JBI database of systematic reviews and implementation reports
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JBI Database System Rev Implement Rep · Jan 2015
ReviewStudent and educator experiences of maternal-child simulation-based learning: a systematic review of qualitative evidence protocol.
The overall aim of this systematic review is to identify the appropriateness and meaningfulness of maternal-child simulation-based learning for undergraduate or pre-registration nursing students in educational settings to inform curriculum decision-making.1. What are the experiences of nursing or health professional students participating in undergraduate or pre-licensure maternal-child simulation-based learning in educational settings?2. What are the experiences of educators participating in undergraduate or pre-licensure maternal-child simulation-based learning in educational settings?3. What teaching and learning practices in maternal-child simulation-based learning are considered appropriate and meaningful by students and educators? ⋯ For this review we will use the definition of "simulation-based learning experience" adopted by the International Nursing Association for Clinical Simulation and Learning (INACSL):We will include any use of simulation in an educational setting (with pre-registration or pre-licensure or undergraduate nursing or health professional students) with a focus relevant for maternal-child nursing.Maternal-child nursing has been variously defined in literature to include maternity care and pediatric nursing. For the purposes of this review, we will include perinatal, neonatal and pediatric contexts of care that focus on families with children under the age of five. We will exclude studies that focus on school age children, adolescents and/or youth.We have adapted an earlier definition of "appropriateness" as the "best conditions under which simulation can be integrated into undergraduate nursing education". In this review "meaningfulness" refers to the experiences and reflections of undergraduate nursing or health professional students and educators as presented in the studies reviewed.
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JBI Database System Rev Implement Rep · Jan 2015
ReviewEffectiveness of ondansetron as an adjunct to lidocaine intravenous regional anesthesia on tourniquet pain and postoperative pain in patients undergoing elective hand surgery: a systematic review protocol.
The objective of this quantitative systematic review is to determine the effects of ondansetron as an adjunct to lidocaine on the tourniquet pain and postoperative pain of American Society of Anesthesiologists (ASA) class 1 or 2 adult patients undergoing elective hand surgery with intravenous regional anesthesia. ⋯ Both injury and deformity of the upper extremity can result in dysfunction to nerves, tendons and bones which can lead to disability and pain. Hand injuries and deformities encompass an area of upper extremity surgery, wherein isolation and accessibility to peripheral nerves allows for a wide range of anesthesia techniques. Common hand surgeries include carpal tunnel or trigger finger release, Dupuytren's contracture fasciectomy, tendon repair, and ganglion cyst removal. According to the extent of injury or deformity, a general anesthetic, regional anesthetic, monitored anesthetic care (MAC) or local anesthetic may be used for these hand surgeries. Depending on the injury or deformity, local anesthesia may not provide sufficient anesthesia, but a general anesthesia may not be completely warranted either. Typical elective hand surgeries performed under regional anesthesia and MAC may be the ideal anesthetic plan that balances adequate sedation and analgesia. Intravenous regional anesthesia (IVRA), commonly known as a bier block, is a safe and effective anesthetic and is typically utilized in uncomplicated hand or forearm surgeries lasting less than an hour. Intravenous regional anesthesia was first developed by August Bier in 1908 for anesthesia of the hand and forearm. It is a regional anesthetic technique that is easy to perform, with success rates up to 98%. Intravenous regional anesthesia is a simple, reliable and cost-effective anesthesia technique for short ambulatory hand surgery. The IVRA technique is ideal for American Society of Anesthesiologists (ASA) class 1 or 2 patients, which according to ASA classification, are individuals who are healthy with well controlled to no comorbidities.The IVRA technique consists of inserting an intravenous catheter into a peripheral vein of the affected extremity. A double pneumatic tourniquet is applied to the same arm. The extremity is lifted and exsanguinated from distal to proximal with an Esmarch bandage. The proximal cuff of the tourniquet is then inflated to the appropriate pressure; standard 250mmHg for an upper extremity followed by the distal cuff. Insufflation times are limited to a maximum of one and a half to two hours, whereas the total insufflation time should never be less than 20 minutes. The Esmarch bandage is removed, and the local anesthetic is injected via the intravenous catheter to promote anesthesia in the operative area. In addition to the advantages of IVRA, there are disadvantages as well. These disadvantages include, but are not limited to, local anesthetic (LA) toxicity, delayed onset of