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Reviewers' Conclusions (reviewer + conclusion)
Selected AbstractsEVIDENCE SYNTHESIS: Systematic review of current executive function measures in adults with and without cognitive impairmentsINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 3 2010Sabrina Pickens PhDc MSN ANP-BC GNP-BC Abstract Background, Executive function pertains to higher cognitive processes historically linked to frontal lobes. Several measures are available to screen for executive function; however, no gold standard exists. The difficulty in assessing executive function is the existence of its many subsets. Objectives, To evaluate the psychometric properties of executive function measures and determine the most effective measure(s) through a systematic review of the literature. Search strategy, The search strategy utilised a comprehensive literature review of articles written in the English language published from January 2003 to September 2009. The following electronic databases were searched: SCOPUS, PUBMED, Medline Ovid, PsychArticles and CINAHL Plus. Initial key words used were ,executive function', ,measures', ,reliability' and ,validity' followed by the addition of ,traumatic brain injury'. The initial search elicited 226 articles, of which 28 were retrieved. After further exclusion 19 were included in the review. Results, Eight measures underwent factor analysis and 18 underwent various forms of reliability and/or validity testing. Factor analysis showed different aspects of executive functions. According to preset evaluation criteria, only the Test of Practical Judgment performed all of the recommended reliability and validity testing. Reviewer's conclusion, Of the recently developed measures, several show promise for future use yet further validity and reliability testing is warranted. Future tool development should measure all subsets of executive function rather than only a few and include the recommended components of reliability and validity testing. [source] Minimising undernutrition in the older inpatientINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 2 2007Dawn Vanderkroft BSc internshipNutr&Diet APD Abstract Background, Malnutrition among elderly hospitalised patients is widespread and has been shown to lead to adverse health outcomes. The effectiveness of interventions to minimise undernutrition in elderly inpatients is not well documented. Objectives, To identify the best available practices, in the hospital setting, that minimise undernutrition or the risk of undernutrition, in the acute care patient especially for the older patient. The review will assesses the effectiveness of a range of interventions designed to promote adequate nutritional intake in the acute care setting, with the aim of determining what practices minimise malnutrition in the elderly inpatients. Search strategy, English language articles from 1980 onwards were sought using Medline, Premedline, Cinahl, Austrom-Australasian Medical Index and AustHealth, Embase and Science Citations Index. Selection criteria, For inclusion the study had to include an intervention aiming to minimise undernutrition in hospitalised elderly patients aged 65 years or older. All study designs were included. Data collection and analysis, Two independent reviewers assessed the eligibility of each study for inclusion into the review, critically appraised the study quality and extracted data using standardised tools. For each outcome measure results were tabulated by intervention type and discussed in a narrative summary. Results from randomised controlled trials were pooled in meta-analyses where appropriate. Main results, Twenty-nine studies met the inclusion criteria, with a total of 4021 participants. The focus of 15 interventions was the supplying of oral supplements to the participants, six focused on enteral nutrition therapy, four interventions made changes to the foods provided as part of the hospital diet, one included the services of an additional staff member and three incorporated the implementation of evidence-based guidelines. Ten meta-analyses were conducted from which the main findings were: significant improvements in weight status and arm muscle circumferences with an oral supplement intervention, P < 0.05. Reviewers' conclusions, The findings of the review support the use of oral supplements to minimise undernutrition in elderly inpatients. The results also emphasise the need for more high-quality research using appropriate outcome measures in the area of minimisation of undernutrition, particularly interventions that make alterations to the hospital diet and address support for feeding patients at the ward level. [source] Systematic review of interventions in the management of overweight and obese children which include a dietary componentINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 1 2007Clare E Collins PhD BSc Dip Nutr Diet Dip Clin Epi APD Background, The prevalence of overweight and obesity in children and adolescents is increasing at an alarming rate around the world and prevention has become a key public health objective. Treatment and management of those already overweight and obese must be aligned with the best available evidence on effectiveness, if the risk of obesity-related morbidity and mortality is yet be reduced. Diet plays a pivotal role in successful treatment of obesity but to date, there is limited evidence on which to base practice. Objectives, To identify and present the best available evidence on the optimal dietetic treatment