JBI database of systematic reviews and implementation reports
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JBI Database System Rev Implement Rep · Nov 2015
ReviewThe effectiveness of selective thoracic fusion for treating adolescent idiopathic scoliosis: a systematic review protocol.
The objective of this review is to assess the effectiveness of selective thoracic fusion as a form of treatment in adolescent idiopathic scoliosis (AIS). This will be compared with all other forms of operative management for major structural thoracic curves. ⋯ Scoliosis is defined as a lateral curvature of the spine of at least 10 degrees, as measured by the Cobb angle. It can be categorized into three broad categories - neuromuscular, congenital and idiopathic. Of these categories, idiopathic is by far the most common, and is a diagnosis of exclusion. Idiopathic scoliosis can then be further broken down into categories based on age of onset. Of these, AIS (children presenting at 10 years of age or older) accounts for 80-85% of cases.Scoliosis curves have a proven complex deformity, consisting of a three-dimensional deformity involving the coronal, sagittal and rotational planes. Each curve (of which there may be many in one patient) can be described with an apex (the vertebra with the greatest lateral distance from the centre of the spine) and the two vertebrae at the end of the curve (named the end vertebrae). The Cobb angle, measured by the intersection of parallel lines from the endplates of the superior and inferior end vertebrae, is the standard way of quantifying the magnitude of scoliosis curves.Major or primary curves are the largest abnormal curves as classified by the Cobb angle. These curves are almost always structural. In addition, secondary or tertiary curves are described as structural if the Cobb angle cannot be reduced to under 25 degrees, on side bending radiographs. Due to the permanent nature of physiological and morphological change of the vertebral bodies and ligaments, structural curves will usually progress as the patient matures, usually at 1 degree per year after maturity. Non-structural curves usually do not progress as the patient matures; instead they are hypothesized to be a product of the body's instinctive nature to provide truncal balance.For many years spinal surgeons have been debating whether a more rigid and straighter spine or a mobile and less straight spine provides better outcomes. The treatment for AIS can include both an operative and non-operative approach. However when the Cobb angle is above 40, the likelihood of curve progression is high and surgical treatment is warranted.Although technology has advanced, the primary goals for operative management have remained constant. The primary goals of surgical treatment in AIS should be to optimize coronal and sagittal correction and avoid further curve progression. This involves not only correction of the major primary curve but also any minor (secondary) curves, while maintaining adequate thoracic kyphosis and lumbar lordosis. Ideally, a balance should be struck between fusing the lowest number of mobile segments and properly correcting the existing deformity. This is where selective spinal fusion has a role to play.The premise of selective thoracic fusion is that after fixation of the primary thoracic curve, there is spontaneous coronal correction of the unfused lumbar curve. Thus the thoracic curve can be exclusively fused to allow for a more mobile lumbar spine. This has been described in studies since the 1950s. However since then, results have varied greatly in the extent of spontaneous lumbar correction. Studies have shown that the degree of spontaneous correction of the lumbar spine is somewhat close to the correction of the thoracic curve; however the extent of optimal correction that can be achieved is uncertain.The alternative to selective thoracic infusion involves complete fusion of both the primary thoracic and secondary lumbar curve in a consecutive series. This can be done via either an anterior or a posterior approach. Complete fusion gives better correction of both curves. It also diminishes the risk of coronal decompensation, adding on phenomenon, junctional kyphosis and eventual revision surgery. However this needs to be calculated against the risk of sagittal decompensation, increased risk of lumbar degeneration and chronic back pain, all of which seem to be more prevalent in patients with fusion of both curves.Another goal of surgical intervention is the need to avoid complications. Examples of complications of selective spinal fusion include: junctional kyphosis, coronal imbalance, adding-on and revision surgery. Junctional kyphosis is described as kyphosis of over 10 degrees more than pre-operative measurements. This is measured by the angle between the inferior end plate of the highest instrumented vertebrae and the superior end plate of the vertebra two levels higher. Coronal imbalance is when the distance between the C7 plumb line and the central sacral vertical line is greater than 2 centimeters. The adding-on phenomenon is described as progression or extension of the primary curve after fusion.In 2001, Lenke et al reported a classification for AIS that has been able to identify those patients who may benefit from a selective spinal fusion (1C, 2C, 5C). A three-tiered approach is used with the Lenke classification system involving curve type, lumbar modifier and sagittal modifier. Firstly the curves of the spinal column (proximal thoracic, main thoracic and thoracolumbar/lumbar) are classified as structural or non-structural before a lumbar modifier (A, B, C) based on the distance from the central sacral vertical line and the lumbar apical vertebra is applied. Further classification is then undertaken measuring the kyphosis of the thoracic curve T5-T12 (-, N, +).Lenke proposed that a selective thoracic fusion could be undertaken when the primary curve is structural and the compensatory lumbar curve is non-structural and that additionally