Interpreting and using meta-analysis in clinical practice

Systematic reviews, which can include a meta-analysis, are considered the gold standard for determination of best practice. Meta-analysis combines the results from many primary studies to identify patterns among the individual study results and then assesses the overall effectiveness of a specific healthcare intervention. The purpose of this article was to describe the process of performing a meta-analysis, discuss advantages and disadvantages of meta-analyses, and interpret the results of a meta-analysis from current research relevant to orthopaedic nursing practice.Cheryl Holly, Jason T. Slye

Caregiver decisions along the Alzheimer's disease trajectory

Paper Session A4: Care-Giving and Care PlanningJason Slyer, Marie Truglio-Londriga

The effectiveness of group visits for patients with heart failure on knowledge, quality of life, self-care, and readmissions: a systematic review

Background Heart failure is a major health burden worldwide. Patient education is the primary process used to increase knowledge of self-care practices for patient with heart failure. Most education occurs during one-to-one visits between a patient and a health care provider. Group visits with a health care provider and a small group of patients provide an alternative method for providing patient education. The goal of group visits for patients with heart failure would be to increase patient knowledge and self-care abilities, while improving self-efficacy. Objective The objective of this review is to identify the effectiveness of group visits for patients with heart failure on knowledge, quality of life, self-care behaviors, and hospital readmissions. Inclusion Criteria Types of participants Community living adult patients, years and above, of all races and ethnicities with a diagnosis of heart failure. Types of outcomes Patient knowledge about heart failure, quality of life, self-care behaviors, unplanned readmissions, and emergency room visits for a HF exacerbation. Types of studies Randomized controlled trials, non-randomized controlled trials, and quasi-experimental trials were considered for inclusion. In their absence other qualitative studied designs were considered. Search Strategy Published and unpublished studies in the English language were sought from the inception of the included databases through September, . The databases searched included, PubMed, CINAHL. Embase, Health Source, Nursing, Academic edition. A search for grey literature and hand searching of reference lists were also performed. Methodological Quality Two reviewers evaluated the included studies for methodological quality using standardized critical appraisal instruments from the Joanna Briggs Institute. Data Collection Data were extracted using standardized data extraction instruments from the Joanna Briggs Institute. Data Synthesis Due to heterogeneity between included studies, statistical pooling was not possible. Results are presented in a narrative form. Results Three papers describing two pilot studies were included n this review. One study demonstrated an improvement in heart failure knowledge and a trend toward improvement in self-care behaviors. The other study showed improvements in self-care behaviors and depression while reducing the number of hospitalizations. Conclusions The group visit model has the potential for improving knowledge and self-care behaviors, while increasing quality of life and decreasing hospitalizations for patients with heart failure.Jason T. Slyer, Lucille R. Ferrar

Caregiver decisions along the Alzheimer's disease trajectory

Available online 29 November 2018Despite the rising prevalence of Alzheimer's disease (AD), there is limited systematic evidence about disease specific decisions. The aim of this qualitative descriptive study was to identify decisions across the AD trajectory using focus groups of past and present caregivers. Qualitative content analysis revealed three main categories with corresponding categories and sub-categories. Main Category One-Decisions pertaining to self-yielded two categories: decision pertaining to the offering of self and care for the caregiver. Main Category Two-Decisions pertaining to the patient-yielded three categories: decisions about care and treatment, living arrangements, and protecting the patient from harm. Main Category Three-Communication and relationships in decisions-yielded two categories: navigation and negotiations. The results of this study will inform healthcare providers and caregivers as they work together to anticipate, prepare, and plan for care management decisions over the AD trajectory.Marie Truglio-Londrigan, Jason T. Slye

The effectiveness of patient-centered self-care education for adults with heart failure on knowledge, self-care behaviors, quality of life, and readmissions: a systematic review

Background: Patient-centered self-care education is an educational approach that employs meaningful, targeted education tailored to an individual patient's needs, preferences, and values. Patient-centered educational approaches may empower patients with heart failure to be successful in self-care management and improve outcomes. Objective: To evaluate the effectiveness of patient-centered self-care education for adults with heart failure on knowledge, self-care behaviors, quality of life, and readmissions. Inclusion criteria: Types of participants: Adult patients, 18 years and older, with a diagnosis of heart failure. Types of interventions: All types of patient-centered, self-care education interventions for adult patients with heart failure provided by any health care provider. Types of outcomes: Heart failure knowledge, heart failure self-care behaviors, heart failure-related quality of life, heart failure admissions or readmissions within one-year post intervention. Types of studies: Randomized controlled trials. Search strategy: The search strategy aimed to find relevant published and unpublished studies in the English language between January 1990 and July 2013. Several electronic databases were searched: CINAHL, Pubmed, PsychINFO, EMBASE, CENTRAL, ERIC, Scopus, and DynaMed. A search for gray literature was also performed. Methodologic al quality: Two reviewers evaluated the included studies for methodological quality using standardized critical appraisal instruments from the Joanna Briggs Institute. Data collection: Data were extracted using a standardized data extraction instrument from the Joanna Briggs Institute. Data synthesis: Due to clinical heterogeneity between included studies, statistical meta-analysis was not possible. Results are presented in a narrative form. Results: A total of seven articles describing five randomized controlled trials and one pseudo-randomized trial were included. Four studies demonstrated reduced readmissions with only one reaching statistical significance at six months follow-up (11.4% intervention, 44.2% control, P=0.01). Five studies demonstrated an improvement in quality of life with only one reaching statistical significance between baseline and 12 months follow-up (P=0.002). One study measured knowledge and demonstrated a statistically significant improvement at the 12 months follow-up (P=0.05). One study measured self-care and demonstrated a statistical significant improvement among the intervention group at one month (P < 0.001) and three months (P=0.005) compared with the control. These statistical significant findings indicate the positive effects of the intervention by demonstrating an improvement in outcomes as measured by patients experiencing a more productive quality of life, an increase in heart failure-related knowledge, improved self-care behaviors, and decreased readmission rates post intervention. Conclusions: Patient-centered self-care education for adult patients with heart failure may have a positive benefit in reducing heart failure readmissions and improving heart failure-related knowledge, self-care behaviors, and quality of life. Factors that may influence outcomes include a multidisciplinary team approach and reinforcement of individualized advice with emphasis during care transitions.Yves E. Casimir, Marvelin M. Williams, Mei Y. Liang, Supawadee Pitakmongkolkul, Jason T. Slye

The effectiveness of web-based programs on the reduction of childhood obestiy in school-aged children: a systematic review

© 2012, Joanna Briggs Institute. All rights reserved. Review Objective: The objective of this review is to synthesise the best available evidence on the effectiveness of web-based programs on the reduction of childhood obesity in school age children.Flora Antwi, Natalya Fazylova, Marie-Carmel Garcon, Liliana Lopez, Rosagna Rubiano, Jason T. Slye

The effectiveness of tight glycemic control on decreasing surgical site infections and readmission rates in adult patients with diabetes undergoing cardiac surgery: a systematic review

Abstract not availableLyn Boreland, Marcia Scott-Hudson, Kathy Hetherington, Antoinette Frussinetty, Jason T. Slye