A Systematic Review and Meta-Analysis of Randomised Controlled Trials

[Posted 24/Oct/2023]

AUDIENCE: Nursing

KEY FINDINGS: Patients with heart failure benefit from home-based cardiac telerehabilitation intervention. With the rapid development of information and communication technology, home-based cardiac telerehabilitation has great potential and may be used as an adjunct or substitute for centre-based cardiac rehabilitation.

BACKGROUND: Purpose of this study is to evaluate the effectiveness of home-based cardiac telerehabilitation in patients with heart failure.

DETAILS: This systematic review and meta-analysis of randomised controlled trials were designed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two researchers independently screened eligible studies. The Cochrane Handbook for Systematic Reviews of Interventions was used to assess the risk of bias within the included studies. A fixed- or random-effects meta-analysis model was used to determine the mean difference, based on the results of the heterogeneity test. A total of 2291 studies were screened. The meta-analysis included data from 16 studies representing 4557 participants. The results indicated that home-based cardiac telerehabilitation could improve heart rate, VO2 peak, 6-minute walk distance, quality of life and reduce readmission rates. No significant differences were observed in the left ventricular ejection fraction percentages between the home-based cardiac telerehabilitation and usual care groups. Compared with centre-based cardiac rehabilitation, home-based cardiac telerehabilitation showed no significant improvement in outcome indicators.

Copyright © John Wiley & Sons Ltd. All rights reserved.

Source: Gao, Y., Wang, N., Zhang, L., et al. (2023). Effectiveness of Home-Based Cardiac Telerehabilitation in Patients With Heart Failure: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. J Clin Nurs. 2023; 32(21-22): 7661-7676. Published: October, 2023. DOI: 10.1111/jocn.16726.

[Posted 23/Oct/2023]

AUDIENCE: Nursing

KEY FINDINGS: Prompt pharmacologic intervention for pain, as well as further coaching and education about pain management should be emphasized for nurses caring for living kidney donors. Further study of how donor’s motivation might mediate their pain experience is needed.

BACKGROUND: This study employed a qualitative descriptive approach to examine living kidney donor’s experience of postoperative pain. Thirteen living kidney donors aged 46.5 (±14.4) years participated in this study.

DETAILS: Semi-structured interviews were conducted and transcribed. Transcripts were inductively coded and reviewed for trends, patterns, and insights into donor’s experience of postoperative pain. Donors experienced postoperative pain from a variety of sources that hindered recovery and created anxiety and fear in some. Donors managed pain with opioid and non-opioid medications, social support, and ambulation. Donor’s past experiences with and expectations about pain, relationships with intended recipients, social support, as well as motivations for and meaning of donation informed their experience of postoperative pain.

Copyright © SAGE Publications. All rights reserved.

Source: Dreesmann, N. J., Jung, W., Shebaili, M., et al. (2023). Kidney Donor Perspectives on Acute Postoperative Pain Management. Clinical Nursing Research. 2023; 32(8): 1124-1133. Published: November, 2023. DOI: 10.1177/105477382311561.

A Systematic Review And Synthesis Guided By The Fundamentals Of Care Framework

[Posted 10/Oct/2023]

AUDIENCE: Nursing

KEY FINDINGS: The strengths of the confidence level in the refined model, and that it is represented from the nurse and patient perspectives in nursing research across countries and cultures, support the recommendation for empirical evaluation.

BACKGROUND: Objective of this study is to test a model for person-centred pain management using qualitative evidence in the literature and refine it based on the results.

DETAILS: A literature search in February 2021 in six scientific databases: CINAHL, PsycInfo, Pubmed, Scopus, Social Science Premium Collection and Web of Science, reported using ENTREQ and PRISMA. Quality assessment was performed for the individual studies. Thematic analysis and the GRADE-CERQual approach were used in the synthesis including the assessment of confidence in the evidence. The model was tested against the evidence in 15 studies appraised with moderate or high quality and found represented in the literature but needed to be expanded. A refined model with a moderate/high confidence level of evidence presents elements to be used in a holistic care process; The nurse is guided to establish a trusting relationship with the patient and enable communication to identify and meet pain management needs using pharmacological and non-pharmacological management. Nurse leaders are guided to support this process by providing the right contextual conditions.

Copyright © John Wiley & Sons Ltd. All rights reserved.

Source: Avallin, T., Muntlin, A., Kitson, A., et al. (2023). Testing A Model for Person-Centred Pain Management: A Systematic Review And Synthesis Guided By The Fundamentals Of Care Framework. 2023; 32(19-20): 6811-6831. Published: September, 2023. DOI: 10.1111/jocn.16770.

A Scoping Review

[Posted 3/Oct/2023]

AUDIENCE: Nursing

KEY FINDINGS: Although the scoping review included different types of chronic diseases, the needs of chronically ill patients concerning their sexual well-being are not very different. Healthcare professionals, especially nurses, who are often the first point of contact for people with chronic illnesses, should take the initiative for open discussions about sexual issues. That requires a new understanding of the role of nurses, training and further education.

