organizations working together within a functioning evidence ecosystem. Collaborative evidence networks are a key mechanism to facilitate the synthesis, transfer, and implementation of evidence into health care policy and practice. Using the network functions approach as a framework for review, this paper explores the strategic functions and form of the JBI Collaboration to illustrate the role of a collaborative evidence network in promoting and supporting EBHC globally. It illustrates how the functions of a collaborative evidence network enable the development, exchange, and dissemination of knowledge, the building of social capital, mobilization of resources, and amplification and advocacy of members work and ideas, which increase the capacity and effectiveness of members in achieving their unified purpose. Effective and sustainable collaborative evidence networks have innovative ways of relating and mobilizing energy for action and combine formal and informal structures and relationships to successfully work together to address complex global health issues and drive the EBHC agenda forward.

Barriers and facilitators to cancer clinical trial enrollment and participation among rural populations: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to identify barriers and facilitators related to cancer clinical trial enrollment and participation among rural populations.

INTRODUCTION

Advancing the effectiveness of cancer treatment and increasing early detection of cancer relies on enrollment and participation of individuals in cancer clinical trials. Lack of enrollment and participation in trials is a concern, and there is evidence that individuals living in rural areas are unlikely to participate in such trials. Information on barriers to, and facilitators of, enrollment and participation in cancer clinical trials is needed for the development of evidence-based interventions to increase the enrollment and participation of rural populations.

INCLUSION CRITERIA

The review will consider studies on adults aged 18 years or older living in rural areas. Studies that report on barriers and facilitators to enrollment and participation in cancer clinical trials, including both cancer therapeutic and cancer early detection trials, will be included in the review. The review will consider quantitative, qualitative, and text and opinion papers for inclusion.

METHODS

The search strategy will aim to locate published primary studies, reviews, and opinion papers, the latter including those by professional oncology organizations. The databases to be searched include MEDLINE, CINAHL, Embase, Web of Science, and Cochrane Library. Gray literature databases will also be searched. Two independent reviewers will retrieve full-text studies and extract data. The results will be presented in diagrammatic format with a narrative summary.

Mobile injury prevention programs for children: a scoping review protocol

OBJECTIVE

The objective of this review is to examine mobile injury prevention programs for children and their families.

INTRODUCTION

Unintentional injuries are the leading cause of death worldwide for children aged one to 18years. Providing injury prevention education to children and their families is a necessary and critical element in health promotion.

INCLUSION CRITERIA

This review will consider studies that include children from birth to 18years of age and their parents or guardians. The concept of this review is mobile or traveling injury prevention education programs for the specified population. Studies conducted in any geographic location or setting that report on how these programs are being utilized, who is providing the education, where education is being provided, who is funding the education, and outcome measures reported with mobile injury prevention programs will be included in the review.

METHODS

This review will follow JBI's guidance for scoping reviews. The key databases to be searched include MEDLINE (PubMed), CINAHL (EBSCO), the Cochrane Library (Wiley), ERIC (EBSCO), Web of Science (Clarivate), and Embase (Elsevier). The search for unpublished studies will consist of OpenGrey ( www.opengrey.eu ) and ProQuest Dissertations and Theses Sciences and Engineering Collection (ProQuest). Studies conducted in English, in any year, will be included. Two independent reviewers will perform title and abstract screening, retrieval and review of full-text studies, and data extraction. The results will be presented in diagrammatic or tabular form that aligns with a narrative summary.

COVID-19 challenges and changes for home care agencies and providers: a scoping review protocol

OBJECTIVE

This scoping review will explore the challenges experienced by home care agencies and home care providers during the COVID-19 pandemic and the changes made to overcome these challenges.

INTRODUCTION

The COVID-19 pandemic has presented many challenges to home care agencies and providers worldwide. In response, home care agencies and providers were forced to make changes to the way they operate in order to continue providing quality care to homebound patients.

INCLUSION CRITERIA

This scoping review will consider studies that explore the challenges experienced by home care agencies and providers during the COVID-19 pandemic and the changes implemented, or strategies, used to overcome the identified challenges. All geographic locations will be considered for inclusion.

METHODS

This review will be conducted in accordance with the JBI methodology for scoping reviews. Key information sources will include MEDLINE, CINAHL, Embase, Scopus, and Web of Science. Sources of unpublished studies and gray literature will include ProQuest Dissertations and Theses, OpenGrey, medRxiv, and bioRxiv. The review will be limited to articles published in English, from 2020 until present day. Two independent reviewers will use a data extraction tool to collect data. Along with a narrative summary, the results will be presented in diagrammatic or tabular format in a manner that aligns with the review objective and questions.

Retention strategies and barriers for millennial nurses: a scoping review

OBJECTIVE

The objectives of this scoping review were to explore the existing literature related to millennial nurse-retention strategies and barriers, to examine and conceptually map the evidence, to extract any differences between Generation Y and Generation Z nurses, and to identify any gaps in the literature.