certain radiological criteria were met such as the Cobb angle magnitude, apical vertebral translation and rotation. These are all objective markers that can be accurately measured on plain radiographs, with good inter-and intra-observer reliability.However all surgeons do not routinely accept these treatment guidelines. It has been reported that only approximately 49-67% of experienced surgeons are performing a selective thoracic fusion in Lenke 1C curves. This may be due to the fear of complications (of which the rates are relatively unknown) and well as misunderstanding of how much correction can be achieved by the un-fused compensatory lumbar curve. A search of PubMed, the Cochrane Library, PROSPERO and the JBI Databases of Systematic Reviews and Implementation Reports found no current systematic review assessing the effectiveness of selective thoracic fusion compared to other approaches. As such, the aim of this review is to evaluate and critically appraise available evidence on selective thoracic fusion in order to provide a suitable estimate of the radiological and functional outcomes of this type of surgical intervention as well as the approximate complication rate in order to give patients correct information prior to their providing their informed consent.
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JBI Database System Rev Implement Rep · Nov 2015
ReviewHealthcare users' experiences of communicating with healthcare professionals about children who have life-limiting conditions: a qualitative systematic review protocol.
The objective of this review is to identify and synthesize the best international qualitative evidence on healthcare users' experiences of communication with healthcare professionals about children who have life-limiting conditions. For the purposes of this review, "healthcare users" will be taken to include children who have life-limiting conditions and their families. The question to be addressed is:What are healthcare users' experiences of communicating with healthcare professionals about children who have life-limiting conditions? ⋯ The prospect of the death of a child from an incurable medical condition is harrowing, yet finding a way to discuss this prospect is crucial to maximize the quality of life for such children and their families. High-quality communication is well recognized as a core skill health care professionals need to maximize the quality of care they provide. This skill is valued by service users, who consistently rate it as one of the highest priorities for the care they receive. Evidence suggests, however, that healthcare professionals can feel ill-equipped or uncomfortable communicating with and about such children. Therefore, it is important to understand what represents high-quality communication and what is involved in accomplishing this within pediatric palliative care.In recent decades there has been an increased focus on providing palliative care for children who have life-limiting conditions. These are conditions for which no cure is available and for which the probable outcome is premature death. Palliative care may also be appropriate for children who have life-threatening conditions; these are conditions where there is not only a high probability of premature death but also a chance of long-term survival into adulthood Although pediatric palliative care is underpinned by the same philosophy as adult palliative care, children who have life-limiting conditions and their families have particular needs that distinguish them from users of adult palliative care. For example, at a physical level children are more likely than adults to have non-malignant conditions that follow trajectories in which children oscillate between feeling relatively well and acutely unwell. The social dynamic of their care is also radically different, particularly given the role of parents or guardians in making surrogate decisions about their child's care. Such factors warrant considering pediatric palliative care as distinct from palliative care more generally.Although the particular circumstances of children who have life-limiting conditions have led to development of pediatric palliative care, the particular provisions of this care differs among countries. One aspect of variation is the age range of patients. Pediatric palliative care is usually provided to neonates, infants, children, adolescents and young adults, but international variations in the definitions of these age ranges, particularly for adolescents and young adults, means pediatric palliative care is provided to different age groups in different countries. This review therefore adopts a pragmatic rather than an age-based definition of a pediatric palliative care, considering all studies relating to service users who are being cared for by pediatric rather than adult healthcare services.In catering for the unique needs of children who have life-limiting conditions and their families, pediatric palliative care aims to achieve pain and symptom management, enhanced dignity and quality of life, and psychosocial and spiritual care. It also seeks to incorporate care for patients' broader families and facilitating access to appropriate services and support. High-quality communication is crucial for achieving these aims. It enables healthcare users and providers to make decisions that underpin the care that is provided and the quality of the life that is possible for patients and their families.Although both users and providers recognize the value of high-quality communication with and about children who have life-limiting conditions, this does not mean that these stakeholders necessarily share the same perspective of what constitutes high-quality communication and the best way of accomplishing this. Focusing on healthcare users' experiences of communication with healthcare professionals about children who have life-limiting conditions, the present review will explore the subjective impact of professionals' communication on the people for whom