JBI database of systematic reviews and implementation reports最新文献

Objective: This umbrella review aimed to determine the effectiveness of non-pharmacological and non-surgical interventions on the impact of rheumatoid arthritis.

Introduction: Patients with rheumatoid arthritis have identified seven major domains of the impact of disease: pain, functional disability, fatigue, sleep, coping, emotional well-being and physical well-being. This impact persists in many patients even after inflammatory remission is achieved, requiring the need for adjunctive interventions targeting the uncontrolled domains of disease impact. Several systematic reviews have addressed non-pharmacologic interventions, but there is still uncertainty about their effectiveness due to scarce or conflicting results or significant methodological flaws.

Inclusion criteria: This review included studies of adult patients with rheumatoid arthritis in any context. Quantitative systematic reviews, with or without meta-analysis, that examined the effectiveness of non-pharmacological and non-surgical interventions of any form, duration, frequency and intensity, alone or in combination with other interventions designed to reduce the impact of disease, were considered. The outcomes were pain, functional disability, fatigue, emotional well-being, sleep, coping, physical well-being and global impact of disease.

Methods: A comprehensive search strategy for 13 bibliometric databases and gray literature was developed. Critical appraisal of eight systematic reviews was conducted independently by two reviewers, using the Joanna Briggs Institute critical appraisal checklist for systematic reviews and research syntheses. Data extraction was performed independently by two reviewers using a standard Joanna Briggs Institute data extraction tool, and data were summarized using a tabular format with supporting text.

Results: Eight systematic reviews were included in this umbrella review, with a total of 91 randomized controlled trials and nine observational studies (6740 participants). Four systematic reviews examined the effects of multicomponent or single exercise/physical activity interventions, two examined the effects of hydrotherapy/balneotherapy, two examined the effects of psychosocial interventions, and one examined the effects of custom orthoses for the foot and ankle. Multicomponent or single exercise/physical activity interventions, psychosocial interventions and custom orthoses appeared to be effective in improving pain and functional disability. Fatigue also improved with the implementation of multicomponent or single exercise/physical activity interventions and psychosocial interventions. Only exercise/physical activity interventions appeared to be effective in reducing the global impact of disease and quality of life. None of the included systematic reviews reported on emotional well-being, sleep, coping or physical well-being as an outcome m

Objectives: The objective of the review was to synthesize the effectiveness and strategies used in family-based behavioral childhood obesity interventions in improving child weight-related outcomes.

Introduction: Family-based interventions are common practice in the treatment of childhood obesity. Research suggests that direct parental involvement can improve child weight-related outcomes. However, challenges remain in assessing the effects of family-based interventions on child weight and weight-related behavior due to the lack of quality programs and diversity of treatment strategies.

Inclusion criteria: The review included systematic reviews and/or meta-analyses of family-based behavioral interventions in children aged ≤18 who were classified as overweight and/or obese, and which reported child weight related outcomes, such as body mass index (BMI), body fat percentage and waist circumferences.

Methods: Seven databases were searched from 1990 to May 2016 to identify English language publications. Reference lists of included reviews and relevant registers were also searched for additional reviews. All included systematic reviews were critically appraised by two reviewers independently. Data extracted included characteristics of included systematic reviews and weight-related outcomes reported. Data synthesis involved categorizing the interventions into seven categories and presented findings in narrative and tabular format. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Results: The umbrella review included 14 systematic reviews (low to moderate methodological quality), published between 2004 and 2015, including 47 independent trials ranging from one month to seven years follow-up conducted in more than 16 countries. The majority of reviews (93%) reported weight outcomes of children aged six to 13 years. All reviews except one indicated that family-based interventions were successful in improving child weight and/or weight-related behavior. Five reviews highlighted that parent-only interventions had similar (n = 4) or greater (n = 1) effectiveness compared to parent-child interventions. Effective interventions employed parent-targeted strategies, including nutrition and physical activity education sessions, positive parenting skills, role modelling and child behavior management to encourage positive healthy eating/exercise behaviors in children and/or whole family.