INTRODUCTION

The millennial generation has become the largest group of nurses in the workforce. As nursing leaders grow to understand this generation's tendency to change employers frequently, organizations need to identify and implement strategies and reduce barriers to retain this generation as employees.

INCLUSION CRITERIA

Studies and reports including registered nurses born between 1980 and 2000 with any level of education preparation and in any setting or geographical location were included. Studies and reports that examined nurse-retention barriers and strategies were considered for inclusion. This review considered experimental and quasi-experimental study designs, analytical observational studies, case-control studies, analytical cross-sectional studies, descriptive observational studies, systematic reviews and meta-analyses, qualitative studies, and text and opinion papers.

METHODS

The review was conducted in accordance with the JBI methodology for scoping reviews. Studies and reports written in English after 2010 were included. The databases searched included MEDLINE, CINAHL, Embase, Scopus, Ovid HealthStar, and PsycINFO. The search for unpublished studies and reports included MedNar and ProQuest Dissertations and Theses. Eligible studies and reports underwent data extraction by two independent reviewers using a tool created by the authors. Along with a narrative summary, results are presented in a diagrammatic format that aligns with the review objectives and questions.

RESULTS

Thirty-eight publications were included in the review. Strategies for millennial nurse retention were provided in 21 publications, barriers were provided in two publications, and 15 publications provided both strategies and barriers. No publications provided information on the differences between Generation Y and Generation Z. The findings from this scoping review were grouped into five concepts, with strategies and barriers for millennial retention identified for each of the concepts. Concepts identified included leadership, work environment, professional growth, professional fatigue, and self-actualization.

CONCLUSIONS

The current evidence base shows that barriers to and strategies for millennial nurse retention commonly focus on the work environment and the relationships between nursing leadership and the bedside nurse. A preliminary scan of the evidence indicates that creating a healthy work environment that is collaborative, fair, flexible, challenging, and provides opportunities for growth may keep millennial nurses engaged. Having nursing leadership that models these values and leads by example may help millennial nurses to feel safe and supported; however, due to the methodology employed in this review, further rigorous research is needed to confirm this.

Emotional intelligence in nurse managers as it relates to staff nurse job satisfaction and retention: a scoping review

OBJECTIVE

The objective of this review was to map what is known about nurse manager emotional intelligence in relation to nurse job satisfaction and retention, and the tools used to measure emotional intelligence in this context.

INTRODUCTION

As the health care environment responds to the demands of high-quality and low-cost care, nurse managers must ensure that patient care environments are safe, efficient, and effective. Understanding nurse manager emotional intelligence may help organizations improve nurse satisfaction and retention as a strategy for reducing costs.

INCLUSION CRITERIA

This review considered experimental and quasi-experimental study designs, analytical observational studies, descriptive observational studies, systematic reviews and meta-analyses, qualitative studies, and text and opinion papers. Studies with staff nurses and experiences working with nurse managers were included. Studies that examined emotional intelligence of nurse managers, in any context, related to staff job satisfaction and retention in nursing and/or that discussed tools used to measure nurse managers' emotional intelligence were considered for inclusion.

METHODS

This review followed JBI methodology for scoping reviews. Key information sources searched included CINAHL (EBSCO), Health and Psychosocial Instruments (EBSCO), Scopus (Elsevier), EBSCO Health Source (EBSCO), JBI Database of Systematic Reviews and Implementation Reports (Ovid), ERIC (EBSCO), WorldWideScience (Worldwidescience.com), Wiley Online Library (Onlinelibrary.wiley.com), ProQuest Dissertations and Theses (ProQuest), MedNar (MedNar.com), Google Scholar (GoogleScholar.com), and ScienceDirect (Elsevier). Studies published in English from 1995 to September 2019 were included in the review. Two independent reviewers assessed titles and abstracts against the inclusion criteria. Studies that met the inclusion criteria were retrieved in full and assessed in detail. The data extraction tool was developed by the authors to examine information retrieved.

RESULTS

Eight quantitative studies were included, all from the United States. The studies included 232 nurse manager participants and 3731 staff nurse participants from academic and non-academic hospitals. Seven of the eight studies used the Mayer-Salovey-Caruso Emotional Intelligence Test to measure nurse manager emotional intelligence, and one study used the Emotional Quotient Inventory 2.0. Of the eight included studies, six studies showed no significant relationship between emotional intelligence and nurse job satisfaction and/or retention, one revealed a positive correlation, and one revealed both positive and negative correlations.

CONCLUSIONS

Limited research exists to determine whether nurse manager emotional intelligence plays a role in staff nurse job satisfaction and/or retention. All studies reported a need for further research, as well as the use of differing methodologies and a more diverse nursing population. This review may raise awareness among nurse managers as well as health care organizations about understanding and developing emotional intelligence.

