Recruiting and engaging new mothers in nutrition research studies: lessons from the Australian NOURISH randomised controlled trial

Background: Despite important implications for the budgets, statistical power and generalisability of research findings, detailed reports of recruitment and retention in randomised controlled trials (RCTs) are rare. The NOURISH RCT evaluated a community-based intervention for first-time mothers that promoted protective infant feeding practices as a primary prevention strategy for childhood obesity. The aim of this paper is to provide a detailed description and evaluation of the recruitment and retention strategies used. Methods: A two stage recruitment process designed to provide a consecutive sampling framework was used. First time mothers delivering healthy term infants were initially approached in postnatal wards of the major maternity services in two Australian cities for consent to later contact (Stage 1). When infants were about four months old mothers were re-contacted by mail for enrolment (Stage 2), baseline measurements (Time 1) and subsequent random allocation to the intervention or control condition. Outcomes were assessed at infant ages 14 months (Time 2) and 24 months (Time 3). Results: At Stage 1, 86% of eligible mothers were approached and of these women, 76% consented to later contact. At Stage 2, 3% had become ineligible and 76% could be recontacted. Of the latter, 44% consented to full enrolment and were allocated. This represented 21% of mothers screened as eligible at Stage 1. Retention at Time 3 was 78%. Mothers who did not consent or discontinued the study were younger and less likely to have a university education. Conclusions: The consent and retention rates of our sample of first time mothers are comparable with or better than other similar studies. The recruitment strategy used allowed for detailed information from non-consenters to be collected; thus selection bias could be estimated. Recommendations for future studies include being able to contact participants via mobile phone (particular text messaging), offering home visits to reduce participant burden and considering the use of financial incentives to support participant retention

The role for osmotic agents in children with acute encephalopathies: a systematic review

Background: Raised intracranial pressure (ICP) is known to complicate both traumatic and non-traumatic encephalopathies. It impairs cerebral perfusion and may cause death due to global ischaemia and intracranial herniation. Osmotic agents are widely used to control ICP. In children, guidelines for their use are mainly guided by adult studies. We conducted this review to determine the current evidence of the effectiveness of osmotic agents and their effect on resolution of coma and outcome in children with acute encephalopathy.Methods: We searched several databases for published and unpublished studies in English and French languages, between January 1966 and March 2009. We considered studies on the use of osmotic agents in children aged between 0 and 16 years with acute encephalopathies. We examined reduction in intracranial pressure, time to resolution of coma, and occurrence of neurological sequelae and death.Results: We identified four randomized controlled trials, three prospective studies, two retrospective studies and one case report. Hypertonic saline (HS) achieved greater reduction in intracranial pressure (ICP) compared to mannitol and other fluids; normal saline or ringer's lactate. This effect was sustained for longer when it was given as continuous infusion. Boluses of glycerol and mannitol achieved transient reduction in ICP. Oral glycerol was associated with lower mortality and neurological sequelae when compared to placebo in children with acute bacterial meningitis. HS was associated with lower mortality when compared to mannitol in children with non-traumatic encephalopathies.Conclusion: HS appears to achieve a greater reduction in ICP than other osmotic agents. Oral glycerol seems to improve outcome among children with acute bacterial meningitis. A sustained reduction in ICP is desirable and could be achieved by modifying the modes and rates of administration of these osmotic agents, but these factors need further investigation

Restraint removal: tension between protective custody and human rights

Aims and objectives.  To describe the culture of an aged care facility relating to restraint use and provide insight into the process of changing to minimal restraint care. Background.  In 1999, the accreditation process for residential aged care facilities (This term has been used in Australia since around 1997 and replaces the terms ‘nursing homes’ and ‘hostels’) in Australia was extended to include a review of restraint use, with the view to minimization. As using restraint had traditionally been viewed as acceptable, it was expected that there would be tensions involved for staff making the transition to providing minimal restraint care. Design.  The research was situated within the qualitative paradigm and guided by symbolic interactionism, grounded theory, and case study. Methods.  Data were collected through observation of instances of restraint, individual interviews with staff, and document analysis. Results.  The transition to minimal restraint care was associated with tensions for staff. Whilst efforts had been made to make the facility restraint-free, bedrails were still in evidence, and were not necessarily viewed by staff as constituting restraint. Conclusions.  Nurses may experience a tension between human rights and duty of care when adopting restraint-minimization practices. Relevance to clinical practice.  Tensions may be alleviated by adopting a universal definition of restraint, acquiring physical resources and new skills in care delivery and modifying staff, resident and family attitudes towards the delivery of care