Conclusions: Family-based interventions targeting parents, alone or with their child, are effective for child weight management. Due to the lack of high quality evidence, especially in emerging parent-only interventions, further research is warranted. Health practitioners can work with parents as agents of change and focus on fostering positive parenting skills, such as mo

Objective: The objective of this review is to evaluate the measurement properties of multidimensional pain assessment tools for postoperative pain in adults.

Introduction: Effective postoperative pain management increases patient safety and satisfaction, and reduces healthcare costs. The most commonly used postoperative pain assessment tools only evaluate pain intensity, which is only one aspect of the sensory dimension of pain. Pain is a subjective phenomenon, and variability exists among patients. Efforts are underway to incorporate multidimensional assessment tools for postoperative pain assessment in clinical practice.

Inclusion criteria: Eligible studies will include postoperative patients aged 18 years and older from all surgical disciplines. Studies evaluating multidimensional assessment instruments for the measurement of postoperative pain during the first two weeks following surgery will be considered. Studies will include the following measurement properties of assessment tools as outcomes: reliability, validity and generalizability.

Methods: MEDLINE, CINAHL, Embase, PsycINFO and Cochrane Trials (CENTRAL) will be searched, as well as ClinicalTrials.gov and multiple gray literature sources. There will be no limitations on publication date. Titles and abstracts will be screened by independent reviewers for inclusion. The full text of selected papers will be retrieved and assessed against the inclusion criteria. Two independent reviewers will assess papers for methodological quality using the COSMIN checklist, and papers with poor scores on relevant items will be excluded. Data will be extracted by two independent reviewers using a standardized data extraction tool. Statistical pooling will be performed, if possible.

Objective: The objective of this scoping review is to identify and map the evidence on non-pharmacological interventions for acute pain management in patients with opioid tolerance and opioid abuse.

Introduction: The mainstay of pain management for adults experiencing moderate to severe acute pain is opioid therapy. However, in light of the known risks of opioid use and the growing number of patients with opioid tolerance or opioid abuse, non-pharmacological interventions are of increasing interest to healthcare providers. Non-pharmacological techniques have shown potential in reducing postoperative pain, opioid consumption, stress and anxiety.

Inclusion criteria: Eligible studies will include participants in a hospital or healthcare facility who are experiencing acute pain and have a tolerance to or dependence on opioids. Studies that examine non-pharmacological interventions for treating acute pain in these patients will be considered. Non-pharmacological interventions may include, but are not limited to, acupuncture, electroacupuncture, massage, mindfulness, electroanalgesia, laser therapy, low-level light therapy, meditation, biofeedback, hypnosis and relaxation techniques. Only studies published in English will be included, and there will be no limit on dates of publication.

Methods: PubMed, CINAHL, Scopus, Embase, Europe PubMed Central, PsycINFO, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov will be searched, as well as sources of unpublished studies. After screening the titles and abstracts of identified citations, two independent reviewers will retrieve potentially relevant full-text studies, assess methodological quality and extract data. Data will be presented in diagrammatic or tabular form, and a qualitative thematic analysis will be undertaken. A narrative summary will accompany the tabulated results.

Objective: The objective of this scoping review is to identify and characterize interventions, programs or models used to deliver respite care services to children and youth with complex care needs and their families.

Introduction: Many children with complex chronic conditions require multifaceted home management plans to address their medical, social and emotional needs. The provision of this care often falls on the parents or primary guardians. Respite care is one strategy to provide families with a break from the demands of caring for a child with complex care needs; however, families commonly face barriers to obtaining respite care services.

Inclusion criteria: This scoping review will consider papers that include children and youth (0-25 years of age, in any location, with complex care needs, medical complexity or complex chronic conditions) and their families. Any interventions, programs or models aimed at delivering respite care services to this population will be included. Studies focusing on support provided at the end of life will be excluded. Only studies published in English will be included. No date limits will be set.