Structural competency curriculum in health sciences education: a scoping review protocol

OBJECTIVE

This scoping review aims to explore existing literature related to structural competency and how this concept is being implemented and evaluated in health sciences programs. Another aim is to examine and summarize any documented outcomes related to structural competency training.

INTRODUCTION

Structural competency is a concept that was introduced in 2014 to train pre-health and health professionals to understand the broader structures that influence health outcomes. Studies have shown structural competency training is beneficial to health science students. To address health outcomes at the population level, students should collaborate with other disciplines to address the larger structures that influence health.

INCLUSION CRITERIA

This scoping review will consider studies that include health science programs that implemented or evaluated structural competency training for undergraduate students, graduate students, and postgraduate trainees.

METHODS

The key databases to be searched include MEDLINE (PubMed), CINAHL (EBSCO), Scopus (Elsevier), Embase (Elsevier), Europe PubMed Central (European Bioinformation Institute), and PsycINFO (EBSCO). The search for unpublished studies will consist of ProQuest Dissertations and Theses (ProQuest), PapersFirst (WorldCat), and OpenGrey (www.opengrey.eu/). Studies conducted in English, in any year, setting, and geographical location will be included. Two independent reviewers will perform retrieval of full-text studies and data extraction. The results will be presented in diagrammatic or tabular format with a narrative summary.

Factors contributing to a positive childbirth experience for women in a hospital setting: an umbrella review protocol

OBJECTIVE

The objective of this umbrella review is to identify and evaluate the factors that contribute to a positive childbirth experience in laboring women in the hospital setting.

INTRODUCTION

Childbirth is a milestone for women. Overall, the experience can positively or negatively affect self-esteem, bonding, future childbirth decisions, and overall health and well-being. Understanding of the mother's perception and expectation of the childbirth event is needed to promote positive experiences and outcomes.

INCLUSION CRITERIA

This review will consider qualitative systematic reviews that include pregnant women, women in active labor, or women who have recently given birth. This review will consider systematic reviews conducted in a hospital setting in any geographical location reporting on women's positive childbirth experiences, and the factors that led to positive experiences.

METHODS

The search strategy will aim to locate qualitative systematic reviews. Databases to be searched include MEDLINE (PubMed), CINAHL (EBSCO), Embase (Elsevier), Scopus (Elsevier), JBI Database of Evidence Based Practice (Ovid), and Cochrane Database of Systematic Reviews (Cochranelibrary.com). Sources of unpublished reviews and gray literature to be searched include ProQuest Dissertations and Theses Sciences and Engineering Collection (ProQuest) and OpenGrey (www.opengrey.eu/). Search limitations include reviews after the year 2001 and in the English language. Data will be extracted from systematic reviews by two independent reviewers and findings from the included reviews, as they relate to the umbrella review question, will be presented in a tabular format with supplemental narrative to ensure interpretability.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO (CRD42021251796).

Association between anti-thyroid antibodies and quality of life in patients with Hashimoto thyroiditis: a systematic review and meta-analysis

OBJECTIVE

The aim of this review was to evaluate the association between anti-thyroid antibodies and quality of life in people with euthyroid Hashimoto thyroiditis.

INTRODUCTION

Patients with Hashimoto thyroiditis report symptom distress more often than those with non-autoimmune thyroid disorders. Therefore, anti-thyroid antibodies may be related to decreased quality of life in persons with Hashimoto thyroiditis. The etiology of lingering symptoms, even in euthyroidism, remains unknown. The relationship between anti-thyroid antibodies and quality of life for people with Hashimoto thyroiditis has not been evaluated in a systematic review.

INCLUSION CRITERIA

The participants were males and females at least 12 years of age, in any country, with Hashimoto thyroiditis. Participants not in a euthyroid state were excluded from this review. In this review, the exposure was the presence of anti-thyroid antibodies and the primary outcome was quality of life as measured by a validated scale.

METHODS

A three-step search strategy was implemented with an initial search of PubMed and CINAHL. A comprehensive database search using all identified keywords and index terms was undertaken in March 2019 for relevant published literature, gray literature, and clinical trial registries. The final updates to the search strategies were conducted in December 2019. The search was limited to studies published in English after 1956. Two independent reviewers completed screening for inclusion and utilized the recommended JBI approach to critical appraisal, study selection, data extraction, and data synthesis. The findings are presented in a meta-analysis and in a narrative synthesis, which includes tables and figures.

RESULTS

All 13 studies had high methodological quality. Four studies found a significant correlation (P < 0.05) between the presence of anti-thyroid antibodies and quality of life. A fifth study found a significant correlation (P < 0.001) between higher antibody levels and quality of life. A meta-analysis was conducted using two cross-sectional studies, which revealed that the summative small effect size was statistically significant and suggested a lower quality of life in antibody-positive patients. Due to the heterogeneity of the studies, a narrative synthesis was conducted for the three secondary outcomes: symptom distress, executive function, and mental health. Three studies found a statistically significant (P < 0.05) correlation between symptom distress and antibodies, two studies found a statistically significant (P < 0.05) association between executive function and antibodies, and all but one study found a statistically significant (P < 0.05) relationship between mental health and antibodies.