A systematic review of topical skin care in aged care facilities

This systematic review aimed to evaluate the best available evidence regarding the effectiveness of topical skin care interventions for residents of aged care facilities. Introduction. Natural changes to skin, as well as increased predisposition to pressure sores and incontinence, means residents of aged care facilities readily require topical skin care. A range of interventions exist that aim to maintain or improve the integrity of skin of older adults. Methods. Pubmed, Embase, Current Contents, CINAHL and The Cochrane Library databases were searched, as well as Health Technology Assessment websites up to April 2003. Systematic reviews and randomized or non-randomized controlled trials were evaluated for quality and data were independently extracted by two reviewers. Results. The effectiveness of topical skin interventions was variable and dependent on the skin condition being treated. Studies examined the effectiveness of washing products on incontinence irritated skin. Disposable bodyworns may prevent deterioration of skin condition better than non-disposable underpads or bodyworns. Clinisan, a no-rinse cleanser may reduce the incidence of incontinence associated pressure ulcers when compared with soap and water. Conclusion. In general the quality of evidence for interventions to improve or maintain the skin condition in the older person was poor and more research in this area is needed. Relevance to Clinical Practice. Skin care is a major issue for nurses working with older people. On the basis of this review no clear recommendations can be made. This lack of strong evidence for nurses to base effective practice decisions is problematic. However, the 'best' evidence suggests that disposable bodyworns are a good investment in the fight against skin deterioration. No rinse cleansers are to be preferred over soap and the use of the bag bath appears to be a useful practice to reduce the risk of dry skin ( a risk factor for breaches in skin integrity)

Appropriateness of using a symbol to identify dementia and/or delirium

Background Alzheimer’s Australia contracted the Dementia Collaborative Research Centre – Consumers, Carers and Social Research to conduct a systematic review to explore the appropriateness of a symbol for dementia. The concept of a symbol for people with dementia was an outcome of the Alzheimer’s Australia National Consumer Summit on Dementia held in Canberra in October 2005. People living with dementia and their carers identified that a national symbol would be helpful in order to encourage appropriate treatment of people with dementia. Funding was provided as part of the Australian Government’s Dementia Initiative to Alzheimer’s Australia to work in collaboration with the Queensland University of Technology and Catholic Health Australia to explore, through research, the viability and potential impact of such a symbol in a range of care settings. Objectives The main objective of this systematic review was to evaluate any published and unpublished evidence regarding the appropriateness of developing a symbol for dementia and/or delirium, which could be used in a variety of settings to indicate that a person has dementia and/or delirium. Search strategy A literature search was performed using the following databases: Ageline, APAIS Health, CINAHL, Dissertations and Theses Abstracts, Embase, MEDLINE, PsycEXTRAS, PsycINFO, PsycArticles, Current Contents, LegalTrac,Health and Society, Sociological Abstracts, Family and Society, CINCH, and Hein Online databases. The reference lists of articles retrieved were hand searched, as well as a range of literature from health, legal, ethical and emergency services. Grey literature was searched for using a number of Internet sites, and personal email communication with authors of relevant studies and known researchers in the field was initiated. Selection criteria Papers were retrieved if they provided information about attitudes or perceptions towards the appropriateness of symbols, identifiers or alerts used to inform others that someone has dementia, delirium and/or another medical condition or functional impairment. Any references to symbols, identifiers or alerts being used to indicate a particular type of service were also considered. Data collection and analysis Retrieved papers were critically appraised by two reviewers, using tools developed by the Joanna Briggs Institute. Due to the type and clinical heterogeneity of papers retrieved, meta-analysis was not possible, and a narrative summary was developed instead. Findings The systematic review revealed that several different symbols and identifiers are in current use, in various parts of the world, to represent a range of medical and functional conditions, including dementia, delirium, falls risk, diabetes, and vision impairment. According to the papers reviewed, the most commonly used colour of symbols representing dementia was blue. There was general consensus amongst the literature that a symbol for dementia is appropriate in the acute care setting. It was also clear from the research that an abstract symbol, as opposed to one which explicitly attempts to depict dementia, was most acceptable to staff, people with dementia and their carers. There appeared to be some support for the use of a body worn symbol (on a bracelet) for people with dementia who may go missing from their home, aged care facility or day centre. Future research should concentrate on the appropriateness of a dementia symbol for commonly used services such as public transport and banking, and the acceptability of large scale marketing campaigns if a dementia symbol were to be introduced at a state or national level. In addition, further research is recommended into the acceptability of such a symbol across a wide range of different cultural and linguistic groups

