JBI database of systematic reviews and implementation reports
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JBI Database System Rev Implement Rep · Sep 2015
Comparative StudyAccurate falls risk assessment and interventions for preventing falls in patients in the acute care setting within a private hospital in a large capital city: a best practice implementation project.
Patient falls are a leading cause of adverse events in Australian hospitals. Most Australian hospitals have fall prevention policies, procedures and programs for preventing inpatient falls; however despite these resources many preventable falls continue to occur in Australian hospitals.It is imperative that clinicians understand the potential impact of inpatient falls, and what triggers can be identified and managed by a multifactorial team approach. Patients admitted to hospital often experience changes in physical and/or cognitive function which is then exacerbated by an unfamiliar environment and medical interventions. Adverse outcomes post falling can range from minor injuries such as skin tears to significant injuries such as intracranial hemorrhages and fractures which can ultimately result in permanent disability or death.In 2007, Calvary Wakefield Hospital implemented a Falls Minimization Program requiring routine assessment of all patients admitted using an Admission Risk Screening Tool in conjunction with completion of a detailed Falls Risk Assessment Tool when indicated. ⋯ The project used the pre- and post-audit strategy to translate evidence into practice, and not only demonstrated that implementation of evidence-based practice is possible in the acute setting but also showed improvement in the prevention of falls and harm from falls in that setting.
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JBI Database System Rev Implement Rep · Sep 2015
Review Meta Analysis Comparative StudyEffectiveness of ketamine gargle in reducing postoperative sore throat in patients undergoing airway instrumentation: a systematic review.
Postoperative sore throat is a common, minor adverse event, second to postoperative nausea and vomiting, occurring in individuals undergoing general anesthesia. Postoperative sore throat has the potential to not only diminish patient satisfaction, but also increase the need for adjunct pain therapy in the post anesthesia care unit. Many techniques are utilized to reduce postoperative sore throat; however no one intervention has proven to be completely effective. The use of ketamine gargle is a novel intervention but the effectiveness of administering it prior to induction of general anesthesia is still uncertain. Therefore, further evaluation of current evidence is needed to determine the effectiveness of ketamine gargle in reducing the incidence of postoperative sore throat. ⋯ Additional research is needed to determine the systemic effects of ketamine gargle and whether other n-methyl-d-aspartate antagonists are effective in reducing postoperative sore throat. Future research should include previously excluded populations and expanded to include other methods of airway manipulation.
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JBI Database System Rev Implement Rep · Sep 2015
Review Meta Analysis Comparative StudyMorphological, functional and neurological outcomes of craniectomy versus cranial vault remodeling for isolated nonsyndromic synostosis of the sagittal suture: a systematic review.
Craniosynostosis is a condition characterized by the premature closure of one or more of the cranial vault sutures. It can occur alone or in association with other congenital defects and may be part of a syndrome. The sagittal suture is most commonly affected, comprising 40-60% of cases. Premature fusion of the sagittal suture can cause scaphocephaly due to compensatory anterior-posterior growth of the skull. This is morphologically considered as a narrow elongated skull with a decreased cephalic index, and is diagnosed clinically and/or radiologically. Both the indications for surgery and the techniques used have varied with time and location. Surgical techniques have evolved, from limited craniectomy to calvarial remodeling. In recent times a return to craniectomy methods has occurred with the more recent introduction of endoscopic methods. ⋯ Conclusions were drawn from both the meta-analysis and the narrative results.When comparing the mean change in cephalic index one year after surgery, remodeling was shown to be superior to limited craniectomy in patients with isolated synostosis of the sagittal suture. However both procedures were seen to give improvements at short, medium and longer term time points. Improvements in cephalic index may be sustained, deteriorate or improve over time; based on the current data neither procedure offers a clear long-term advantage over the other. Longer follow-up is required to compare outcomes at different time points.Patients who have surgery (any type) for isolated sagittal synostosis may have deficiencies in different subdomains at later school-age testing, whilst maintaining an age-appropriate global intelligence quotient (IQ) and school performance. There is no evidence to suggest that surgery of either type imparts any benefit in terms of functional or neurological outcomes.There is no evidence to suggest that surgery of either type imparts any benefit in terms of functional or neurological outcomes. While school performance and general IQ may be comparable to age-matched controls, patients with sagittal synostosis who have undergone surgical repair of any type may be at risk of deficiencies in sub-areas of testing and be at risk of learning disorders.There is insufficient evidence regarding mortality, infection, postoperative ICP and aesthetic outcome. While transfusion rates were greater in the remodeling group, this may be due to higher rates of elective transfusion.The inconclusive findings indicate an ongoing need for higher quality primary research comparing the morphological and functional outcomes of craniectomy and cranial vault remodeling in primary sagittal synostosis. Outcomes should be measured in both the short and long term.
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JBI Database System Rev Implement Rep · Sep 2015
ReviewThe effectiveness of interventions in managing treatment adherence in adult heart transplant patients: a systematic review.
Over the past 20 years, solid organ transplantation has evolved from experimental treatments to an effective alternative for the treatment of various diseases, including heart failure. Treatment non-adherence is a limiting factor for the success of heart transplants. A systematic review of the evidence is needed to examine the effectiveness of interventions for managing adherence to treatment in heart transplant patients. ⋯ The current best evidence to guide decisions regarding interventions to manage treatment adherence in heart transplant patients is limited. There is weak evidence that psycho-educational interventions (other than the standard care) has a positive impact on adherence and that decreasing the complexity of the treatment regimen by reducing the daily dose of the immunosuppressant drug improves adherence in heart transplant patients.
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JBI Database System Rev Implement Rep · Sep 2015
Face care amongst patients admitted to the Adult Burn Service: a best practice implementation project.
Burn injuries to the face and neck are very common. Once vital structures such as the mouth, ears, nose and eyes are damaged by burn injury, there will be pain, swelling, deformity and the potential for contractures to develop. This can lead to a lifetime of physical and psychological issues. It is very important to deliver evidence-based recommended practice in order to achieve the best outcome as these structures heal. ⋯ The aims of the project were partially achieved. Future plans to undertake another project and look into the compliance rate of face care procedures with the face care protocol across both Adult Burn Service and Intensive Care Units have been discussed with current stakeholders. This will involve auditing a further ten cases of actual face care procedures performed by nursing staff in both settings.