CONCLUSIONS

The findings in this review did not reveal a definitive relationship between antibodies and quality of life. However, our meta-analysis suggested a link between anti-thyroid antibodies and decreased quality of life in euthyroid children and adults. Though not conclusive, poor mental health and symptom distress may be associated with anti-thyroid antibodies. Therefore, it may be beneficial to periodically evaluate the quality of life and mental health in euthyroid patients with positive antibodies. It is unlikely that antibodies and executive functions are related. The studies and our review's limitations require replication of findings to confirm a connection between antibodies, quality of life, and the secondary outcomes. Future research should continue to evaluate the relationship between anti-thyroid antibodies and the quality of life in individuals with euthyroid Hashimoto thyroiditis.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42018084663.

Advanced practice nurse professional advancement programs: a scoping review

OBJECTIVE

The objective of this review was to explore existing literature related to advanced practice nurse professional advancement programs, to examine and map the evidence, and to identify any gaps in the literature.

INTRODUCTION

Internationally, there is literature regarding the implementation and benefits of professional advancement programs for staff nurses, but there is scant literature addressing professional advancement programs for advanced practice nurses. Professional advancement programs may enhance workplace engagement and foster retention by empowering employees to grow and excel.

INCLUSION CRITERIA

This scoping review considered studies that included advanced practice nurses in direct patient care roles participating in professional advancement programs. The concept of the review was advanced practice nurse professional advancement programs and related criteria and characteristics (eg, length of service, performance review, educational preparation) and outcomes (eg, improved recruitment, retention, employee satisfaction). Studies conducted in any setting and geographical location where advanced practice nurses were employed were included.

METHODS

Studies published in English from 1965 to search date were included. The databases searched included PubMed, CINAHL, Embase, Scopus, and PsycINFO. The search for unpublished evidence and gray literature included ProQuest Dissertations and Theses, MedNar, and various hospital websites. Retrieval of full-text studies and data extraction was performed independently by two reviewers. The extracted data is presented in diagrammatic or tabular form with an accompanying narrative summary.

RESULTS

Nine descriptive studies were included in this review. All nine studies detailed the names of advancement programs, and provided characteristics and criteria for advancement for those participating in the programs. In addition, six studies described benefits of advancement, two studies described outcomes associated with advancement, and two studies described outcomes and benefits.

CONCLUSION

There are few advanced practice nurse professional advancement programs discussed in the literature. In the included studies detailing these programs, there were wide variations in the names, criteria, and characteristics. There is also limited data available regarding outcomes associated with advanced practice nurse professional advancement programs.

Strategies to improve financial literacy and related outcomes among medical students, residents, and fellows in the United States: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to explore strategies to improve financial literacy and related outcomes among medical students, residents, and fellows in the United States.

INTRODUCTION

Financial wellness and literacy are essential parts of overall wellness for medical students, residents, and fellows. Financial illiteracy and increased financial debt have negative implications for medical professionals and health care. Burnout is common among medical students, residents, and practicing physicians, and financial stress is one of the causes. High medical school debt results in decreased interest in primary care specialties as the payments are lower, resulting in a shortage of primary care providers.

INCLUSION CRITERIA

The review will include studies that identify strategies to improve financial literacy among medical students, residents, and fellows in the United States.

METHODS

The proposed review will be conducted as per JBI methodology for scoping reviews. The search strategy will aim to locate both published and unpublished studies. The key databases to be searched include PubMed, Embase, Cochrane Library, Scopus, and Academic Search Premier. Two independent reviewers will screen titles and abstracts for assessment against the inclusion criteria for the review. The results of the search will be reported and presented in a PRISMA flow diagram. Data will be extracted from papers included in the scoping review using a data extraction tool. The extracted data will be presented in both diagrammatic and narrative forms.

Prevalence and incidence of adverse events with catheter ablation for adults with Wolff-Parkinson-White syndrome: a systematic review protocol

OBJECTIVE

The objective of this review is to synthesize the best available evidence to determine the prevalence and incidence of adverse events in patients with Wolff-Parkinson-White syndrome who have undergone catheter ablation.

INTRODUCTION

Wolff-Parkinson-White syndrome is a rare congenital heart disease affecting the normal cardiac conduction system that predisposes an individual to tachyarrhythmias. Patients with Wolf-Parkinson-White syndrome can experience a wide range of life-threatening symptoms and frequently undergo catheter ablation procedures to treat this disease. These patients are at risk of developing a variety of adverse events, including pericardial effusion, cardiac tamponade, atrial fibrillation, stroke, cerebral hemorrhage, major bleeding or hematoma, deep vein thrombosis, atrioventricular-block, cardiac perforation, coronary artery injury, pulmonary emboli, and death.