Appropriateness of using a symbol to identify dementia and/or delirium: a systematic review

Background Alzheimer’s Australia contracted the Dementia Collaborative Research Centre – Consumers, Carers and Social Research to conduct a systematic review to explore the appropriateness of a symbol for dementia. The concept of a symbol for people with dementia was an outcome of the Alzheimer’s Australia National Consumer Summit on Dementia held in Canberra in October 2005. People living with dementia and their carers identified that a national symbol would be helpful in order to encourage appropriate treatment of people with dementia. Funding was provided as part of the Australian Government’s Dementia Initiative to Alzheimer’s Australia to work in collaboration with the Queensland University of Technology and Catholic Health Australia to explore, through research, the viability and potential impact of such a symbol in a range of care settings. Objectives The main objective of this systematic review was to evaluate any published and unpublished evidence regarding the appropriateness of developing a symbol for dementia and/or delirium, which could be used in a variety of settings to indicate that a person has dementia and/or delirium. Search strategy A literature search was performed using the following databases: Ageline, APAIS Health, CINAHL, Dissertations and Theses Abstracts, Embase, MEDLINE, PsycEXTRAS, PsycINFO, PsycArticles, Current Contents, LegalTrac, Health and Society, Sociological Abstracts, Family and Society, CINCH, and Hein Online databases. The reference lists of articles retrieved were hand searched, as well as a range of literature from health, legal, ethical and emergency services. Grey literature was searched for using a number of Internet sites, and personal email communication with authors of relevant studies and known researchers in the field was initiated. Selection criteria Papers were retrieved if they provided information about attitudes or perceptions towards the appropriateness of symbols, identifiers or alerts used to inform others that someone has dementia, delirium and/or another medical condition or functional impairment. Any references to symbols, identifiers or alerts being used to indicate a particular type of service were also considered. Data collection and analysis Retrieved papers were critically appraised by two reviewers, using tools developed by the Joanna Briggs Institute. Due to the type and clinical heterogeneity of papers retrieved, meta-analysis was not possible, and a narrative summary was developed instead. Findings The systematic review revealed that several different symbols and identifiers are in current use, in various parts of the world, to represent a range of medical and functional conditions, including dementia, delirium, falls risk, diabetes, and vision impairment. According to the papers reviewed, the most commonly used colour of symbols representing dementia was blue. There was general consensus amongst the literature that a symbol for dementia is appropriate in the acute care setting. It was also clear from the research that an abstract symbol, as opposed to one which explicitly attempts to depict dementia, was most acceptable to staff, people with dementia and their carers. There appeared to be some support for the use of a body worn symbol (on a bracelet) for people with dementia who may go missing from their home, aged care facility or day centre. Future research should concentrate on the appropriateness of a dementia symbol for commonly used services such as public transport and banking, and the acceptability of large scale marketing campaigns if a dementia symbol were to be introduced at a state or national level. In addition, further research is recommended into the acceptability of such a symbol across a wide range of different cultural and linguistic groups

Oral liquid nutritional supplements for people with dementia in residential aged care facilities: a systematic review

