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Selected AbstractsImproving Child Protection in the Emergency Department: A Systematic Review of Professional Interventions for Health Care ProvidersACADEMIC EMERGENCY MEDICINE, Issue 2 2010Amanda S. Newton PhD Abstract Objectives:, This systematic review evaluated the effectiveness of professional and organizational interventions aimed at improving medical processes, such as documentation or clinical assessments by health care providers, in the care of pediatric emergency department (ED) patients where abuse was suspected. Methods:, A search of electronic databases, references, key journals, and conference proceedings was conducted and primary authors were contacted. Studies whose purpose was to evaluate a strategy aimed at improving ED clinical care of suspected abuse were included. Study methodologic quality was assessed by two independent reviewers. One reviewer extracted the data, and a second checked for completeness and accuracy. Results:, Six studies met the inclusion criteria: one randomized controlled trial (RCT), one quasi-RCT, and four observational studies. Study quality ranged from modest (observational studies) to good (trials). Variation in study interventions and outcomes limited between-study comparisons. The quasi-RCT supported self-instructional education kits as a means to improve physician knowledge for both physical abuse (mean ± standard deviation [SD] pretest score = 13.12 ± 2.36; mean ± SD posttest score = 18.16 ± 1.64) and sexual abuse (mean ± SD pretest score = 10.81 ± 3.20; mean ± SD posttest score = 18.45 ± 1.79). Modest-quality observational studies evaluated reminder systems for physician documentation with similar results across studies. Compared to standard practice, chart checklists paired with an educational program increased physician consideration of nonaccidental burns in burn cases (59% increase), documentation of time of injury (36% increase), and documentation of consistency (53% increase) and compatibility (55% increase) of reported histories. Decisional flow charts for suspected physical abuse also increased documentation of nonaccidental physical injury (69.5% increase; p < 0.0001) and had a similar significant effect as checklists on increasing documentation of history consistency and compatibility (69.5 and 70.0% increases, respectively; p < 0.0001) when compared to standard practice. No improvements were noted in these studies for documentation of consultations or current status with child protective services. The introduction of a specialized team and crisis center to standardize practice had little effect on physician documentation, but did increase documentation of child protective services involvement (22.7% increase; p < 0.005) and discharge status (23.7% increase; p < 0.02). Referral to social services increased in one study following the introduction of a chart checklist (8.6% increase; p = 0.018). A recently conducted multisite RCT did not support observational findings, reporting no significant effect of educational sessions and/or a chart checklist on ED practices. Conclusions:, The small number of studies identified in this review highlights the need for future quality studies that address care of a vulnerable clinical population. While moderate-quality observational studies suggest that education and reminder systems increase clinical knowledge and documentation, these findings are not supported by a multisite randomized trial. The limited theoretical base for conceptualizing change in health care providers and the influence of the ED environment on clinical practice are limitations to this current evidence base. ACADEMIC EMERGENCY MEDICINE 2010; 17:117,125 © 2010 by the Society for Academic Emergency Medicine [source] Psychosocial interventions for non-professional carers of people with Parkinson's disease: a systematic scoping reviewJOURNAL OF ADVANCED NURSING, Issue 3 2008Susanne Hempel Abstract Title.,Psychosocial interventions for non-professional carers of people with Parkinson's disease: a systematic scoping review. Aim., This paper is a report of a scoping review to systematically identify and collate the evidence on psychosocial interventions for non-professional carers of people with Parkinson's disease. Background., Carers are critical to people with Parkinson's disease maintaining independent living and quality of life. Parkinson's disease imposes a challenging constellation of symptoms and no summary of effective interventions for carers and their unique support needs exists. Data sources., Thirty electronic databases were searched from their inception to July 2006, and bibliographies and specific internet sites were scanned. Methods., Eligible studies were categorized according to design, type of economic evaluation where applicable, number of participants, country of evaluation, intervention, orientation, provider, setting, method of delivery, carer population, patient population, carer outcomes, patient outcomes and authors' conclusions. Data were extracted by one reviewer and checked by another reviewer; discrepancies were resolved through discussion or arbitration by a third reviewer. Findings., Thirty studies met the inclusion criteria. Most investigated relatively unique interventions involving multiple elements; the majority were not aimed primarily at carers but were embedded in patient treatment programmes. Many were pilot studies, employing weak research designs and involving very small numbers of participants and most were not designed to assess the clinical or cost effectiveness of the intervention for the carers. Conclusion., Several interventions merit further investigation but there is currently little evidence to show which approaches are effective and cost effective in supporting carers. Future studies need to employ appropriate and rigorous research designs with adequate samples and outcome measures, and with more focus on the carer. [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] Hypothyroidism in neonates post-iodinated contrast media: a systematic reviewACTA PAEDIATRICA, Issue 10 2009Alexandra Ahmet Abstract Aim:, To determine if neonates exposed to iodinated contrast media are at risk of hypothyroidism. Methods:, A systematic review was conducted by searching electronic databases (e.g. MEDLINE), contacting experts and scanning reference lists. Studies examining the effects of contrast media on neonatal thyroid function were included. Two reviewers independently screened the literature and assessed the risk of bias, while one reviewer abstracted data. Results:, Eleven studies were included; nine studies directly examined the risk of hypothyroidism (n = 182 neonates exposed to contrast media). All were highly affected by bias. In the three studies including term infants, one showed a trend towards increased thyroid-stimulating hormone (TSH) and decreased free thyroxine (FT4) among exposed groups. Six of 72 (8.3%) term infants exposed were treated for hypothyroidism. In studies of premature infants, there was a trend towards increased TSH (n = 3/7 studies), lower total thyroxine (n = 1), decreased triidothyronine and FT4 (n = 3) and hypothyroidism (n = 5). Twenty of 110 (18.2%) premature infants exposed were treated for hypothyroidism. Conclusion:, Hospitalized neonates exposed to iodinated contrast media are at risk for abnormal thyroid function and development of hypothyroidism. Premature infants might be at increased risk. Well-controlled studies are required to replicate our findings because the included studies were highly affected by bias. [source] | ||||||||||