BEST SYSTEMATIC REVIEW IN NURSING
Friday, 17 April 2009, 1700–1800hrs Auditorium, College of Medicine Building, Ministry of Health EBM-NUR (1720) Patency of Arterial Catheters with Heparinised Solutions versus Non-Heparinised Solutions: A Systematic Review and Meta-Analysis of Randomised Controlled Trials Ms Chen Ling Jun, Nursing, Singapore General Hospital EBM-NUR (1730) Use of Water Irrigation for Bowel Management in Patients with Spinal Cord Injury: A Systematic Review Ms Jiang Yan, Nursing, Singapore General Hospital EBM-NUR (1740) Maggot Therapy, A Quantum Leap From the Past: A Systematic Review Ms Sivagame Maniya, Nursing, Singapore General Hospital EBM-NUR (1750) Effectiveness Multidisciplinary Interventions for People with Parkinson’s Disease Ms Tan Siok Bee, Nursing, Singapore General Hospital EBM-NUR (1800) The Effectiveness of Cranberries Juice in Reducing UTI in Elderly Patients: A Systematic Review Ms Wong Yin Yin, Nursing, Singapore General Hospital
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Best Systematic Review in Nursing
EBM-NUR (1720) PATENCY OF ARTERIAL CATHETERS WITH HEPARINISED SOLUTIONS VERSUS NONHEPARINISED SOLUTIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS Chen LJ1, Ng GH1, Ong S2, Lee P2 1 Surgical Intensive Care Unit, Singapore General Hospital, Singapore; 2Department of Anaesthesiology, Singapore General Hospital, Singapore Aim: This systematic review evaluates the effect of heparin on duration of patency of arterial catheters. Methods: A literature search was conducted from MEDLINE, EMBASE, CINAHL, The Cochrane Library from their inception to December 2008, and National Guideline Clearinghouse and Joanna Briggs Institute web sites. Keywords used for the search, with cross-referencing of MeSH terms, were heparin, heparinised, arterial lines, arterial catheters, catheterisation, arterial cannulas, cannulation, clotting, occlusion, patency, randomisation, random allocation and randomised controlled trials. The methodological quality of the included randomised controlled trials was assessed using criteria for masking of randomisation, masking of intervention, masking of outcome measurement and completeness of follow-up. The main outcome measure was patency of arterial catheter. Data on relevant outcomes were extracted and the effect size was estimated by calculating Relative Risk (RR), Risk Difference (RD) and associated 95% Confidence Intervals (CI). Results: Four trials met the eligibility criteria. Owing to inconsistency in the outcomes reported, only three trials could be included in the meta-analysis. These studies included 5145 adults. Heparin significantly prolonged duration of patency of arterial catheters and decreased the risk of clot formation (RR 0.47, CI 0.41 to 0.52). Conclusions: Infusion of low-dose heparin through an arterial catheter prolonged the duration of patency. The use of heparin for arterial catheters enables haemodynamic monitoring continuously as intended therapy by reducing occlusion. Evidence from this systematic review supports the use of heparin in flush solutions to maintain the patency of arterial lines. None of these studies was powered to evaluate the incidence of adverse events. Caution is reinforced and monitoring of side-effects of heparin is recommended if adopting this therapy as routine practice. EBM-NUR (1730) USE OF WATER IRRIGATION FOR BOWEL MANAGEMENT IN PATIENTS WITH SPINAL CORD INJURY: A SYSTEMATIC REVIEW Jiang Y, Lim SF, Lee Y, Fazila ABA, Ong SY Division of Nursing, Singapore General Hospital, Singapore Aims: This systematic review seeks to determine the effectiveness of water irrigation for bowel management of patients with spinal cord injury Methods: The search strategy included computerised searches of database: Ovid Medline, Cochrane Database of Systematic Reviews, ACP Journal, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cumulative Indexes to Nursing and Allied Health Literature (CINAHL), Pubmed, Science Direct, Joanna Briggs Institute; manual search of relevant journal articles and reference trackings. Keywords used for the search were “irrigation”, “evacuation”, “constipation”, “bowel care”, “bowel management”, “neurogenic bowel”, “spinal cord injury”, “spinal trauma”, “paraplegia” and “tetraplegia”. Results: One randomised controlled trial (RCT) and three prospective studies were identified. The studies were small and heterogeneous in design. Two studies reported successful stool evacuations within shorter time using either transanal irrigation or external irrigation (RD 41%; 95% CI: 28% to 55%). There was also a trend towards reduced caregiver dependence on bowel care in 2 studies (RD 42%; 95% CI: -12% to 96%). Conclusion: The limited evidence available suggests potential benefits of water irrigation. Due to limited number of RCTs, small sample sizes and design heterogeneities, further RCTs are required to ascertain its efficacy for bowel management.