This systematic review investigated the prescription, administration and effectiveness of oral liquid nutritional supplements (OLNS) for people with dementia in residential aged care facilities (RACF). Dementia is an umbrella term for a large group of conditions that cause a progressive decline in a person’s functioning. There are different forms of dementia and each has its own causes [1]. Residents with Alzheimer’s disease and dementia are particularly vulnerable to malnutrition and weight loss [2] because of increased energy demands due to pacing or wandering; food refusal due to lack of appetite, agitation or memory loss [3]; or physical deterioration leading to inability to self-feed, chew or swallow, though these symptoms are not unique to persons with dementia. Maintaining adequate nutrition for persons with dementia in residential care, in the context of these special needs, presents an increased challenge. A comprehensive search of relevant databases, hand searching and cross- referencing found 15 relevant articles from a total of 2910 possible results. Included studies examined a range of strategies, issues and results related to OLNS for persons with dementia in RACFs; however there appear to be significant gaps in the current body of research, particularly in relation to examinations of effectiveness. Thus, this review was unable to produce a definitive finding regarding effectiveness. Main findings Prescription of OLNS OLNS are most frequently prescribed by physicians, but also on occasion by dieticians. Poor oral intake and weight loss are the most common reasons for OLNS prescription. Most studies do not specify which OLNS brands are prescribed. OLNS may be more effective when given with medications rather than with food. There is little investigation of the reasons for weight loss before OLNS are prescribed Administration of OLNS Families seem to prefer that RACF providers use other strategies to address poor intake before having OLNS prescribed OLNS are ordered daily, three times per day, or four times per day, though they are not always provided to the person with dementia as per the order. There is evidence to suggest that staff assistance is an important factor in residents’ consumption of OLNS Medication rounds (medication pass routines) for giving OLNS may decrease wastage and increase consumption Studies that address administration timing of OLNS generally recommend between-meals administration A significant amount of the administered OLNS is never actually consumed by the person with dementia Assistance should be given to physically impaired residents to aid OLNS intake Effectiveness of OLNS There is no evidence that OLNS has an effect on the morbidity and mortality of people with dementia in RACFs. There is no evidence that OLNS has an effect on the functional status of people with dementia in RACFs. There is very slight evidence to suggest that OLNS may increase the energy intake of people with dementia in RACFs. There is some evidence that OLNS may promote increases in the body weight of people with dementia in RACFs however further research is needed. There is some evidence to suggest OLNS may improve the nutritional status and anthropometry of people with dementia in RACFs. There is very slight evidence that OLNS may arrest declines in the cognitive status of people with dementia in RACFs. There is no evidence that OLNS has any effect on the bowel function of people with dementia in RACFs. Conclusion From this systematic review it is clear that further research is required into the prescription, administration and effectiveness of OLNS. No definitive evidence of effectiveness for OLNS was found. However, our findings suggest that if administered with care and assistance and prescribed after investigation of the reasons for weight loss TRUNCATED AT 600 WORDS

Oral liquid nutritional supplements for people with dementia in residential aged care facilities

AIM: \ud \ud This systematic review investigated the prescription, administration and effectiveness of oral liquid nutritional supplements (OLNS) for people with dementia in residential aged care facilities (RACF).\ud \ud METHODS: \ud \ud A comprehensive search of relevant databases, hand searching and cross-referencing found 15 relevant articles from a total of 2910 possible results. Articles which met the inclusion criteria were critically appraised by two independent reviewers using the relevant Joanna Briggs Institute (JBI) appraisal checklist. Data were extracted using the relevant JBI extraction instruments. No data synthesis was possible due to clinical and methodological heterogeneity.\ud \ud RESULTS: \ud \ud Included studies examined a range of strategies, issues and results related to OLNS for persons with dementia in RACFs; however there appear to be significant gaps in the current body of research, particularly in relation to examinations of effectiveness.\ud \ud CONCLUSIONS: \ud \ud This review was unable to produce a definitive finding regarding effectiveness. OLNS may improve the nutritional state of residents with dementia and help prevent weight loss, and there is some suggestion that it may slow the rate of cognitive decline. However, in order for OLNS to be effective, nursing and care staff need to ensure that sufficient attention is paid to the issues of prescription and administration