they provide care.It may be necessary to consider a range of contextual factors to understand healthcare users' experiences of communicating with healthcare professionals about children who have life-limiting conditions. For instance, age, developmental stage, cognitive capacity, emotional and social strengths, and family dynamics can influence a child's level of involvement in discussions about their condition and care. Although there are factors that appear more consistent across the range of pediatric palliative care users, such as parents' preferences for being treated by healthcare professionals as partners in making decisions about the care of their child, there is not always such consistency. Nor is it clear whether such findings can be generalized across different cultural contexts. In appraising existing research, this systematic review will therefore consider the relationship between the context of individual studies and their reported findings.The primary aim of this review is to identify, appraise and synthesize existing qualitative evidence of healthcare users' experiences of communicating with healthcare professionals about children who have life-limiting conditions. The review will consider relevant details of these findings, particularly whether factors like age are relevant for understanding particular experiences of communication. An outcome of this review will be the identification of best available qualitative evidence that can be used to inform professional practice, as well as an identification of priorities for future research in pediatric palliative care.A preliminary search in MEDLINE and CINAHL found primary studies exploring healthcare users' experiences of aspects of communicating with healthcare professionals about children who have life-limiting conditions. A search was also conducted for existing systematic reviews in PubMed, CINAHL, EMBASE, PsycINFO, the Cochrane Database of Systematic Reviews, the JBI Database of Systematic Reviews and Implementation Reports, and PROSPERO. No systematic reviews on this topic were found.
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JBI Database System Rev Implement Rep · Nov 2015
ReviewParenting experiences of living with a child with attention deficit hyperactivity disorder: a systematic review of qualitative evidence.
Attention deficit hyperactivity disorder is the most prevalent mental disorder among children and adolescents worldwide. Parenting a child with attention deficit hyperactivity disorder is challenging and parents find it difficult to raise the child and struggle to get professional support. Research has shown how living with a child with Attention Deficit Hyperactivity Disorder influences the families' daily life. This includes how the parents manage to maintain a bearable family life, supportive or not supportive factors as well as parents' experiences of collaboration with professionals in diverse settings. ⋯ Further research is needed to examine how professionals in health care settings can address the individual needs of the families and how future interventions may support the families and improve competences of health professionals.
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JBI Database System Rev Implement Rep · Nov 2015
Effectiveness of interventions to improve family-staff relationships in the care of people with dementia in residential aged care: a systematic review protocol.
The objective of this review is to identify and appraise existing evidence regarding the effectiveness of interventions designed to enhance staff-family relationships for people with dementia living in residential aged care facilities.More specifically, the objectives are to identify the effectiveness of constructive communication, cooperation programs, and practices or strategies to enhance family-staff relationships. The effectiveness of these interventions will be measured by comparing the intervention to no intervention, comparing one intervention with another, or comparing pre- and post-interventions.Specifically the review question is: What are the most effective interventions for improving communication and cooperation to enhance family-staff relationships in residential aged care facilities? ⋯ In our aging world, dementia is prevalent and is a serious health concern affecting approximately 35.6 million people worldwide. This figure is expected to increase two-fold by 2030 and three-fold by 2050. Although younger-onset dementia is increasingly recognized, dementia is most commonly a disease that affects the elderly. Among those aged 65 to 85, the prevalence of dementia increases exponentially, and doubles with every five-year increase in age.Dementia is defined as a syndrome, commonly chronic or progressive in nature, and caused by a range of brain disorders that affect memory, thinking and the ability to perform activities of daily living. While the rate of progression and manifestation of decline differs, all cases of dementia share a similar trajectory of decline. The progressive decline in cognitive functions and ultimately physical function that these people face affects not only the person with the disease but also their family caregivers and health care staff.The manifestation of dementia presents unique and extreme challenges for the family caregiver. Generally it causes great physical, emotional and social strain because the caregiving process is long in duration, unfamiliar, unpredictable and ambiguous. In the later stages of dementia, many family caregivers relocate their relative to a residential aged care facility, most often when the burden of care outweighs the means of the caregiver. This is especially likely when the person with dementia ages, and has lower cognitive function increased limitations in activities in daily living and poorer self-related health. As a result, approximately 50% of all persons aged 65 years or over admitted into residential aged care facilities have dementia.The relocation of a relative into a residential aged