INCLUSION CRITERIA

This review will include adults aged 18 or older with a diagnosis of Wolff-Parkinson-White syndrome who have undergone catheter ablation, including radiofrequency ablation and cryoablation.

METHODS

MEDLINE, CINAHL, Scopus, Embase, and Web of Science databases will be searched from 1980 to the present for English-language studies only. Prevalence and incidence data, experimental, quasi-experimental, observational, and descriptive studies will be included and critically appraised by two independent reviewers. Data will be extracted using the standardized data extraction tool for prevalence data. If sufficient data is available, a meta-analysis will be conducted; otherwise, the findings will be presented in narrative form including tables and figures to aid in data presentation where appropriate.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42020180391.

Free clinic oversight and outcomes in the United States: a scoping review protocol

OBJECTIVE

The objective of this review is to explore existing literature related to free clinic oversight, and patient and health outcomes reported with the use of free clinics in the United States, to examine and conceptually map the evidence, and to identify any gaps.

INTRODUCTION

Free clinics serve a unique role in American health care; however, little is known about clinic oversight and the outcomes seen in uninsured and under-insured patients who are treated at free health clinics.

INCLUSION CRITERIA

The review will consider studies that include hospital or privately owned and operated community free clinics, and adults and children who utilize free clinics in the United States. In addition to information about clinic oversight, patient outcomes to be considered include disease course management metrics and patient satisfaction. Health outcomes to be considered include hospitalization rates and emergency room visit rates.

METHODS

This scoping review will consider both experimental and quasi-experimental study designs in addition to analytical observational studies. Qualitative studies, systematic reviews that meet the inclusion criteria, and text and opinion papers will also be included. The search will be limited to those studies published in English since 1967, the year the first free clinic opened in the United States. The proposed review will be conducted in accordance with the JBI methodology for scoping reviews. Data will be extracted from papers by two independent reviewers using an extraction tool developed by the reviewers.

Effectiveness of intrathecal nicardipine on cerebral vasospasm in non-traumatic subarachnoid hemorrhage: a systematic review

OBJECTIVE

The objective of this review was to determine the effectiveness of intrathecal nicardipine compared to usual care on cerebral vasospasm and its impact on the following outcome measures: mean flow velocities, angiographic and/or clinical vasospasm, and infection rates.

INTRODUCTION

The results of non-traumatic (aneurysmal) subarachnoid hemorrhage can have devastating effects on patients in terms of functional outcomes. Although other medications have been and continue to be used, Nimodipine is the only Food and Drug Administration-approved medication for treating and improving outcomes following non-traumatic subarachnoid hemorrhage, which may be caused by aneurysmal rupture or arteriovenous malformation. Cerebral vasospasm after non-traumatic subarachnoid hemorrhage is a major concern; cerebral vasospasm refers to the narrowing of the cerebral vessels, which can lead to stroke. Delayed ischemic neurological deficit, as a result of cerebral vasospasm, is the number one reason for death and disability following subarachnoid hemorrhage. This review will determine the effects that intrathecal nicardipine has on cerebral vasospam following non-traumatic subarachnoid hemorrhage.

INCLUSION CRITERIA

The participants of this review included adult patients (18 years and over) in intensive care units. The patients must have had a subarachnoid hemorrhage without history of trauma as cause of subarachnoid hemorrhage, along with the presence of an external ventricular drain. The intervention was administration of intrathecal nicardipine in patients with cerebral vasospasm as a result of non-traumatic subarachnoid hemorrhage. The comparator was usual care, which does not include use of intrathecal nicardipine as part of the treatment regimen. The current review considered both experimental and quasi-experimental study designs. The primary outcomes measured included presence of cerebral vasospasm (identified by mean flow velocities measured by transcranial Doppler and the presence of angiographic vasospasm identified on angiogram) and clinical/symptomatic vasospasm. Secondarily, infection rates as a result of intrathecal nicardipine administration were evaluated.

METHODS

The search strategy aimed to find both published and unpublished studies. Seven databases were searched with no date limitations due to the limited amount of research on this topic.Two independent reviewers assessed the methodological validity of the papers prior to inclusion in the review using the standardized critical appraisal instruments from Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI).Quantitative data was extracted from included studies using the standardized data extraction tool from JBI SUMARI.Statistical pooling was not possible; therefore findings were presented in a narrative form.

RESULTS

Two studies examined the effect that intrathecal nicardipine has on cerebral vasospasm, clinical/symptomatic vasospasm and safety concerns (i.e. infection). The studies indicate that intrathecal nicardipine has shown potential benefits and safety in the treatment of cerebral vasospasm.

