International journal of evidence-based healthcare
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Int J Evid Based Healthc · Jun 2008
A systematic review of psychometric evidence and expert opinion regarding the assessment of faecal incontinence in older community-dwelling adults.
Objectives This review had two objectives: (i) to determine what is required in an assessment of faecal incontinence issues for older community-dwelling adults; and (ii) to determine the psychometric tools most effective for assessment of faecal incontinence in older community-dwelling adults. Inclusion criteria For the review of psychometric tools, studies were included if they were concerned with people living in the community, included a significant proportion of the sample aged 65 years or over, and either examined psychometric properties of assessment tools or assessed sensitivity of assessment tools to non-surgical interventions available in the community setting. For the review of expert opinion, the search was limited to expert opinion provided by an expert in faecal incontinence that related to community-based assessment. ⋯ Although studies in the review of psychometric properties suffer from limitations such as inadequate sample sizes, the Vaizey and Wexner scales would appear to be the tools of choice. The FIQLS is clearly the tool of choice at this stage for measuring faecal incontinence quality of life. Further validation of tests used in faecal incontinence assessments is required.
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Int J Evid Based Healthc · Jun 2008
Effectiveness of interventions that assist caregivers to support people with dementia living in the community: a systematic review.
Objectives The objective of this review was to assess the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community. Inclusion criteria Types of participants Adult caregivers who provide support for people with dementia living in the community (non-institutional care). Types of interventions Interventions designed to support caregivers in their role such as skills training, education to assist in caring for a person living with dementia and support groups/programs. ⋯ No meta-analysis was possible for the outcome categories of health, self-efficacy or subjective well-being. Implications for practice From this review there is evidence to support the use of well-designed psycho-educational or multi-component interventions for caregivers of people with dementia who live in the community. Factors that appear to positively contribute to effective interventions are those which: • Provide opportunities within the intervention for the person with dementia as well as the caregiver to be involved • Encourage active participation in educational interventions for caregivers • Offer individualised programs rather than group sessions • Provide information on an ongoing basis, with specific information about services and coaching regarding their new role • Target the care recipient particularly by reduction in behaviours Factors which do not appear to have benefit in interventions are those which: • Simply refer caregivers to support groups • Only provide self help materials • Only offer peer support.
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Int J Evid Based Healthc · Jun 2008
Implementation of best practice in advance care planning in an 'ageing in place' aged care facility.
Background For many older people, a residential aged care facility is home, a place where they should have the choice to die comfortably with a sense of control of care and treatment. An advance care plan describes the process of planning end-of-life care while a person is still able to make decisions with the aim of using this information should a person become unable to communicate their wishes. In the residential aged care setting, an advance care plan should be based on discussions involving the resident, family members and caregivers regarding the beliefs, values and goals of the resident and their family. ⋯ Several improvements were made to the facility's documentation and records keeping processes, including the identification of resident's wishes regarding end-of-life treatment. Residents and their families expressed a high level of satisfaction with these changes. Indeed, an increase in completed advance care plans at the facility had a clear benefit in improving care for residents towards the end of their life.
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Int J Evid Based Healthc · Jun 2008
The role of patient isolation and compliance with isolation practices in the control of nosocomial MRSA in acute care.
Background Nosocomial infection remains the most common complication of hospitalisation. Despite infection control efforts, nosocomial methicillin resistant Staphylococcus aureus (MRSA) transmission continues to rise. Various isolation practices are used to minimise MRSA transmission in acute care. ⋯ Additionally, the role of extraneous factors, such as environmental reservoirs, specific MRSA strains and patient mix, is unclear. None of the included studies measured financial, social or psychological factors associated with isolation practices. There is an urgent need for well-designed research with significant sample sizes to develop an evidence base upon which to underpin future clinical practice.