It's an exciting time here at EBN. For the second year we are sponsoring the Marjorie Simpson Award at the Royal College of Nursing's International Nursing Research Society Conference. Marjorie Simpson (1924–1992) was one of the founder members of the research discussion group for nurses in the UK that eventually became the Royal College of Nursing's Research Advisory Group. Marjorie endeavoured to foster research-mindedness among nurses and it is a fitting tribute to her commitment to research within nursing that this award for new researchers is named in her honour. Continuing Marjorie's desire to ensure nursing care is based on the best available evidence, it is right that Evidence-Based Nursing sponsors this award given the journal's role in promoting research awareness among nurses. At EBN we continue to strive to achieve in a range of ways. Some of our activities are described in the following sections.
Whenever we encounter a research finding based on the interpretation of a p value from a statistical test, whether we realise it or not, we are discussing the result of a formal hypothesis test. This is true irrespective of whether the test involves comparisons of means, Odds Ratios (ORs), regression results or other types of statistical tests. As readers of research, it is important to understand the underlying principles of hypothesis testing, so that when faced with statistical results, we reach the right conclusions and make good decisions about which findings are robust enough to be translated into clinical practice.
The article by Yinon et al
Obesity is associated with an increased risk of venous thromboembolism (VTE) including both spontaneous and postoperative events. Further research is needed regarding factors responsible for the increase in postoperative VTE in overweight patients, and whether management should be altered (eg, increased focus on postoperative mobilisation, altered doses of prophylactic anticoagulants, lower threshold for starting prophylactic anticoagulation for minor surgical procedures). Weight loss prior to surgery may reduce risk of venous thrombosis.
About 0.1% of individuals develop VTE each year.
Commentary on: Hodnett ED, Gates S, Hofmeyr GJ, et al. Continuous support for women during childbirth. Cochrane Database Syst Rev 2011;2:CD003766.
Models of care supporting continuous support during labour were shown to be more likely to result in a spontaneous vaginal birth. Women receiving continuous support required less analgesia and were less likely to report negative feelings about the birth experience. Women receiving continuous support experienced shorter labours and their babies were less likely to have low 5-min Agpar scores. Therefore, such models of care should be considered for more extensive implementation in clinical practice settings.
There is a need for further research in models of care which provide continuity of care and support to women during labour and birth. Future studies should compare outcomes between different types of continuous support (eg,...]]>
Behavioural interventions can reduce maternal, fetal and neonatal obstetric and weight-related risks. Good-quality research is required to inform the development of behavioural interventions to determine effectiveness and cost-effectiveness for short-term and long-term health outcomes.
There has been a rapid development of international maternal obesity and gestational weight gain (GWG) guidelines due to increasing evidence of risk.
Children of mothers who are obese prior to pregnancy, and/or gain excessive weight in early pregnancy, carry increased risk for obesity in adolescence. Obese women of childbearing age should be actively supported to achieve lifestyle modification prior to conception or in early pregnancy. Research is needed to identify strategies for optimal gestational weight gain (GWG) and lifestyle modification before and during pregnancy. Studies need to identify women at highest risk of excess GWG plus potential benefits of intense dietary and lifestyle counselling.
In the last two decades, UK rates of obesity in pregnancy have doubled, and currently one in five women are obese at...]]>
Increasingly, there is recognition that women with heart disease have greater psychological morbidity than men. Owing to increased rates of depression and other factors, such as older age, women are less likely to adhere to behaviour change strategies and attend cardiac rehabilitation (CR). A tailored and targeted approach, using a gender-based framework and a theoretically derived behaviour change strategy, can improve depressive symptoms in women following an acute cardiac event. The worth of tailoring and targeting strategies to women's readiness to change behaviours as well as the likely benefit of providing a gender-based approach to care delivery. The need to replicate this study in other...]]>
This study found that nurses on cardiovascular care units were able to administer depression screening tools and document referral activities for positive screens. It is not known whether depression screening improved depression outcomes. Evidence of benefits in excess of harms, established by well-conducted randomised controlled trials (RCTs) of depression screening interventions, is needed before depression screening is implemented in cardiovascular care settings.
Major depressive disorder (MDD) may be present in up to 20% of heart disease patients and has been associated with poorer cardiac prognosis, reduced quality of life, less favourable self-care behaviours and higher healthcare costs.
Although early switch therapy and hospital discharge are well-recognised processes, current practices show that these practices are not well established worldwide. Pathways are useful tools to remind treating physicians about criteria for early switch and discharge. A behavioural change may be necessary in order to decrease the gap between national recommendations and current management of hospitalised patients with community-acquired pneumonia.
Community-acquired pneumonia (CAP) remains within the 10 leading causes of death.
Children with disabilities are at increased risk for virtually every type of violence that has been measured in this population. Healthcare providers and researchers need to take a more comprehensive, person-centered approach that focuses on the vulnerability to polyvictimisation and the interconnection among forms of violence for children with disabilities.
Many forms of violence against children are all too common
Extreme cardiorespiratory events can be documented during sleep and are more common in immature preterm infants. The supine sleep position does not appear to decrease the risk of Sudden Infant Death Syndrome (SIDS) by decreasing the risk of extreme cardiorespiratory events in vulnerable infants. Reasons for the physiological advantage of the supine sleep position remain speculative and require ongoing study despite decreases in SIDS death rates in recent years.