CONCLUSIONS

Although intrathecal nicardipine has shown potential to be effective in treating cerebral vasospasm, variance existed among those who received intrathecal nicardipine. In terms of safety, one study had no occurrences of associated bacterial meningitis and the other study had two reported cases of bacterial meningitis out of 50 among those who received intrathecal nicardipine. Limited studies on the use of intrathecal nicardipine following non-traumatic subarachnoid hemorrhage and lack of pooling of results for this review demonstrate the need for more research in this field.

Glycemic control outcomes of manual and computerized insulin titration protocols: a systematic review protocol

OBJECTIVE

The object of this systematic review is to determine the effectiveness of computerized insulin titration protocols compared to manual insulin titration protocols for glycemic control in hospitalized adult patients.

INTRODUCTION

Hyperglycemia is common during acute illness, and current recommendations for patients with altered glucose metabolism is the use of intravenous insulin therapy. Due to the narrow therapeutic index of insulin, euglycemia is difficult to achieve and requires frequent dose titrations and blood glucose checks. Dose titrations can be accomplished through the use of manual or computerized insulin titration protocols.

INCLUSION CRITERIA

This review will consider studies that compare manual and computerized insulin titration protocols for hospitalized adult patients requiring intravenous insulin therapy for hyperglycemia. Studies must have considered one or more glycemic control outcomes.

METHODS

This systematic review will use the JBI methodology for evidence of effectiveness. The search will be limited to studies published in English from 1984, as this was the approximate year that the first pilot study of a computerized titration protocol was implemented. The databases to be searched include: Cochrane Central Register of Controlled Trials, CINAHL, PubMed, Embase, Health Technology Assessments and Ovid Healthstar. The trial registers to be searched include: US National Library of Medicine (ClinicalTrials.gov). The search for unpublished studies will include ProQuest Dissertations and Theses, and MedNar. Retrieval of full-text studies, assessment of methodological quality and data extraction will be performed independently by two reviewers. Meta-analysis will be performed if possible, and a Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Summary of Findings presented.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42019142776.

Family Experiences with the Diagnosis of Autism Spectrum Disorder: System Barriers and Facilitators of Efficient Diagnosis

This paper examines family experiences with the efficiency of ASD diagnosis. Children were age 8 or younger with ASD (n = 450). Outcomes were delay from first parent concern to diagnosis, shifting diagnoses, and being told child did not have ASD. Predictors were screening, travel distance, and problems finding providers. Logit models were used to examine associations. Screening was associated with reduced delay in diagnosis; problems finding providers were associated with greater delay. Screening, travel distance, and delay in diagnosis were associated with shifting diagnoses and being told child did not have ASD. Physician and parent training in communication and addressing mental health professional shortages and maldistribution may improve the diagnosis experiences of families of children with ASD.

Effectiveness of financial incentives for long-acting injectable antipsychotic adherence in patients with psychotic and bipolar disorders: a systematic review protocol

REVIEW QUESTION

The question of this review is: what is the effectiveness of financial compensation for receiving a dose of long-acting injectable antipsychotic medication on the rate of medication adherence in adult patients with psychotic and bipolar disorders in an outpatient/community setting?

Registered nurse experiences of nursing professional identity: a qualitative systematic review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this review is to identify, appraise and synthesize the best available evidence related to registered nurses' experiences of nursing professional identity in nursing care settings.

The association between anti-thyroid antibodies and quality of life in patients with thyroid disorders: a systematic review protocol

REVIEW QUESTION

The objective of this systematic literature review is to identify the association between anti-thyroid antibodies and quality of life in patients with thyroid disorders.

Effectiveness of prophylactic intravenous immunoglobulins in preventing infection in pediatric oncology patients: a systematic review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this review is to identify the effectiveness of prophylactic intravenous immunoglobulins (IVIGs) for the prevention of infection in pediatric oncology patients, and to identify which types of patients would benefit from the intervention, such as patients with specific diagnoses or those with previous infections. A further objective of this review is to identify the effectiveness of prophylactic IVIGs on the prevention of diffuse interstitial pneumonitis and mortality in pediatric oncology patients.The review questions are.

Adding heat to the live-high train-low altitude model: a practical insight from professional football

Objectives

To examine with a parallel group study design the performance and physiological responses to a 14-day off-season ‘live high-train low in the heat’ training camp in elite football players.

Methods

Seventeen professional Australian Rules Football players participated in outdoor football-specific skills (32±1°C, 11.5 h) and indoor strength (23±1°C, 9.3 h) sessions and slept (12 nights) and cycled indoors (4.3 h) in either normal air (NORM, n=8) or normobaric hypoxia (14±1 h/day, FiO₂ 15.2–14.3%, corresponding to a simulated altitude of 2500–3000 m, hypoxic (HYP), n=9). They completed the Yo-Yo Intermittent Recovery level 2 (Yo-YoIR2) in temperate conditions (23±1°C, normal air) precamp (Pre) and postcamp (Post). Plasma volume (PV) and haemoglobin mass (Hb_mass) were measured at similar times and 4 weeks postcamp (4WPost). Sweat sodium concentration ((Na⁺)_sweat) was measured Pre and Post during a heat-response test (44°C).

