International journal of evidence-based healthcare
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Int J Evid Based Healthc · Mar 2021
Nutrition and hydration management among stroke patients in inpatient rehabilitation: a best practice implementation project.
In 2012 in Australia, stroke was the cause of 11 791 deaths and affected the lives of over 420 000 survivors. Survivors experience significant physical and cognitive deficits; and accumulate a 43% risk of subsequent stroke. Effective evidence-based management of stroke is essential. The Stroke Foundation released Clinical Guidelines for Stroke Management in 2017. Within these guidelines, nutrition and hydration are recognized as important aspects of poststroke management. Audit criteria drawn from the guidelines focussed on the role of multidisciplinary screening, assessment, monitoring and treatment of dehydration and malnutrition; as well as provision of nutrition education and counselling relating to secondary prevention of stroke. The implementation team included dietetics, medical and nursing staff. The project was completed in the stroke unit at Hampstead Rehabilitation Centre (Adelaide, South Australia). ⋯ The current project successfully increased knowledge of nutrition and hydration management for stroke survivors and more closely aligned inpatient management with best practice guidelines to improve health outcomes. It highlighted areas of focus moving forward and has prompted ongoing work for sustaining evidence-based practice change.
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Int J Evid Based Healthc · Jul 2020
Nonpharmacological analgesic interventions among newborn infants in the University Hospital of the University of Sao Paulo: a best practice implementation project.
Despite evidence from studies on nonpharmacological pain management among newborns, many health professionals still don't apply evidence from scientific knowledge in their clinical practice. ⋯ The current best practice implementation project contributed to establishing evidence-based practice and enhancing neonatal pain management during skin-breaking painful procedures in the University Hospital. However, to achieve 100% compliance with all the evidence-based audit criteria, we will need to invest in continuing education and extend this implementation project to other related settings of the hospital. Moreover, it is necessary to perform follow-up cyclical audits to assess compliance and address barriers to best practice, enhancing the quality of nursing care, ensuring better results on pain management of the newborn and ongoing sustainability of this project.
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Int J Evid Based Healthc · Jun 2020
A clinical pharmacist-led integrated approach for evaluation of medication errors among medical intensive care unit patients.
Medication errors jeopardize the safety of critically ill patients. Using only one method for the detection of medication errors may not reflect an existing picture of patient safety accurately. Therefore, we designed a clinical pharmacist-led integrated approach to evaluate incidence rate, type, and severity of medication errors and preventable adverse drug events (ADEs) and to assess the impact of the implementation of interventions recommended by the clinical pharmacist. ⋯ The clinical pharmacist-led integrated approach revealed that medication errors commonly occurred among critically ill patients, and the clinical pharmacist's interventions intercepted the majority of these medication errors. The number of preventable ADEs was significantly fewer in a group of patients who received these interventions. However, medication errors formed chains of errors that adversely affected patients' investigated outcomes in the study group with no implementation of the clinical pharmacist interventions.
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Int J Evid Based Healthc · Jun 2020
Interventions to ensure medication safety in acute care: an umbrella review.
Medication errors are one of the leading avoidable sources of harm to hospital patients. In hospitals, a range of interventions have been used to reduce the risk of errors at each of the points they may occur, such as prescription, dispensing and/or administration. Systematic reviews have been conducted on many of these interventions; however, it is difficult to compare the clinical utility of any of the separate interventions without the use of a rigorous umbrella review methodology. ⋯ For some interventions, there are strong indications of effectiveness in reducing medication errors in the inpatient setting. Government initiatives, policy makers and practitioners interested in improving medication safety are encouraged to adopt those interventions.
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Int J Evid Based Healthc · Mar 2020
Are results from randomized trials in anesthesiology robust or fragile? An analysis using the fragility index.
In anesthesiology, the findings from randomized controlled trials often underpin guidelines influencing clinical decision-making and therefore directly affect patient care. The aim of this study is to evaluate the fragility index and fragility quotient of randomized controlled trials published in the eight highest ranked anesthesiology journals. In addition, we assess the extent to which risk of bias scores, loss to follow-up, Web of Science Citation Index, and journal impact factor influence fragility index and fragility quotient. ⋯ In assessing the fragility of randomized controlled trials published in the top eight anesthesiology journals, our study suggests that statistically significant results in these journals are disconcertingly fragile. The median fragility index calculated from our 131 primary studies reveals that only three nonevents must be replaced with events to negate statistical significance. Although a current scale does not exist for fragility index ranges, many trials published by the top journals in anesthesiology are based on concerning methodology and highly fragile outcomes. With small median sample sizes and few patient events characterizing a large number of these trials, many of today's current guidelines and clinical practices may be founded on research containing statistical significance but lacking clinical significance.