and management of children and adolescent who are overweight or obese. Search strategy, Published English language literature was searched using the electronic databases CINAHL, MEDLINE, PRE-MEDLINE, DARE, COCHRANE, EMBASE, AUSTROM, Current Concepts and Dissertation Abstracts. The databases were limited to English Language from 1975 until 2003. Government reports from the UK, USA and Australian were also searched and a hand search performed for the Journal of the Dietitians Association of Australia, International Journal of Obesity and the Journal of Human Nutrition and Dietetics and the bibliographies of retrieved articles. Selection criteria, (i) Interventions that evaluated the effectiveness of nutrition or dietary interventions to treat or manage overweight and obesity; (ii) Children aged less than 18 years; and (iii) Participants were defined as overweight or obese by relative weight or a measure of body weight status, studies that reported body weight per se were excluded. Data collection and analysis, An experienced professional librarian searched the databases, and two trained research assistants independently identified studies for retrieval and assessed each article for inclusion. The included studies were critically appraised for methodological quality by two people independently. Data were extracted from the appropriate articles and when a discrepancy arose, a third party would arbitrate. Main results, There were 116 articles that met the inclusion criteria. While 49 articles described randomised controlled trials, they arose from 37 separate studies. There were 67 non-randomised trials. Meta-analyses were performed on eight studies that included both a dietary intervention component and an adequate control group and on four studies that had follow-up data. There was a high degree of heterogeneity between studies and this made comparisons between studies problematic. Interventions that include diet therapy generally result in significant weight loss, at least in the short term. Many studies were poorly designed and had no or only minimal follow up. The details of the dietary intervention were often inadequately described and dietary outcomes rarely reported, making repetition of the studies difficult. Reviewers' conclusions, There is an urgent need for high quality studies investigating the optimal dietary approach to management of paediatric overweight and obesity. These studies require adequate follow up to ascertain if weight loss can be sustained in the long term. Details of the dietary prescription, adherence to the dietary intervention and diet-specific outcomes need to be reported in order to inform best practice. [source] Continuous Support for Women During ChildbirthBIRTH, Issue 1 2005E.D. Hodnett ABSTRACT Background:, Historically, women have been attended and supported by other women during labour. However, in recent decades in hospitals worldwide, continuous support during labour has become the exception rather than the routine. Concerns about the consequent dehumanization of women's birth experiences have led to calls for a return to continuous support by women for women during labour. Objectives:, Primary: to assess the effects, on mothers and their babies, of continuous, one-to-one intrapartum support compared with usual care. Secondary: to determine whether the effects of continuous support are influenced by: (1) routine practices and policies in the birth environment that may affect a woman's autonomy, freedom of movement, and ability to cope with labour; (2) whether the caregiver is a member of the staff of the institution; and (3) whether the continuous support begins early or later in labour. Search strategy:, We searched the Cochrane Pregnancy and Childbirth Group trials register (30 January 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003). Selection criteria:, All published and unpublished randomized controlled trials comparing continuous support during labour with usual care. Data collection and analysis:, Standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group were used. All authors participated in evaluation of methodological quality. Data extraction was undertaken independently by one author and a research assistant. Additional information was sought from the trial authors. Results are presented using relative risk for categorical data and weighted mean difference for continuous data. Main results:, Fifteen trials involving 12,791 women are included. Primary comparison: Women who had continuous intrapartum support were less likely to have intrapartum analgesia, operative birth, or to report dissatisfaction with their childbirth experiences. Subgroup analyses: In general, continuous intrapartum support was associated with greater benefits when the provider was not a member of the hospital staff, when it began early in labour, and in settings in which epidural analgesia was not routinely available. Reviewers' conclusions:, All women should have support throughout labour and birth. Citation:, Hodnett ED, Gates S, Hofmeyr G J, Sakala C. Continuous support for women during childbirth (Cochrane Review). In: The Cochrane Library, Issue 3, 2004. Chichester, UK: John Wiley & Sons, Ltd. ,,,The preceding report is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X). The Cochrane Library is designed and produced by Update Software Ltd, and published by John Wiley & Sons, Ltd. [source] Amniotomy for Shortening Spontaneous LabourBIRTH, Issue 2 2001W.D. Fraser A substantive amendment to this systematic review was last made on 25 