action, poor muscle relaxation, tourniquet pain, and minimal postoperative analgesia. A method for improving analgesia and IVRA is to add medications to the IVRA solution. The ideal IVRA should include rapid onset of sensory and motor block, reduced LA dose, reduced intraoperative and tourniquet pain, prolonged postoperative analgesia, and minimal side effects.Adjuncts to LA can help offset some of the disadvantages mentioned above. In a systematic review of adjuncts for intravenous regional anesthesia conducted by Choyce and Peng, 29 studies were systematically reviewed to include various adjuncts to LA in IVRA. Adjuncts studied in this review included opioids, tramadol, non-steroidal anti-inflammatory drugs (NSAIDs), clonidine, muscle relaxants, sodium bicarbonate and potassium. The results of this systematic review suggest that NSAIDs have the most potential to offer as adjuncts to IVRA, while opioid adjuncts to IVRA proved to be disappointing as a form of postoperative analgesia. The search for the optimal IVRA adjunct that improves analgesia but has limited side effects is ongoing. More recent studies on adjuncts to IVRA have included medications such as neostigmine, dexmetomidine, nitroglycerin, and ondansetron.Ondansetron is a specific 5-hydroxytryptamine-3 (5-HT3 or serotonin) antagonist, commonly used as an antiemetic drug for prevention or treatment of postoperative nausea and vomiting. Used in the recommended dose range, there are minimal reported side effects, with constipation, dizziness and headache being the most common. 5-HT3 antagonists such as ondansetron possess anti-inflammatory, anesthetic, and analgesic properties which may have a potential role in decreasing pain. 5-HT3 antagonists participate in the pathway of nociception by interfering with peripheral effects of serotonin on nociception. By binding to opioid mu receptors and acting as a potential opioid agonist, the result is a peripheral nociceptive analgesic effect. A study by Deegan shows that there are 5-HT3 receptors on the central spinal terminal, which suggests that ondansetron could have both peripheral and central nociceptive effects. Ambesh et al. found that pain during injection of propofol can be successfully prevented by the administration of 4 mg of ondansetron. In a study performed by Reddy et al., it was shown that 4 mg of ondansetron could significantly reduce pain during the intravenous (IV) injection of rocuronium and propofol.Ondansetron may be useful for its potential anti-in-ammatory effect as an adjunct to medication to reduce acute inflammation. Ondansetron can block sodium channels similar to local anesthetics and produce a local anesthetic effect. It has been shown to be approximately fifteen times more potent than lidocaine. A study by Farouk suggests the addition of ondansetron to lidocaine may improve the quality of IVRA and prolong postoperative analgesia in patients undergoing hand surgery. A study conducted by Honarmand, concluded that the addition of ondansetron to lidocaine for IVRA reduced intraoperative and postoperative analgesic use.Tourniquet pain, which is described as a dull and aching pain sensation, is caused by the nerve compression from the tourniquet. Neuropathic pain produced by nerve compression plays an important role in the etiology of this discomfort. Tourniquet pain is thought to be mediated by impulse propagation via small, unmyelinated, slow-conducting C fibers. The duration of the tourniquet time is directly proportional to the onset of tourniquet pain. In a study by Asik, onset of tourniquet pain ranged from eight to fifteen minutes. Tourniquet pain is a well-known limitation of IVRA and is a factor that can limit the number of times which IVRA can be used for extremity surgery. Lidocaine is one of the most frequently used LAs for IVRA. It has a relatively brief duration of action which may limit the postoperative analgesia. Duration of postoperative analgesia, measured as time to first analgesic requirement ranged from 34 to 45 minutes (median) with LA alone.Outcome measures will include pain assessment for intraoperative tourniquet pain and postoperative pain measured by first analgesic requirement time (the time elapsed after tourniquet release to the first request by the patient for analgesic). Pain will be assessed with a visual analog scale (VAS) (0 = no pain and 10 = worst pain imaginable). A VAS score of more than three would indicate pain threshold has been exceeded.A preliminary search of the Joanna Briggs Database of Systematic Reviews and Implementation Reports, the Cochrane Library, CINAHL, PubMed and PROSPERO has revealed that there are currently no systematic reviews (either published or underway) on the topic of ondansetron as an adjunct to lidocaine intravenous regional anesthesia. Search terms included Zofran, ondansetron, intravenous regional anesthesia, and IVRA. Outcomes of this review will determine if ondansetron, admixed with lidocaine, has an effect on tourniquet pain, and secondly to determine if ondansetron, admixed with lidocaine, has an effect on the duration of postoperative analgesia.
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JBI Database System Rev Implement Rep · Jan 2015
ReviewDiagnostic test accuracy of nutritional tools used to identify undernutrition in patients with colorectal cancer: a systematic review.