Results

Both groups showed very large improvements in Yo-YoIR2 at Post (+44%; 90% CL 38, 50), with no between-group differences in the changes (−1%; −9, 9). Postcamp, large changes in PV (+5.6%; −1.8, 5.6) and (Na⁺)_sweat (−29%; −37, −19) were observed in both groups, while Hb_mass only moderately increased in HYP (+2.6%; 0.5, 4.5). At 4WPost, there was a likely slightly greater increase in Hb_mass (+4.6%; 0.0, 9.3) and PV (+6%; −5, 18, unclear) in HYP than in NORM.

Conclusions

The combination of heat and hypoxic exposure during sleep/training might offer a promising ‘conditioning cocktail’ in team sports.

Effectiveness of Nurse Practitioners in nursing homes: a systematic review

BACKGROUND

There are 1.5 million people living in nursing homes in the United States. The number of people admitted to nursing homes has increased since 1994, and it is expected that the number of people aged 65 and older living in nursing homes will double by the year 2020. Nursing home patients are sicker than they have been in the past 10 years, and the frail, sick patients are more likely to be hospitalized.Unnecessary hospitalization of nursing home patients is a costly and critical problem in our healthcare system. Hospitalization can cause irreversible decline in function for the elderly patient and can "expose residents to iatrogenic disease and delirium".It has been claimed that nurse practitioners (NPs) can play a valuable role in caring for the long term care patient, reducing unnecessary hospital admissions, and supporting the physician's practice. A NP on site in the nursing home can provide quick assessment and treatment when a patient has a change of condition. The NP can intervene and treat the patient as needed, instead of transferring the patient to the hospital for assessment.

OBJECTIVES

The objective of this systematic review was to evaluate the effectiveness of having a NP in the nursing home and whether this lead to a decrease in the rate of patient hospitalizations.

INCLUSION CRITERIA

Types of Participants This systematic review considered studies that include long term care nursing home residents.Types of Interventions The review considered studies that evaluate utilization of a NP (in collaboration with a physician) as a primary care provider for long term care nursing home patients.Types of Outcomes This review considered studies that include the following outcome measures: incidence of hospitalization, types of hospitalization and duration of hospitalization of nursing home patients.Types of Studies Randomized controlled trials (RCTs) were not identified in the search. Therefore, other research designs, such as non-randomized controlled trials and before and after studies, were included.

SEARCH STRATEGY

Major databases were searched for English articles written from 1983 to December 2008.

METHODOLOGICAL QUALITY

Seven papers were selected for retrieval, and were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) ().

DATA COLLECTION/EXTRACTION

Quantitative data was extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI ().

DATA SYNTHESIS

Statistical pooling was not possible and the findings are presented in narrative form.

RESULTS

The review consisted of 12,681 patients in 238 nursing homes. All of the seven included articles found a decrease in hospitalization rates when NPs were utilized as a part of the medical team. Five of the 7 studies found a decrease in ER transfers with the NP group. Garrard, Kane, et al did not measure ER transfers and Kane, Garrard et al found no difference in rate of ER use. Three studies also measured length of hospitalization, and all 3 found that the patients with NPs had shorter lengths of stay.

CONCLUSIONS

This review has demonstrated that nurse practitioners can reduce hospitalization and ER transfers of nursing home patients.

IMPLICATIONS FOR RESEARCH

It is recommended that more studies be initiated using only Master's prepared advanced practice nurses.

IMPLICATIONS FOR PRACTICE

It is recommended that NPs be utilized as primary care providers in nursing homes. Physicians should be encouraged to employ NPs to improve patient outcomes and to assist with patient loads.

Blood Volume Measurement as a Tool in Diagnosing Syncope

BACKGROUND

The cause of syncope remains unknown in 24% to 37% of cases even after standard diagnostic tests. Measuring blood volume may elucidate the mechanisms of syncope in the individual patient and prove helpful in determining optimal therapy. This report includes the largest set of blood volume measurements performed in syncope patients to date.

METHODS

We performed radioisotopic blood volume measurement (Daxor BVA-100) on 539 patients who presented to our center with syncope/presyncope of unclear etiology. There were 202 men and 337 women, ages 16 to 88 years; many were receiving treatment at the time they were referred to our center. We also measured blood pressure, heart rate, and cardiac index before and during tilt, with complete data available for 411 patients.

RESULTS

Blood volume derangements ranged from -32% to +116% deviation from normal. Hematocrit could not be used to predict volume status. Volume depletion was found in 241 (44.7%) patients and volume expansion was found in 63 (11.7%). Blood pressure, heart rate, and cardiac index before and during tilt did not correlate with any component of blood volume and could not be used to predict volume status.