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Best Systematic Review in Nursing
EBM-NUR (1740) MAGGOT THERAPY, A QUANTUM LEAP FROM THE PAST: A SYSTEMATIC REVIEW Sivagame M, Lim GNY, Juriyah Y, Teh AHM, Chua AFS Division of Nursing, Singapore General Hospital and National Cancer Centre, Singapore Aim: Maggot therapy, a naturally occurring biological agent for debridement, is currently resurfacing again in the world of wounds. Larva therapy has been proposed as an effective low-cost, low technology and selfsustained debriding organism. This paper aims to systematically review evidence to determine the efficacy of maggot therapy in debridement of diabetic and leg ulcers. Secondary outcomes such as reduction in bacterial burden, time to healing, cost-effectiveness and patient experiences were also investigated. Methods: Cochrane (7), CINAHL (18), Medline (22), Pubmed (51), Embase (39), ScienceDirect (7), Blackwell Synergy (9), AHQR (0), Joanna Briggs Institute (0), NGC (0) were searched. Keywords used in search were maggot and larva therapy, biosurgery, myiasis. Combinations were used with diabetic foot ulcers, leg ulcers and debridement. In addition, the reference papers from included trials were also searched and relevant wound journals were hand-searched. 23 articles were identified and on appraisal, there were 1 randomised controlled trial, 12 cohort studies, and 11 cases reports. The papers were analysed qualitatively. Results: 7 retrospective cohort studies (total N=308) reported that 65% of patients had complete debridement after variable 1-3 applications of maggot therapy. 2 studies (total N=23) reported a reduction of bacterial load below infective levels in the wounds. 5 cohort studies (total N=225) that surveyed pain experience reported inconsistency in the pain experience during the maggot therapy. In 1 randomised controlled trial (N=6) that explored cost-effectiveness, all patients achieved complete debridement and had lower cost of treatment (p<0.05). Conclusions: Definite conclusions regarding the efficacy of maggot therapy in debridement of diabetic foot and leg ulcer cannot be drawn due to the lack of randomised controlled trials on maggot therapy. It is suggestive that maggots may have a role to play in reducing the bacterial load on wounds that consequently can result in lower risk of developing infection.
EBM-NUR (1750) EFFECTIVENESS OF MULTIDISCIPLINARY INTERVENTIONS FOR PEOPLE WITH PARKINSON’S DISEASE Tan SB1, Williams A2, Morris ME3, Kelly DH3 1 Division of Nursing, Singapore General Hospital, Singapore; 2School of Nursing and Social Work, The University of Melbourne, Australia; 3Melbourne Physiotherapy School, The University of Melbourne, Australia Aims: To conduct a systematic review and critical evaluation of the literature on the effectiveness of multidisciplinary interventions for people with Parkinson’s disease. Methods: An electronic search of the following publication databases were performed for records from 1998 to 2008: CINAHL PLUS (EBSCO), MEDLINE, Joanna Briggs Institute, Pubmed , Web of Science (ISI), Expanded Academic ASAP (Gale), Academic Search Premier (EBSCO), Ovid, psycINFO, BIOSIS Previews (ISI), Cochrane library and Meditext (Informit). The keywords used were Parkinson, nursing, physical therapy, team, intervention, rehabilitation, multidisciplinary and their various combinations. Key terms were matched to MeSH subject headings and exploded (exp) where relevant to include all subheadings and related terms to each key term used. 80 articles were initially identified based on our selection criteria and the primary source of these articles was hand searched. Eight studies were included after this sifting process and critiqued by 2 reviewers (TSB & KDH). The critiques were conducted using the McMaster University Critical Review Form and rated using SIGN. Results: 1 RCT, 7 non-randomised cohort studies were included. For these studies the level of evidence ranged from SIGN level 1+ to 2-. The outcome measures assessed were heterogeneous, including measures of disability of disease, stage of disease and various quality of life measures. Conclusion: The evidence quantifying positive and sustained effects of multidisciplinary interventions for people with Parkinson’s disease is inconclusive. There has been an absence of controlled experimentation to quantify therapy outcomes. The studies reviewed were heterogenous and lacked long-term follow-up to quantify retention of intervention.
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Best Systematic Review in Nursing
EBM-NUR (1800) THE EFFECTIVENESS OF CRANBERRIES JUICE IN REDUCING UTI IN ELDERLY PATIENTS: SYSTEMATIC REVIEW Wong YY, Tee YM, Rubiyah BK, Siah CJ Department of Infection Control Ward 47, Singapore General Hospital, Singapore Background: Urinary tract infection (UTI) is the most frequently reported healthcare-associated infection (HAI), accounting for up to 40% of all HAIs. Old age is one of the risk factors. The adverse consequences associated with these infections include duration of hospital stay, extra hospital costs or charges, additional inpatient care requirements, costly alternative antimicrobials, potential costs, lost productivity, untreatable infections, and death. Our review would like to consider a non-pharmacological approach in reducing UTIs in the elderly. Cranberries have been widely used for several decades for the prevention and treatment of urinary tract infection (UTIs). Cranberries contain a substance that can prevent bacteria from sticking on the walls of the bladder. This may help prevent bladder and other urinary tract infections. Aims: To assess the effectiveness of cranberry products in preventing UTIs in elderly patients who are or above 60 years old. Methods: We searched MEDLINE, CINAHL, EMBASE, OVIDSP, Science Direct Health Sciences Collection, the Cochrane Central Register of Controlled Trials and Internet. We used keywords such as UTI, elderly, old, cranberries products, reducing, urinary catheter, indwelling catheter in our search engine. All randomised controlled trials (RCTs), quasi-RCTs, cohort, case-control or cross-sectional of cranberry products for the prevention of UTIs in elderly patients. Potentially relevant titles and abstracts of studies relevant to the review were screened independently. All the authors assessed the articles that were selected to decide whether the studies met the inclusion criteria. Results: 5 studies comparing cranberry products with placebo, juice and water. Ascertained that cranberry juice reduced the risk of UTI in elderly 60 years old, with a RB of 0.51 [0.33 0.79]. Conclusion: The evidence from these studies could significantly benefit the patients and caregivers in the hospital.
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