care facility can be complex and distressing for family caregivers. While relocation alleviates many issues for the family caregiver, it does not consequently reduce their stress. The stress experienced by the family caregivers who remain involved post-relocation often continues and may even worsen. This is because family caregivers are uncertain about how to transition from a direct caregiving role to a more indirect, supportive interpersonal role, and may be provided with little support from care staff in this regard. Although family caregivers experience a new form of stress post-relocation, family involvement in residential aged care settings has been shown to be beneficial to residents with dementia, their families and care staff.Family involvement is widely acknowledged to provide the resident physical and emotional healing, optimal well-being, and the sustainment of quality of life. Family caregivers benefit from improved satisfaction with the facility and experiences of care, and greater well-being. Care staff benefit from enhanced job satisfaction and greater motivation to remain in their job. The key to these positive outcomes is effective communication and strong relationships between care staff and family caregivers.Effective communication between care staff and family caregivers is crucial for residents with dementia. This is because residents with cognitive impairment may have difficulties articulating their needs, concerns and preferences effectively. Family caregivers rely on staff for information about their relative's behavior in the residential aged care facility; however they themselves have in-depth information about the resident's physical, psychosocial and emotional histories that are necessary for developing individualized care support plans. Family involvement can support care staff in reducing residents' behavioral symptoms by assisting to identify social and emotional needs, or unmet medical needs. Ineffective communication from family caregivers in conveying information to care staff may be disruptive in the caregiving process, and may lead to disagreement regarding respective roles and approaches to caring for the resident. Consequently, family caregivers may withhold information that may support care staff and improve care. They may also be concerned about negative repercussions for the resident.Care staff and family caregivers generally have differing needs and expectations. Care staff are usually in the position where they have to manage a relationship with the family, which is based on multiple roles. Perceptions of family caregivers by care staff include seeing them as colleagues, subordinates, or people who themselves may be in need of nursing care. These different perceptions lead to role ambiguity and result in separate approaches to the caregiving process.Cohen et al. suggest in their study that family involvement can benefit people with dementia in residential aged care settings, their family carers and staff; however further research is required. The relationship between care staff and family caregivers is often challenging due to problems with communication, role ambiguity of both care staff and family carers, and differing approaches to caring for the resident. These problems highlight the need for interventions to constructively enhance the quality of family-staff relationships. For example, one intervention called Partners and Caregiving has been reported as being designed to increase cooperation and effective communication between staff and family. In this study, staff and family members were randomly subjected to treatment and control conditions. The treatment group received parallel training sessions on communication and conflict resolution techniques, followed by a joint meeting with the facility administrators. The results of the study demonstrated improved outcomes in the form of improved attitudes of staff and family members towards each other, less conflict between family and staff, and fewer intentions of staff to quit. Further research is vital in order to identify effective family-staff intervention studies that can provide directions for implementation in residential aged care facilities. Furthermore, it is equally important to identify interventions that are ineffective, so as to provide insights into potential pitfalls to avoid in order to improve staff and family members' relationships and the provision of care to people living with dementia in the future.Previous systematic reviews have focused on factors associated with constructive family-staff relationships in caring for older adults in the institutional setting and the family's involvement in decision making for people with dementia in residential aged care facilites. This review will however specifically investigate interventions for improving communication and cooperation that promote effective family-staff relationships when caring for people with dementia living in residential aged care facilities.
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JBI Database System Rev Implement Rep · Nov 2015
Preoperative fasting among burns patients in an acute care setting: a best practice implementation project.
Major burn injury patients commonly fast preoperatively before multiple surgical procedures. The Societies of Anesthesiology in Europe and the United States recommend fasting from clear fluids for two hours and solids for six to eight hours preoperatively. However, at the Royal Adelaide Hospital, patients often fast from midnight proceeding the day of surgery. This project aims to promote evidence-based practice to minimize extended preoperative fasting in major burn patients. ⋯ These results demonstrate that education improves compliance with documentation and preoperative fasting that is more reflective of evidence-based practice. Collaboration with key stakeholders and a hospital wide fasting protocol is warranted to sustain change and further advance compliance with evidence-based practice at an organizational level.