Effective nutritional screening, nutritional care planning and nutritional support are essential in all settings, and there is no doubt that a health service seeking to increase safety and clinical effectiveness must take nutritional care seriously. Screening and early detection of malnutrition is crucial in identifying patients at nutritional risk. There is a high prevalence of malnutrition in hospitalized patients undergoing treatment for colorectal cancer. ⋯ This systematic review highlights the need for the following: Further studies needs to investigate the diagnostic accuracy of already existing nutritional screening tools in the context of colorectal cancer patients. If new screenings tools are developed, they should be developed and validated in the specific clinical context within the same patient population (colorectal cancer patients).
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JBI Database System Rev Implement Rep · Jan 2015
ReviewThe effect of weight management interventions that include a diet component on weight-related outcomes in pregnant and postpartum women: a systematic review protocol.
What are the effects of weight management interventions that include a diet component on weight-related outcomes in pregnant and postpartum women?The primary objective of this systematic review is to evaluate the effectiveness of weight management interventions which include a diet component and are aimed at limiting gestational weight gain and postpartum weight retention in women.The second objective of this systematic review is to investigate included intervention components with respect to effect on weight-related outcomes. This may include, but is not limited to: length of intervention, use of face-to-face counselling, group or individual consultations, use of other interventions components including exercise, use of goals and use of support tools like food diaries, coaching, including email or text message support. ⋯ Around half of all women of reproductive age are either overweight or obese, with women aged 25-34 years having a greater risk of substantial weight gain compared with men of all ages. Excessive gestational weight gain (GWG) and postpartum weight retention (PPWR) may play a significant role in long term obesity. Having one child doubles the five- and 10-year obesity incidence for women, with many women who gain excessive weight during pregnancy remaining obese permanently. Excessive GWG and/or PPWR can also significantly contribute to short- and long-term adverse health outcomes for mother, baby and future pregnancies.Maternal obesity increases the risk of pregnancy related complications such as pre-eclampsia, gestational diabetes mellitus, stillbirth and the rate of caesarean section. Childhood obesity is a further long term complication of maternal obesity for offspring, which may persist in to adulthood. Excess GWG is also a risk factor for PPWR both in the short and long-term. Nehring et al. conducted a meta-analysis with over 65,000 women showing that, compared to women who gained weight within recommendations during pregnancy, women with GWG above Institute of Medicine weight gain recommendations, retained an additional 3.1 kg and 4.7kg after three and greater than or equal to 15 years postpartum, respectively. The health risk associated with PPWR is highlighted in a study of 151,025 Swedish women followed between 1992 and 2001.The study identified the risk of adverse pregnancy outcomes for those who gained three or more units of Body Mass Index (kg/m2) between consecutive pregnancies (an average of two years) was much higher compared with women whose BMI changed from -1.0 and 0.9 units. Long-term chronic disease risk may also be affected by PPWR as weight retention at the end of the first year post-partum has been found to be a predictor of maternal overweight 15 years later.With around 14-20% of women retaining 5kg or more 12 months postpartum, the risk of developing conditions like diabetes, metabolic syndrome and cardiovascular disease may be increased. It becomes evident that interventions which aim to support attainment of healthy weight both in the antenatal and postpartum periods are key health priorities for women during this life stage.Lifestyle factors of overweight, having poor diet quality, and not undertaking enough moderate-to-vigorous physical activity are amongst the top five predictors of mortality in women. Additionally it is noted that, for many women, pregnancy and the postpartum period are associated with a reduction in physical activity. It is known that a combination of poor dietary choices, an increase in sedentary time and reduction in physical activity are all contributors to the development of overweight and obesity. With this in mind, current research has focused on lifestyle interventions to limit GWG and PPWR. Thangaratinam et al. reviewed 44 randomized controlled trials (7278 women) where interventions including diet, physical activity or both were evaluated for their influence on maternal weight during pregnancy. Results indicate that all were significantly effective in reducing GWG compared with the control group. More specifically, dietary interventions were the most effective in reducing weight gain, with a mean weight loss of -3.84kg compared with -0.72kg and -1.06kg for physical activity and the mixed (diet plus physical activity) approach, respectively. This finding is supported by Hill and colleagues' recent systematic review of theory based interventions to limit GWG. Included studies in this review reported an underpinning theory base and were classified as adopting a dietary, physical activity or mixed approach. Hill et al. concluded that studies which included a diet intervention were significantly more effective at limiting GWG.In 2011 Tanentsapf et al. reviewed the effect of dietary interventions alone for reducing GWG in normal weight, overweight and obese pregnant women. This