Methods: A search will be conducted in five databases, as well as multiple sources of unpublished literature. The text words contained in the titles and abstracts of relevant articles and index terms will be used to develop a full search strategy. All potentially relevant papers will be retrieved in full. A pre-defined data extraction tool developed by the reviewers will be used, and extracted data will be presented in tabular form accompanied by a narrative summary.

Objective: The objective of this review was to identify associations between premorbid neuropsychological conditions and pediatric mild traumatic brain injury/concussion recovery time and symptom severity.

Introduction: There is a lack of evidence-based clinical guidelines for the care of children with a premorbid neuropsychological condition who have sustained a mild traumatic brain injury, also known as concussion. This necessitates inquiry for any associations that may exist, which may contribute to an enhanced understanding of injury recovery patterns.

Inclusion criteria: Participants included children ages six through 18 years with any diagnosed or self-reported premorbid neuropsychological condition(s) and mild traumatic brain injury/concussion. Participants with concomitant intracranial or extra-axial head injury found on diagnostic imaging were excluded. Outcomes for this review included recovery time or symptom(s) severity post-concussion. Studies considered for review were analytical observational studies, including retrospective, prospective, cross-sectional or longitudinal cohort studies or case-control studies, as well as descriptive observational study designs, including case series, individual case reports and descriptive cross-sectional studies.

Methods: A comprehensive search was undertaken in January 2018 for both published and unpublished studies utilizing an a priori protocol. Major databases searched included CINAHL, Embase, PubMed, Psychology and Behavioral Sciences Collection and PsycINFO. Other sources searched for unpublished and gray literature included the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Google Scholar, ProQuest Dissertations and Theses Global: Sciences and Engineering Collection and MedNar. Additional searches of government websites and reports targeting healthcare or sports-related concussions included Australian Sports Commission, Canadian Institutes for Health Research, the National Health Service of the United Kingdom, the U.S. Department of Health and Human Services: Agency for Healthcare Research and Quality, and the U.S. Department of Health and Human Services: Centers for Disease Control and Prevention. Critical appraisal and data extraction were completed by two independent reviewers. Validation of methodologic quality was performed utilizing standardized tools from the Joanna Briggs Institute, and any disputes were resolved through discussion. Due to significant heterogeneity among studies, a meta-analysis could not be conducted. Therefore, extracted data are reported in a narrative synthesis.

Results: A total of 12 studies (one analytical cross-sectional, two case-control and nine cohort) with 2,973 participants met inclusion criteria. Results of the findings among premorbid conditions varied. However, statistically significant associations with prolonged recover

Objective: The purpose of this systematic review is to summarize the barriers and facilitators to physical activity among ethnic Chinese children.

Introduction: Several studies have been conducted to determine the barriers and facilitators to physical activity among ethnic Chinese children. However, no qualitative systematic review on this topic has been published in English.

Inclusion criteria: This review will consider studies conducted among ethnic Chinese children (between six and 17 years of age) residing in either Chinese or non-Chinese territories or among people who have responsibility for the children (such as their ethnic Chinese/non-Chinese parents, guardians or teachers). Any study setting will be included, such as home, community and school. Studies that present qualitative data on the views and experiences of the barriers and facilitators to physical activity will be considered.

Methods: MEDLINE, Embase, CINAHL, PsycINFO, British Nursing Index, Allied and Complementary Medicine Database, Web of Science, Scopus, CNKI, Wanfang and VIP will be searched to identify published studies. EThOS, OpenGrey, ProQuest Dissertations and Theses, CNKI and Wanfang will be searched to identify unpublished studies. Databases will be searched from their inception dates, and no language restrictions will be applied. The Joanna Briggs Institute (JBI) systematic review guidelines will be followed to conduct the review. The JBI process of meta-aggregation will be used to identify categories and synthesize findings. The ConQual approach will be used to assess confidence in the findings.

Objective: The objective of this systematic review was to identify, evaluate and synthesize evidence of the effectiveness of vibratory stimulation to reduce needle-related procedural pain in children aged 18 years and younger.

