Complementary and alternative therapies for management of odor in malignant fungating wounds: a critical review

Malignant fungating wounds (MFWs) affect an estimated 5%-10% of all people with cancer. They have a profound effect on the individual, and their associated symptoms such as bleeding, odor, exudate, and pain cause much distress, anxiety, and social isolation. Odor is cited by patients and clinicians as the worst aspect of such wounds. Strategies to manage odor at the wound site include the use of complementary and alternative therapies. This review aimed to synthesize the current evidence for the use of complementary and alternative therapies in the management of odor in MFWs. No restrictions on date, language, or care setting were applied. Nine databases were searched yielding four papers meeting our criteria. Of the four papers, one was a randomized controlled trial (RCT), and three were case studies. Two papers investigated the use of green tea teabags as a secondary dressing, while others used essential oils either combined with a cream applied directly to the wound or as a secondary dressing. In an RCT, green tea was used as a solution to cleanse the wound followed by the application of green tea teabag as a secondary dressing versus metronidazole powder for the management of odor over 7 days. All patients reported a reduction in odor and physical discomfort, and an improvement in social interaction and appetite, but the difference between groups was not statistically significant. The case studies all reported an improvement in odor management. The use of complementary and alternative therapies in the management of MFW-associated malodor is not supported by evidence from RCTs. Green tea may have potential as a secondary dressing to manage odor. Further research in this area is warranted

Nurses are research leaders in skin and wound care

The World Health Assembly declared 2020, the International Year of the Nurse and the Midwife. Recent editorials and commentaries support the leading role of nurses and midwives as frontline caregivers emphasizing the need to invest in the nursing workforce worldwide to meet global health needs. Today nurses are also leaders in research and one example is skin and wound care. In order to reflect on the contribution of nurses as researchers we conducted a systematic review of published articles in five international leading wound care journals in the years 1998, 2008 and 2018. We aimed to determine the type of research publication and percentage of nurses as first, second or senior authors. The place in the authorship was selected as indicative of leadership as it implies responsibility and accountability for the published work. Across the years 1998, 2008 and 2018, 988 articles were published. The overall proportion of nurse-led articles was 29% (n = 286). The total numbers of articles increased over time and so too did the nurse-led contributions. Nurse-led research was strongest in the design categories 'cohort studies' (46%, n = 44), 'systematic reviews' (46%, n = 19), and 'critically appraised literature and evidence-based guidelines' (47%, n = 55).Results of this review indicate that, in addition to the crucial clinical roles, nurses also have a substantial impact on academia and development of the evidence base to guide clinical practice. Our results suggest that nurse led contributions were particularly strong in research summarizing research to guide skin and wound care practice

A descriptive survey study of violence management and priorities among psychiatric staff in mental health services, across seventeen european countries

BACKGROUND: In mental health services what is commonplace across international frontiers is that to prevent aggressive patients from harming themselves, other patients or staff, coercive measures and foremost, violence management strategies are required. There is no agreement, recommendations or direction from the EU on which measures of coercion should be practiced across EU countries, and there is no overall one best practice approach. METHODS: The project was conceived through an expert group, the European Violence in Psychiatry Research Group (EViPRG). The study aimed to incorporate an EU and multidisciplinary response in the determination of violence management practices and related research and education priorities across 17 European countries. From the EVIPRG members, one member from each country agreed to act as the national project coordinator for their country. Given the international spread of respondents, an eDelphi survey approach was selected for the study design and data collection. A survey instrument was developed, agreed and validated through members of EVIPRG. RESULTS: The results included a total of 2809 respondents from 17 countries with 999 respondents who self-selected for round 2 eDelphi. The majority of respondents worked in acute psychiatry, 54% (n = 1511); outpatient departments, 10.5% (n = 295); and Forensic, 9.3% (n = 262). Other work areas of respondents include Rehabilitation, Primary Care and Emergency. It is of concern that 19.5% of respondents had not received training on violence management. The most commonly used interventions in the management of violent patients were physical restraint, seclusion and medications. The top priorities for education and research included: preventing violence; the influence of environment and staff on levels of violence; best practice in managing violence; risk assessment and the aetiology and triggers for violence and aggression. CONCLUSION: In many European countries there is an alarming lack of clarity on matters of procedure and policy pertaining to violence management in mental health services. Violence management practices in Europe appear to be fragmented with no identified ideological position or collaborative education and research. In Europe, language differences are a reality and may have contributed to insular thinking, however, it must not be seen as a barrier to sharing best practice