review analysed 13 randomized controlled trials and quasi-randomized controlled trials with a dietary intervention to prevent excessive GWG in women. The review concluded that dietary interventions during pregnancy were effective in reducing GWG with an effect of -1.92kg (n=1434) compared with the control group.Tanentsapf et al. identified that trials differed in the conduct of the interventions with various diet and non-diet related components utilised. Dietary approaches were highly variable with some trials focusing only on calorie restriction and others included additional target macronutrient distribution for intake. Some trials further provided feedback based on maternal weight gain guidelines. Interventions also varied in delivery method with a variety of modes used, including face-to-face, individual or group consultations and/or written correspondence. The frequency of communication, despite the type or mix, also changed from trial to trial with additional methods via telephone, posted materials, feedback or food diaries utilised. The inclusion of physical activity in addition to diet intervention was also common. Whilst the recent review by Tanentsapf et al. identified that dietary interventions are effective in reducing GWG, the review did not investigate the impact that different intervention components, delivery methods or dietary counselling approaches had on gestational weight management. It remains unclear as to which intervention components optimize GWG in women.The impact of lifestyle interventions has also been investigated in the postpartum period. The recent systematic review from van der Pligt et al. reported seven of 11 studies reviewed were successful in limiting PPWR. As with studies aimed at limiting GWG, interventions included in van der Pligt et al.'s review differed greatly in their conduct. Six of these seven studies included both dietary and physical activity components for the intervention, with the final successful study including a diet only intervention. Five of the successful studies recruited overweight or obese women only. Intervention time varied considerably in successful studies with some running for as little at ten days, and others up to six months.Bertz et al. demonstrated that their 12-week behavior modification intervention which targeted diet alone or diet and exercise, including two individual sessions with a dietitian and physical therapist, provision of scales for weight self-monitoring and bi-weekly text messages was successful in achieving significant weight loss following the intervention, and sustained at one year. The diet intervention and the diet and exercise intervention yielded significant weight loss compared to the control. Following 12 weeks a reduction of -8.3 +/- 4.2kg for diet intervention and -6.9 +/- 3.0kg for diet and exercise was observed. Additionally after one year, the diet intervention showed -10.2 +/- 5.7kg reduction and -7.3 +/- 6.3kg for the diet and exercise intervention (p<0.001). Colleran et al. also found significant weight change results by implementing a 16-week intervention which consisted of weekly individual sessions with a dietitian regarding calorie restriction, two additional home visits regarding exercise, weekly food diary completion and email support. The intervention group had greater weight loss compared to the control group (-5.8kg +/- 3.5kg vs -1.6kg +/- 5.4kg). It can be seen that various methods have been utilized in investigating the impact of diet and physical activity interventions on PPWR. The review by van der Pligt et al. highlights the impact successful lifestyle interventions can have on postpartum weight change. However, this review did not investigate the different intervention strategies utilized. It remains unclear as to the optimal setting, delivery method, diet strategy, contact frequency or intervention length to limit PPWR.Previous systematic reviews for both GWG and PPWR have focused on the effectiveness of lifestyle interventions as a whole for weight management in pregnant and postpartum women. And despite Tanentsapf et al.'s focus on dietary interventions for GWG, much is still unknown about the effectiveness of differing diet interventions over the antenatal and postpartum period. Specifically, the impact of differing diet intervention strategies on maternal weight gain is not known. Firstly, this systematic review will focus on whether weight management interventions which include a dietary component are effective in pregnant and postpartum women. In addition to this, this review will investigate the different intervention strategies utilized and their effectiveness in maternal weight management. A search of systematic review protocol databases has shown that there is no current review underway for this topic.
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JBI Database System Rev Implement Rep · Jan 2015
ReviewThe effectiveness of prehabilitation or preoperative exercise for surgical patients: a systematic review.
Major surgery can induce functional decline and pain, which can also have negative implications on health care utilization and quality of life. Prehabilitation is the process of optimizing physical functionality preoperatively to enable the individual to maintain a normal level of function during and after surgery. Prehabilitation training can be a combination of aerobic exercises, strength training, and functional task training to suit individual needs. ⋯ Future prehabilitation studies are not recommended in patients with osteoarthritis for whom arthroplasty is planned. However, should prehabilitation be tested in other surgical populations, programs must consider patient suitability, setting, delivery of intervention and clinical effectiveness. It is also recommended that the exercises prescribed should be maintained and adhered to after surgery. Most importantly, prehabilitation studies must have adequately powered sample sizes.