CONCLUSIONS

Syncope patients are heterogeneous with respect to blood volume, and blood volume derangements are common and are not identified through tilt table testing. Empirically prescribed pharmacological treatment for syncope is frequently inappropriate. Blood volume measurement should be included in syncope diagnosis.

Exploring the value of shiatsu in palliative care day services

This qualitative study sought to evaluate the effects of shiatsu therapy on clients attending hospice day services. Eleven clients with advanced progressive disease received five therapy sessions each at weekly intervals. Data about the effects was collected through five unstructured interviews with each client. Four of these were conducted before, during, and shortly after the therapy regime, and the fifth was undertaken four weeks after treatment ended. All the interviews were tape-recorded, transcribed and subject to content analysis. The results of the analysis revealed significant improvements in energy levels, relaxation, confidence, symptom control, clarity of thought and mobility. These benefits were of variable duration - in some instances lasting a few hours but in others extending beyond the 5-week treatment regime. Action to ensure research trustworthiness included keeping research journals to provide an audit trail, conducting member checks and using peer debriefing. The study involved three overlapping cohorts of participants in a data collection period that took approximately 6 months.

Purification and structure elucidation of the N-acetylbacillosamine-containing polysaccharide from Bacillus licheniformis ATCC 9945

The exopolysaccharide of Bacillus licheniformis ATCC 9945 (formerly B. subtilis ATCC 9945) contains among other glycoses 4-acetamido-2-amino-2,4,6-trideoxy-D-glucose, termed N-acetylbacillosamine (Bac2N4NAc). A similar diamino glycose, 2-acetamido-4-amino-2,4,6-trideoxy-D-glucose, was found in a surface layer (S-layer) glycoprotein preparation of Clostridium symbiosum HB25. Electron microscopic studies, however, showed that B. licheniformis ATCC 9945 is not covered with an S-layer lattice, indicating that the N-acetylbacillosamine present in that organism might be a constituent of a cell wall-associated polymer. For elucidation of the structure of the N-acetylbacillosamine-containing polysaccharide, it was purified from a trichloroacetic acid extract of B. licheniformis ATCC 9945 cells. Using different hydrolysis protocols and a hydrolysate of the S-layer glycoprotein preparation from C. symbiosum HB25 as reference, the purified polysaccharide was found to contain 2,4-diamino-2,4,6-trideoxy-glucose, 2-acetamido-2-deoxy-glucose, 2-acetamido-2-deoxy-galactose and galactose in a molar ratio of 1 : 1 : 1 : 2. One- and two-dimensional NMR spectroscopy, including 800 MHz proton magnetic resonance measurements, in combination with chemical modification and degradation experiments, revealed that the polysaccharide consists of identical pyruvylated pentasaccharide repeating units with the structure: [-->3)-[(S)Py-(3,4)-beta-D-Galp-(1-->6)]-alpha-D-GlcpNAc-(1-->3)-beta-D-Bacp2N4NAc-(1-->3)-[(S)Py-(3,4)-beta-D-Galp-(1-->6)]-beta-D-GalpNAc-(1-->](n)

A pyrophosphate bridge links the pyruvate-containing secondary cell wall polymer of Paenibacillus alvei CCM 2051 to muramic acid

The peptidoglycan, the secondary cell wall polymer (SCWP), and the surface layer (S-layer) glycoprotein are the major glycosylated cell wall components of Paenibacillus alvei CCM 2051. In this report, the complete structure of the SCWP, its linkage to the peptidoglycan layer, and its physicochemical properties have been investigated. From the combined evidence of chemical and structural analyses together with one- and two-dimensional nuclear magnetic resonance spectroscopy, the following structure of the SCWP-peptidoglycan complex is proposed: [(Pyr4,6)-beta-D-ManpNAc-(1-->4)-beta-D-GlcpNAc-(1-->3)]n-11-(Pyr4,6)-beta-D-ManpNAc-(1-->4)-alpha-D-GlcpNAc-(1-->O)-PO2-O-PO2-(O-->6)-MurNAc- Each disaccharide unit is substituted by 4,6-linked pyruvic acid residues. Under mild acidic conditions, up to 50% of them are lost, leaving non-substituted ManNAc residues. The anionic glycan chains constituting the SCWP are randomly linked via pyrophosphate groups to C-6 of muramic acid residues of the peptidoglycan layer. 31P NMR reveals two signals that, as a consequence of micelle formation, experience different line broadening. Therefore, their integral ratio deviates significantly from 1:1. By treatment with ethylenediaminetetraacetic acid, sodium dodecyl sulfate, and sonication immediately prior to NMR measurement, this ratio approaches unity. The reversibility of this behavior corroborates the presence of a pyrophosphate linker in this SCWP-peptidoglycan complex. In addition to the determination of the structure and linkage of the SCWP, a possible scenario for its biological function is discussed.