June 1999. Cochrane reviews are regularly checked and updated if necessary. ABSTRACT Background: Early amniotomy has been advocated as a component of the active management of labour. Several randomised trials comparing routine amniotomy to an attempt to conserve the membranes have been published. Their limited sample sizes limit their ability to address the effects of amniotomy on indicators of maternal and neonatal morbidity. Objectives: To study the effects of amniotomy on the rate of Cesarean delivery and on other indicators of maternal and neonatal morbidity (Apgar less than 7 at 5 minutes, admission to NICU). Search strategy: The register of clinical trials maintained and updated by the Cochrane Pregnancy and Childbirth Group. Selection criteria: All acceptably controlled trials of amniotomy during first stage of labour were eligible. Data collection and analysis: Data were extracted by two trained reviewers from published reports. Trials were assigned methodological quality scores based on a standardised rating system. Typical odds ratios (ORs) were calculated using Peto's method. Main results: Amniotomy was associated with a reduction in labour duration of between 60 and 120 minutes. There was a marked trend toward an increase in the risk of Cesarean delivery: OR = 1.26; 95% Confidence Interval (CI) = 0.96,1.66. The likelihood of a 5-minute Apgar score less than 7 was reduced in association with early amniotomy (OR = 0.54; 95% CI = 0.30,0.96). Groups were similar with respect to other indicators of neonatal status (arterial cord pH, NICU admissions). There was a statistically significant association of amniotomy with a decrease in the use of oxytocin: OR = 0.79; 95% CI = 0.67,0.92. Reviewers' conclusions: Routine early amniotomy is associated with both benefits and risks. Benefits include a reduction in labour duration and a possible reduction in abnormal 5-minute Apgar scores. The meta-analysis provides no support for the hypothesis that routine early amniotomy reduces the risk of Cesarean delivery. Indeed there is a trend toward an increase in Cesarean section. An association between early amniotomy and Cesarean delivery for fetal distress is noted in one large trial. This suggests that amniotomy should be reserved for women with abnormal labour progress. Citation: Fraser WD, Turcot L, Krauss I, Brisson-Carrol G. Amniotomy for shortening spontaneous labour (Cochrane Review). In: The Cochrane Library, 1, 2001. Oxford: Update Software. MeSH: Amnion/*surgery; Cesarean Section; Female; Human; *Labor; Labor Complications/*prevention & control; Pregnancy The preceding reports are abstracts of regularly updated, systematic reviews prepared and maintained by the Cochrane Collaboration. The full text of the reviews are available in The Cochrane Library (ISSN 1464-780X). The Cochrane Library is prepared and published by Update Software Ltd. All rights reserved. See www.update-software.com or contact Update Software, info@update.co.uk, for information on subscribing to The Cochrane Library in your area. Update Software Ltd, Summertown Pavilion, Middle Way, Oxford OX2 7LG, United Kingdom. (Tel: +44 1865 513902; Fax: +44 1865 516918). [source] Commercial Hospital Discharge Packs for Breastfeeding WomenBIRTH, Issue 1 2001J. K. Gupta A substantive amendment to this systematic review was last made on 23 March 1999. Cochrane reviews are regularly checked and updated if necessary. ABSTRACT Background: For centuries, there has been controversy around whether being upright (sitting, birthing stools, chairs, squatting) or lying down has advantages for women delivering their babies. Objectives: The objective of this review was to assess the benefits and risks of the use of different positions during the second stage of labour (i.e., from full dilatation of the cervix). Search strategy: Relevant trials are identified from the register of trials maintained by the Cochrane Pregnancy and Childbirth Group, and from the Cochrane Controlled Trials Register. Selection criteria: Trials were included which compared various positions assumed by pregnant women during the second stage of labour. Randomised and quasi-randomised trials with appropriate follow-up were included. Data collection and analysis: Trials were independently assessed for inclusion, and data extracted by the two authors. Disagreements would have been resolved by consensus with an editor. Meta-analysis of data is performed using the RevMan software. Main results: Results should be interpreted with caution as the methodological quality of the 18 trials was variable. Use of any upright or lateral position, compared with supine or lithotomy positions, was associated with: 1Reduced duration of second stage of labour (12 trials,mean 5.4 minutes, 95% confidence interval (CI) 3.9,6.9 minutes). This was largely due to a considerable reduction in women allocated to use of the birth cushion. 2A small reduction in assisted deliveries (17 trials,odds ratio (OR) 0.82, 95% CI 0.69,0.98). 3A reduction in episiotomies (11 trials,OR 0.73, 95% CI 0.64,0.84). 4A smaller increase in second degree perineal tears (10 trials,OR 1.30, 95% CI 1.09,1.54). 5Increased estimated risk of blood loss > 500ml (10 trials,OR 1.76, 95% CI 1.34,3.32). 6Reduced reporting of severe pain during second stage of labour (1 trial,OR 0.59, 95% CI 0.41,0.83). 