Introduction: Needle-related procedures (NRPs) are common medical procedures associated with pain. Children, in particular, experience unpredictable and severe pain in response to NRPs. The gate control theory is commonly used to countermeasure this pain. Based on this theory, various types of vibratory stimulation have been used to reduce pain in several clinical studies.

Inclusion criteria: Participants were 0- to 18-year-old children who underwent NRPs for any condition. The intervention included any type of vibratory stimulation during the NRPs. The main outcome was pain measured on any pain scale, including both self-rated and observer-rated pain scales. The secondary outcomes were anxiety, the duration of the procedure and the success rate. All studies were randomized controlled trials (RCTs) or quasi-randomized trials published in English.

Methods: The search strategy aimed to identify both published and unpublished studies. A three-step search strategy was utilized in this review. An initial search of MEDLINE and CINAHL was undertaken, followed by a search for unpublished studies. Nine databases were used for the search in October 2017. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments. Any disagreements that arose between the reviewers were resolved through discussion. Quantitative data were extracted from papers included in the review using a standardized data extraction tool. Where possible, quantitative data were pooled in the statistical meta-analysis. All results were subject to double data entry. Effect sizes were expressed as risk ratios (for categorical data) and weighted mean differences (for continuous data), and their 95% confidence intervals were calculated for analysis.

Results: Twenty-one RCTs involving 1727 children were identified. Blinding of the participants and those delivering the treatment was not achieved in all studies, introducing a potential risk of bias. Overall, the vibratory stimulation was significantly effective in reducing NRP pain in children as shown by measurement of self-rated pain outcomes (standardized mean difference [SMD]: -0.55, 95% confidence interval [CI]: -0.92 to -0.18) and observer-rated pain outcomes (SMD: -0.47, 95% CI: -0.76 to -0.18). Among secondary outcomes, the effect on the child's anxiety (SMD: -1.03, 95% CI: -1.85 to -0.20) was significant.

Conclusions: Vibratory stimulation was effective in reducing NRP pain in children; however, blinding was not possible in the trials. Moreover, heterogeneity wa

Introduction: The prevalence of OSA is substantial in North America. Post-operative patients with OSA are at risk for respiratory complications, but about 60% of surgical patients with this condition go undiagnosed. If the presence of sleep apnea is known, non-invasive capnography monitoring can be applied post-operatively to help detect early respiratory compromise during the recovery phase. The STOP-Bang Questionnaire, a validated screening tool to evaluate the risk of OSA, can efficiently be used as part of the pre-surgical evaluation.

Objectives: The aim of this project was to improve safety by averting post-operative respiratory events in patients with obstructive sleep apnea (OSA) through early detection of compromise during recovery from anesthesia. Specific objectives focused on implementing nurse-initiated capnography monitoring of patients with OSA in two post-anesthesia care units and, when indicated, expediently communicating abnormal end-tidal carbon dioxide excursions.

Methods: Strategies and audit data were organized and evaluated using the Joanna Briggs Institute's Getting Research into Practice (GRiP) and Practical Application of Clinical Evidence Systems (PACES) tools. Medical record review was used for the baseline audit and three follow-up compliance audits of evidence-based practice. Multiple teaching methodologies were employed to reach and engage post-anesthesia care unit nurses. Equipment was maintained at the point of care. Nurses' participation in the project was voluntary.

Results: There was nearly full compliance with the new practice of initiating capnography, when indicated. Compliance with escalating abnormal capnography results with associated concerning assessment findings was 100%, but the escalation sample size was only two patients.

Conclusions: Patients with known OSA benefited from non-invasive capnography monitoring during recovery from anesthesia because post-anesthesia care unit nurses were empowered to initiate evidence-based technology. Expedient adoption of the new practice was due to comprehensive nurse education, familiarity with a similar capnography monitoring process and the value nurses placed on capnography as another assessment tool to safeguard patients. A larger sample of patients is needed to evaluate compliance with escalating concerning findings to providers. Sustainability will be impacted if the post-anesthesia care unit's standards of care include capnography for patients with OSA.