International journal of evidence-based healthcare
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Int J Evid Based Healthc · Dec 2007
Advance care planning for residents in aged care facilities: what is best practice and how can evidence-based guidelines be implemented?
Background Advance care planning in a residential care setting aims to assist residents to make decisions about future healthcare and to improve end-of-life care through medical and care staff knowing and respecting the wishes of the resident. The process enables individuals and others who are important to them, to reflect on what is important to the resident including their beliefs/values and preferences about care when they are dying. This paper describes a project conducted as part of the Joanna Briggs Institute Clinical Aged Care Fellowship Program implemented at the Manningham Centre in metropolitan Melbourne in a unit providing services for 46 low and high care residents. ⋯ Conclusion The outcomes of the project were extremely positive and demonstrate a genuine improvement in practice. All audit criteria indicate that the Manningham Centre is now positively working towards improved practice based on the best available evidence. It is hoped that as the expertise developed during this project is shared, other areas of gerontological practice will be similarly improved and more facilities caring for the older person will embrace evidence-based practice.
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Int J Evid Based Healthc · Dec 2007
Reducing and/or minimising physical restraint in a high care, rural aged care facility.
Background This report takes you through a journey of implementing evidence-based best practice guidelines in relation to physical restraint in an aged care facility. It describes the processes involved in making changes to an existing system, introducing evidence-based guidelines and collaboratively achieving compliance with best practice. The project formed part of a combined initiative between the Joanna Briggs Institute and the Commonwealth Department of Health and Ageing, called the Aged Care Clinical Fellowship Program. ⋯ Those criteria with the least compliance in the initial audit showed the most improvement in the re-audit. Conclusion Effective change processes can be achieved when there is an identified reason or need for change, and when staff are aware of that need. With clinical leadership and education attitudes, fears and myths can be dispelled and improved performance will come out.
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Int J Evid Based Healthc · Sep 2007
Nursing administration of medication via enteral tubes in adults: a systematic review.
Background Enteral tubes are frequently inserted as part of medical treatment in a wide range of patient situations. Patients with an enteral tube are cared for by nurses in a variety of settings, including general and specialised acute care areas, aged care facilities and at home. Regardless of the setting, nurses have the primary responsibility for administering medication through enteral tubes. ⋯ Some of the evidence that was identified included that nurses should consider the use of liquid form medications as there may be fewer tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastronomy tubes. Nurses may need to consider the sorbitol content of some liquid medications, for example, elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself. In addition, the use of 30 mL of water for irrigation when administering medications or flushing small-diameter nasoenteral tubes may reduce the number of tube occlusions.
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Background Various solutions have been recommended for cleansing wounds, however, normal saline is favoured as it is an isotonic solution and is less likely to interfere with the normal healing process. Tap water is commonly used in the community for cleansing wounds because it is easily accessible, efficient and cost-effective; however, there is an unresolved debate about its use. Objectives The objective of this review was to assess the effects of water compared with other solutions for wound cleansing. ⋯ The use of isotonic saline, distilled water and boiled water for cleansing open fractures also did not demonstrate a statistically significant difference in the number of fractures that were infected. Conclusions Although the evidence is limited one trial has suggested that the use of tap water to cleanse acute wounds reduces the infection rate and other trials conclude that there is no difference in the infection and healing rates between wounds that were not cleansed and those cleansed with tap water and other solutions. In the absence of drinkable tap water, boiled and cooled water as well as distilled water can be used as cleansing agents.
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Int J Evid Based Healthc · Sep 2007
Meta-analysis comparing clinical effectiveness of drug-eluting stents, bare metal stents and coronary artery bypass surgery.
Objective To compare clinical outcomes among patients receiving drug-eluting stents, bare metal stents, or coronary artery bypass grafting surgery (CABG) to treat coronary artery disease. Data sources Randomised controlled trials were systematically selected from electronic database for head-to-head comparisons. The results from these head-to-head comparisons were used for an adjusted indirect comparison. ⋯ Conclusions Drug-eluting stents and CABG were superior to bare metal stents in terms of target lesion revascularisation (drug-eluting stents only), target vessel revascularisation, restenosis and major adverse cardiac events. There was no difference in clinical outcomes when comparing CABG and drug-eluting stents in patients with single vessel disease, and CABG may be superior to drug-eluting stents for target vessel revascularisation and major adverse cardiac events in patients with multiple vessel disease. However, results may vary between subpopulations with different clinical or socioeconomic differences.