7Fewer abnormal fetal heart rate patterns (1 trial,OR 0.31, 95% CI 0.11,0.91). Reviewers' conclusions: The tentative findings of this review suggest several possible benefits for upright posture, with the possibility of increased risk of blood loss > 500 mL. Women should be encouraged to give birth in the position they find most comfortable. Until such time the benefits and risks of various delivery positions are estimated with greater certainty when methodologically stringent trials data are available, then women should be allowed to make informed choices about the birth positions in which they might wish to assume for delivery of their babies. Citation: Gupta JK, Nikodem VC. Women's position during second stage of labour (Cochrane Review). In: The Cochrane Library, Issue 4, 2000. Oxford: Update Software. [source] Continuity of Caregivers for Care During Pregnancy and ChildbirthBIRTH, Issue 3 2000E.D. Hodnett A substantive amendment to this systematic review was last made on 17 May 1999. Cochrane reviews are regularly checked and updated if necessary. ABSTRACT Background: Social support may include advice or information, tangible assistance, and emotional support. Objectives: The objective of this review was to assess the effects of continuous support during labour (provided by health care workers or lay people) on mothers and babies. Search strategy: I searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. Date of last search: April 1999. Selection criteria: Randomised trials comparing continuous support during labour with usual care. Data collection and analysis: Trial quality was assessed. Study authors were contacted for additional information. Main results: Fourteen trials, involving more than 5000 women, are included in the Review. The continuous presence of a support person reduced the likelihood of medication for pain relief, operative vaginal delivery, Caesarean delivery, and a 5-minute Apgar score less than 7. Continuous support was also associated with a slight reduction in the length of labour. Six trials evaluated the effects of support on mothers' views of their childbirth experiences; while the trials used different measures (overall satisfaction, failure to cope well during labour, finding labour to be worse than expected, and level of personal control during childbirth), in each trial the results favoured the group who had received continuous support. Reviewers' conclusions: Continuous support during labour from caregivers (nurses, midwives, or lay people) appears to have a number of benefits for mothers and their babies and there do not appear to be any harmful effects. Citation: Hodnett ED. Caregiver support for women during childbirth (Cochrane Review). In: The Cochrane Library, Issue 1, 2000. Oxford: Update Software. [source] Continuity of Caregivers for Care During Pregnancy and ChildbirthBIRTH, Issue 3 2000E.D. Hodnett A substantive amendment to this systematic review was last made on 04 March 1998. Cochrane reviews are regularly checked and updated if necessary. ABSTRACT Background: Care is often provided by multiple caregivers, many of whom work only in the antenatal clinic, labour ward, or postnatal unit. However, continuity of care is provided by the same caregiver or a small group from pregnancy through the postnatal period. Objectives: The objective of this review was to assess continuity of care during pregnancy and childbirth and the puerperium with usual care by multiple caregivers. Search strategy: The Cochrane Pregnancy and Childbirth Group trials register was searched. Selection criteria: Controlled trials comparing continuity of care with usual care during pregnancy, childbirth and the postnatal period. Data collection and analysis: Trial quality was assessed. Study authors were contacted for additional information. Main results: Two studies involving 1815 women were included. Both trials compared continuity of care by midwives with non-continuity of care by a combination of physicians and midwives. The trials were of good quality. Compared to usual care, women who had continuity of care from a team of midwives were less likely to be admitted to hospital antenatally (odds ratio 0.79, 95% confidence interval 0.64,0.97) and more likely to attend antenatal education programs (odds ratio 0.58, 95% confidence interval 0.41,0.81). They were also less likely to have drugs for pain relief during labour (odds ratio 0.53, 95% confidence interval 0.44,0.64), and their newborns were less likely to require resuscitation (odds ratio 0.66, 95% confidence interval 0.52,0.83). No differences were detected in Apgar scores, low birthweight, and stillbirths or neonatal deaths. While they were less likely to have an episiotomy (odds ratio 0.75, 95% confidence interval 0.60,0.94), women receiving continuity of care were more likely to have either a vaginal or perineal tear (odds ratio 1.28, 95% confidence interval 1.05, 1.56). They were more likely to be pleased with their antenatal, intrapartum, and postnatal care. Reviewers' conclusions: Studies of continuity of care show beneficial effects. It is not clear whether these are due to greater continuity of care, or to midwifery care. Citation: Hodnett ED. Continuity of caregivers for care during pregnancy and childbirth (Cochrane Review). In: The Cochrane Library, Issue 2, 2000. Oxford: Update Software. The preceding reports are abstracts of regularly updated, systematic reviews prepared and maintained by the Cochrane Collaboration. The full texts of the reviews are available in The Cochrane Library (ISSN 1464-780X). Seehttp://www.update-software.com/cochrane.htmor contact Update Software,info@update.co.uk, for information on subscribing to The Cochrane Library in your area. Update Software Ltd, Summertown Pavilion, Middle Way, Oxford OX2 7LG, United Kingdom (Tel.: +44 1865 513902; Fax: +44 1865 516918). [source] SELECTED COCHRANE SYSTEMATIC REVIEWS Absorbable Synthetic Versus Catgut Suture Material for Perineal RepairBIRTH, Issue 2 2000C. Kettle A substantive amendment to this systematic review was last made on 19 May 1999. Cochrane reviews are regularly checked and updated if necessary. ABSTRACT Background and objectives: Approximately 70% of women will experience some degree of perineal trauma following vaginal delivery and will require stitches. This may result in perineal pain and superficial dyspareunia. The objective of this review was to assess the effects of absorbable synthetic suture material as compared with catgut on the amount of short- and long-term pain experienced by mothers following perineal repair. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register. Selection criteria: Randomised trials comparing absorbable synthetic (polyglycolic acid and polyglactin) with plain or chromic catgut suture for perineal repair in mothers after vaginal delivery. Data collection and analysis: Trial quality was assessed independently by two reviewers. Data were extracted by one reviewer and checked by the second reviewer. Main results: Eight trials were included. Compared with catgut, the polyglycolic acid and polyglactin groups were associated with less pain in first three days (odds ratio 0.62, 95% confidence interval 0.54,0.71). There was also less need for analgesia (odds ratio 0,63, 95% confidence interval 0.52,0.77) and less suture dehiscence (odds ratio 0.45, 95% confidence interval 0.29,0.70). There was no significant difference in long-term pain (odds ratio 0.81, 95% confidence interval 0.61,1.08). Removal of suture material was significantly more common in the polyglycolic acid and polyglactin groups (odds ratio 2.01, 95% confidence interval 1.56,2.58). There was no difference in the amount of dyspareunia experienced by women. Reviewers' conclusions: Absorbable synthetic suture material (in the form of polyglycolic acid and polyglactin sutures) for perineal repair following childbirth appears to decrease women's experience of short-term pain. The length of time taken for the synthetic material to be absorbed is of concern. A trial addressing the use of polyglactin has recently been completed and this has been included in this updated review. Citation: Kettle C, Johanson RB. Absorbable synthetic versus catgut suture material for perineal repair (Cochrane Review). In: The Cochrane Library, Issue 4, 1999, Oxford: Update Software. ,,, The preceding report is an abstract of regularly updated, systematic reviews prepared and maintained by the Cochrane Collaboration. The full texts of the reviews are available in The Cochrane Library (ISSN 1464-780X). Seehttp://www.update-software.com/cochrane.htmor contact Update Software,info@update.co.uk, for information on subscribing to The Cochrane Library in your area. Update Software Ltd, Summertown Pavilion, Middle Way, Oxford OX2 7LG, United Kingdom (Tel.: +44 1865 513902; Fax: +44 1865 516918). [source] Evidence for the effectiveness of sterile injecting equipment provision in preventing hepatitis C and human immunodeficiency virus transmission among injecting drug users: a review of reviewsADDICTION, Issue 5 2010Norah Palmateer ABSTRACT Aims To review the evidence on the effectiveness of harm reduction interventions involving the provision of sterile injecting equipment in the prevention of hepatitis C virus (HCV) and human immunodeficiency virus (HIV) transmission among injecting drug users (IDUs). The interventions assessed were needle and syringe programmes (NSP), alternative modes of needle/syringe provision (pharmacies, vending machines and outreach) and the provision of injecting equipment other than needles/syringes. Methods Systematic searches of the English language literature to March 2007 were undertaken to identify systematic, narrative or meta-analytical reviews (also known as a review of reviews) of the impact of interventions on HCV transmission, HIV transmission or injecting risk behaviour (IRB). Critical appraisal criteria classified the reviews as either high quality (,core') or supplementary: a framework based on the quality of reviews, the reviewers' conclusions and the designs/findings of the primary studies was used to derive evidence statements. Results Three core and two supplementary reviews of injecting equipment interventions were identified. According to the proposed framework, this study found (a) insufficient evidence to conclude that any of the interventions are effective in preventing HCV transmission; (b) tentative evidence to support the effectiveness of NSP in preventing HIV transmission; (c) sufficient evidence to support the effectiveness of NSP (and tentative evidence of an additional impact of pharmacy NSP) in reducing self-reported IRB; and (d) little to no evidence on vending machines, outreach or providing other injecting equipment in relation to any of the outcomes. Conclusions The evidence is weaker than given credit for in the literature. The lack of evidence for effectiveness of NSP vis-à-vis biological outcomes (HCV and HIV incidence/prevalence) reflects the limitations of studies that have been undertaken to investigate these associations. Particularly for HCV, low levels of IRB may be insufficient to reduce high levels of transmission. New studies are required to identify the intervention coverage necessary to achieve sustained changes in blood-borne virus transmission. [source] | ||||||||||