Using an e-Delphi technique in achieving consensus across disciplines for developing best practice in day surgery in Ireland

Background: The benefits of day surgery are supported internationally by the provision of standards. However, standards from one health jurisdiction are not readily transferable to others as national health strategy, policy and funding are influencing factors. Objective: To determine, through consensus from experts in day surgery, a list of best practice statements for day surgery in Ireland. Methods: A three round e-Delphi technique. Professionals in surgery, anaesthesia, nursing and management involved in day surgery across all hospitals in Ireland were invited to participate as the expert panel. In round 1 a list of proposals for best practice were obtained from panel members. In round 2 experts were asked to rank each statement according to their importance on a nine point scale (1 = not important, 9 = high importance) using an online questionnaire. Consensus was set at 70%, meaning the items that 70% of people deemed to be important were carried over to round 3. A repeat online questionnaire was conducted with the remaining statements in round 3. Results: Round 1 provided 261 statements. These were grouped and reduced to 62 statements for ranking. Following the iterative process over the subsequent two rounds a final list of 40 statements were developed and grouped into six thematic areas. Conclusion: By using an e-Delphi process of gaining consensus among experts working in day surgical services, a list of best practice statements were developed

A descriptive survey study of violence management and priorities among psychiatric staff in mental health services, across seventeen european countries.

BACKGROUND: In mental health services what is commonplace across international frontiers is that to prevent aggressive patients from harming themselves, other patients or staff, coercive measures and foremost, violence management strategies are required. There is no agreement, recommendations or direction from the EU on which measures of coercion should be practiced across EU countries, and there is no overall one best practice approach. METHODS: The project was conceived through an expert group, the European Violence in Psychiatry Research Group (EViPRG). The study aimed to incorporate an EU and multidisciplinary response in the determination of violence management practices and related research and education priorities across 17 European countries. From the EVIPRG members, one member from each country agreed to act as the national project coordinator for their country. Given the international spread of respondents, an eDelphi survey approach was selected for the study design and data collection. A survey instrument was developed, agreed and validated through members of EVIPRG. RESULTS: The results included a total of 2809 respondents from 17 countries with 999 respondents who self-selected for round 2 eDelphi. The majority of respondents worked in acute psychiatry, 54% (n = 1511); outpatient departments, 10.5% (n = 295); and Forensic, 9.3% (n = 262). Other work areas of respondents include Rehabilitation, Primary Care and Emergency. It is of concern that 19.5% of respondents had not received training on violence management. The most commonly used interventions in the management of violent patients were physical restraint, seclusion and medications. The top priorities for education and research included: preventing violence; the influence of environment and staff on levels of violence; best practice in managing violence; risk assessment and the aetiology and triggers for violence and aggression. CONCLUSION: In many European countries there is an alarming lack of clarity on matters of procedure and policy pertaining to violence management in mental health services. Violence management practices in Europe appear to be fragmented with no identified ideological position or collaborative education and research. In Europe, language differences are a reality and may have contributed to insular thinking, however, it must not be seen as a barrier to sharing best practice

RAZUMIJEVANJE PODATAKA; UVOD U KRITIČKU PROCJENU

Some basic information on how to help clinicians in understanding the results of papers are presented. Evidence based medicine is discussed and accepted concept of hierarchy of evidence presented in figure. Randomized control trial (rtC) is stressed as gold standard for evaluating the effectiveness of interventions. The examples of exercises (descriptive and inferential statistics) for understanding results are given. it is concluded that once one has a grasp of the basic steps outlined in presented text, the way to developing knowledge around evidence based practice is achieved.Prikazani su neki osnovni podaci kako pomoći kliničarima u razumijevanju rezultata radova. Raspravlja se o medicini temeljenoj na dokazima i o prihvaćenom konceptu hijerarhije dokaza, što je izneseno u slikovnom prikazu. Naglašeno je da je randomizirani kontrolirani pokus (RTC - Randomised Control Trial) zlatni standard za evaluaciju učinkovitosti intervencije. Izneseni su primjeri vježbi deskriptivne i inferentne (prosuđivačke) statistike za razumijevanje rezultata. Naglašeno je da je razumijevanje temeljnih koraka koji su naglašeni u ovom radu put prema stvaranju vlastitog znanja o praktičnom radu temeljenom na dokazu. Na kraju su dane definicije često upotrebljavanih statističkih termina