Despite the successful worldwide introduction of preventative measures to decrease the risk of infants dying of SIDS the final mechanism of death in these infants has not been fully elucidated. While it has been established that placing...]]>
Quitting smokers who use nicotine replacement therapy (NRT) are often advised to stop using this if they restart smoking; quitters often discontinue NRT after brief smoking lapses. Quitters who continue using NRT during brief lapses may be more likely to return to abstinence. Treating lapses with NRT probably encourages short-term cessation; research should investigate this further and test the impact on smokers’ long-term abstinence and health gain.
Smoking is the greatest reversible cause of morbidity and mortality; cessation is the most important lifestyle change for improving future health. NRT is the most widely used cessation treatment, but 75% of those who attempt cessation will restart smoking within 1 year.
Low-dose aspirin (≤300 mg/day) increases the risk of major bleeding. Individuals with diabetes have a higher risk of bleeding independent of aspirin exposure. Future work should include comparative effectiveness studies to help inform treatment strategies based on individual risks, benefits, patient preferences and values.
Aspirin has a proven role in the secondary prevention of cardiovascular disease.
Ara and colleagues studied the effectiveness and cost effectiveness of weight-reducing drugs and found that they provide statistically significant weight loss and are worth the investment. The analysis contains several unwarranted assumptions, notably around the amount of weight lost, subsequent weight regained and the permanency of weight loss. Definitive conclusions cannot be drawn from this study.
Obesity is a large and growing health problem. For patients unable to achieve sufficient weight loss by improving their lifestyle, weight-reducing drugs are a treatment option. This study aimed to evaluate the effectiveness and cost effectiveness of three pharmacological interventions (orlistat, sibutramine and rimonabant) in obese patients in...]]>
Intravenous ketamine has been shown to be useful for acute pain in a variety of settings. The present study shows that it provides a greater reduction in pain than morphine but causes more adverse effects in out-of-hospital care.
Conscious trauma patients often suffer severe pain. In general, once a head injury has been ruled out, it is safe to give analgesics as promptly as possible.
Commentary on:
Role development of advance practice nurses (APNs) and organisational culture are important contributing factors for the adoption of evidence-based practice (EBP) by nurses. Nursing and APN workload were factors limiting adoption of EBPs. Education on EBP, leadership and facilitation should be part of all APN education. Further research across a range of settings is needed to determine additional factors that may influence adoption of EBP.
The importance of utilising EBP to enhance patient care is known, yet front line nurses (FLN) remain slow to adopt.
Client reminders and one-on-one education are effective community-based interventions for improving screening rates for colorectal cancer (CRC), breast and cervical cancers. Group education is now shown to be an effective approach for improving breast cancer screening rates. Needs particular to the target population should be considered in conjunction with published recommendations when choosing interventions to improve screening rates. Studies which address interventions for increasing CRC screening other than with faecal occult blood test are needed. An important area to address in future research is the effectiveness of electronic communications in improving screening rates.
Higher nurse staffing levels for postoperative care of cardiac surgery patients reduces the risk of unplanned re-admission to the intensive care or operating theatre and in-hospital mortality. Larger international studies are needed to assess the effect of nurse staffing levels and risk of hospital-wide adverse events.
The effect of nurse staffing levels associated with adverse events in the hospital setting has been an important area of patient safety research. Market forces, in particular in North America, have resulted in efforts to reduce costs in all sectors of the healthcare setting.
These results will aid the development of protocols for screening bereaved individuals who are eligible for study participation. These results provide insight into bereaved participants’ preferences for data collection methods (eg, face-to-face, phone and self-completion postal surveys). The needs of non-cancer-related deaths and paediatric populations (eg, bereaved child participants; childhood deaths) need consideration in future studies.
In 2008, the Department of Health in England called for a better understanding of bereaved relatives’ views of end-of-life care. However, ethical concerns exist regarding whether the vulnerable population of bereaved relatives should be involved as research study participants. With little research evidence addressing this ethical debate, Koffman and colleagues explored the appropriateness and acceptability of an end-of-life-care survey instrument...]]>
Clinicians should have heightened awareness and inquire about feelings of loneliness when providing care for older adults. More studies are needed to further elucidate gender-based differences on the relationship between loneliness and mortality.
The demographic imperative indicates aging of the western hemisphere. Whereas some older adults would prefer continued employments until late in life, chronic-health conditions
Non-pharmacological interventions (NPIs) should be the first line of treatment for the behavioural and psychological symptoms of dementia (BPSD). Multicomponent NPIs tailored to individual and caregiver needs can reduce BPSD in community settings. Current instruments that measure BPSD lack precision, diluting the observed effect of NPIs; more precise outcome measures are needed. Quality-of-life indicators may be more sensitive measures of NPI benefits than reduction in negative behaviours.
Behavioural and psychological symptoms of dementia (BPSD) are prevalent, impose a high burden on caregivers and greatly increase the cost of care. The use of pharmacological treatments is a common practice, but these drugs have not demonstrated efficacy and they carry a substantial risk for increased mortality in frail older...]]>
Brown L, de Bruin N. A music-based multitask exercise programme is a promising intervention for improving gait, balance and fall risk in older adults. Evid Based Nurs 2011;14:108–9. doi:10.1136/ebn-2011-100095. This article was published in print with an incorrect DOI. The DOI should be 10.1136/ebn.2011-100095 as this is the DOI it was published Online First with.
]]>