BACKGROUND: Objective of this study is to systematically identify and summarize the needs of chronically ill people concerning their sexual well-being in peer-reviewed published literature, to enable healthcare professionals to provide support in self-management satisfying the needs. A scoping review was performed according to the framework of (JBI Manual for Evidence Synthesis. JBI Global Wiki, 2020). Findings are reported in line with the PRISMA extension for scoping reviews. Full research was carried out in 2022 in the search engine BASE and the following databases: Scopus, MEDLINE, Science Citation Index Expanded, Social Sciences Citation Index and CINAHL. Peer-reviewed articles published after 2011 were included.

DETAILS: Fifty articles could be found. Seven categories of needs could be identified. People with chronic diseases want their providers to initiate discussions about sexual concerns and treat them trustfully and respectfully. Most of the patients would like the issue of sexuality to be included in routine care. They perceive their medical specialists and psychologists as preferred providers to talk to about this issue. Nurses are seen as primary contact persons but in a smaller number of studies.

Copyright © John Wiley & Sons Ltd. All rights reserved.

Source: Igerc, I. and Schrems, B. (2023). Sexual Well-Being Needs of Patients With Chronic Illness Expressed in Health Care: A Scoping Review. J Clin Nurs. 2023; 32(19-20): 6832-6848. Published: September, 2023. DOI: 10.1111/jocn.16773.

A Demonstration of the Robson Ten-Group Classification System for Use in Quality Improvement and Benchmarking

[Posted 26/Sep/2023]

AUDIENCE: Nursing, Ob/Gyn

KEY FINDINGS: The TGCS provides a method for between-hospital comparisons, particularly for revealing usage patterns of labor induction, TOLAC, and cesarean birth. Adoption of the TGCS in the United States would provide organizations and quality improvement leaders with an effective benchmarking tool to assist in reducing the use of cesarean birth and increasing the support of TOLAC.

BACKGROUND: The World Health Organization-endorsed Robson Ten-Group Classification System (TGCS) is a standard reporting mechanism for cesarean birth, yet this approach is not widely adopted in the United States. Purpose of this study is to describe the application and utility of the TGCS to compare hospital-level cesarean births rates, for use in quality improvement and benchmarking.

DETAILS: Authors conducted a descriptive, secondary data analysis of the Consortium on Safe Labor dataset using data from 228,438 women's births, from 2002 to 2008, in 12 sites across the United States. Authors stratified births into 10 mutually exclusive groups and calculated within-group proportions of group size and cesarean birth rates for between-hospital comparisons of cesarean birth, trial of labor after cesarean (TOLAC), and labor induction utilization. There is variation in use of cesarean birth, labor induction, and TOLAC across the 12 sites.

Copyright © Wolters Kluwer Health, Inc. and/or its subsidiaries. All rights reserved.

Source: Smith, D. C., Phillippi, J. C., Tilden, E. L., et al. (2023). Comparing Cesarean Birth Utilization Between US Hospitals: A Demonstration of the Robson Ten-Group Classification System for Use in Quality Improvement and Benchmarking. Journal of Perinatal and Neonatal Nursing. 2023; 37(3): 214-222. Published: July/September, 2023. DOI: 6735418.

A Non-A Priori Analysis.

[Posted 19/Sep/2023]

AUDIENCE: Nursing

KEY FINDINGS: Routine diaper changes in preterm infants may increase the risk for acute reductions in RrSO₂ as measured by NIRS; however, the impact on kidney health remains unknown. Larger prospective cohort studies assessing kidney function and outcomes related to this phenomenon are needed.

BACKGROUND: Reduction in oxygen delivery to developing kidneys of premature infants may be an important source for acute kidney injury in premature infants. Objective of this study is to describe changes in continuous kidney oxygenation (RrSO₂) measures before, during, and after routine diaper changes.

DETAILS: Method used: Non–a priori analysis of a prospective cohort that received continuous measurement of RrSO₂ with near-infrared spectroscopy (NIRS) over the first 14 days of life demonstrating acute RrSO₂ drops surrounding diaper changes. In total, 26 of 38 (68%) infants (<=1800 g) from our cohort exhibited acute drops in RrSO₂ that temporally correlated with diaper changes. Mean (SD) RrSO₂ baseline prior to each diaper change event was 71.1 (13.2), dropped to 59.3 (11.6) during diaper change, and recovered to 73.3 (13.2). There was a significant difference between means when comparing baseline to diaper change (P < .001; 95% CI, 9.9 to 13.8) and diaper change to recovery (P < .001; 95% CI, -16.9 to -11.2). The mean decrease in RrSO₂ during diaper change averaged 12 points (17%) below 15-minute RrSO₂ mean prior to diaper change, with quick recovery to prediaper change levels. No decreases in SpO₂, blood pressure, or heart rate were documented during the intermittent kidney hypoxic events.

Copyright © The National Association of Neonatal Nurses. All rights reserved.

Source: Marin, T., Ghosh, S., Cockfield, C., et al. (2023). Routine Diaper Change Alters Kidney Oxygenation in Premature Infants: A Non-A Priori Analysis. Advances in Neonatal Care. 2023; 23(5): 450-456. Published: October, 2023. DOI: 10.1097/ANC.0000000000001082.