Melissa Helwig

Mapping the literature of hospital pharmacy.

OBJECTIVES This study describes the literature of hospital pharmacy and identifies the journals most commonly cited by authors in the field, the publication types most frequently cited, the age of citations, and the indexing access to core journals. The study also looks at differing citation practices between journals with a wide audience compared to a national journal with a focus on regional issues and trends in the field. METHOD Cited references from five discipline-specific source journals were collected and analyzed for publication type and age. Two sets were created for comparison. Bradfords Law of Scattering was applied to both sets to determine the most frequently cited journals. RESULTS Three-quarters of all cited items were published within the last 10 years (71%), and journal articles were the most heavily cited publication type (n=65,760, 87%). Citation analysis revealed 26 journal titles in Zone 1, 177 journal titles in Zone 2, and the remaining were scattered across 3,886 titles. Analysis of a national journal revealed Zone 1 comprised 9 titles. Comparison of the 2 sets revealed that Zone 1 titles overlapped, with the exception of 2 titles that were geographically focused in the national title. CONCLUSION Hospital pharmacy literature draws heavily from its own discipline-specific sources but equally from core general and specialty medical journals. Indexing of cited journals is complete in PubMed and EMBASE but lacking in International Pharmaceutical Abstracts. Gray literature is a significant information source in the field.

The experiences of midwives and nurses collaborating to provide birthing care: a systematic review

Background Collaboration has been associated with improved health outcomes in maternity care. Collaborative relationships between midwives and physicians have been a focus of literature regarding collaboration in maternity care. However despite the front line role of nurses in the provision of maternity care, there has not yet been a systematic review conducted about the experiences of midwives and nurses collaborating to provide birthing care. Objective The objective of this review was to identify, appraise and synthesize qualitative evidence on the experiences of midwives and nurses collaborating to provide birthing care. Specifically, the review question was: what are the experiences of midwives and nurses collaborating to provide birthing care? Inclusion criteria Types of participants This review considered studies that included educated and licensed midwives and nurses with any length of practice. Nurses who work in labor and delivery, postpartum care, prenatal care, public health and community health were included in this systematic review. Phenomena of interest This review considered studies that investigated the experiences of midwives and nurses collaborating during the provision of birthing care. Experiences, of any duration, included any interactions between midwives and nurses working in collaboration to provide birthing care. Birthing care referred to: (a) supportive care throughout the pregnancy, labor, delivery and postpartum, (b) administrative tasks throughout the pregnancy, labor, delivery and postpartum, and (c) clinical skills throughout the pregnancy, labor, delivery and postpartum. The postpartum period included the six weeks after delivery. Types of studies The review considered English language studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. Context This review considered qualitative studies that explored the experiences of collaboration in areas where midwives and nurses work together. Examples of these areas included: hospitals, birth centers, client homes, health clinics and other public or community health settings. These settings were located in any country, cultural context, or geographical location. Search strategy A three‐step search strategy was used to identify relevant published and unpublished studies. English papers from 1981 onwards were considered. The following databases were searched: Anthrosource, CENTRAL (The Cochrane Library), CINAHL, EMBASE, PsycINFO, PubMed, Social Services Abstracts and Sociological Abstracts. In addition to the databases, several grey literature sources were searched. Methodological quality Papers that were selected for retrieval were independently assessed for inclusion in the review by two JBI‐trained reviewers. The two reviewers used a standardized critical appraisal instrument from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Data extraction Qualitative data were extracted from papers included in the review using the standardized data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument. Data synthesis Once qualitative studies were assessed using the the Joanna Briggs Institute Qualitative Assessment and Review Instrument critical appraisal tool, findings of the included studies were extracted. These findings were aggregated into categories according to their similarity in meaning. These categories were then subjected to a meta‐synthesis to produce a comprehensive set of synthesized findings. Results Five studies were included in the review. Thirty‐eight findings were extracted from the included studies and were aggregated into five categories. The five categories were synthesized into two synthesized findings. The two synthesized findings were: Synthesized finding1: Negative experiences of collaboration between nurses and midwives may be influenced by distrust, lack of clear roles, or unprofessional or inconsiderate behavior. Synthesized finding 2: If midwives and nurses have positive experiences collaborating thenthere is hope that the challenges of collaboration can be overcome. Conclusions Qualitative evidence about the experiences of midwives and nurses collaborating to provide birthing care was identified, appraised and synthesized. Two synthesized findings were created from the findings of the five included studies. Midwives and nurses had negative experiences of collaboration which may be influenced by: distrust, unclear roles, or a lack of professionalism or consideration. Midwives and nurses had positive experiences of teamwork which can be a source of hope for overcoming the challenges of sharing care. There is clearly a gap in the literature about the collaborative experiences of midwives and nurses, given that only five studies were located for inclusion in the systematic review. More qualitative research exploring collaboration as a process and the interactional dynamics of midwives and nurses in a variety of practice and professional contexts is required. Implications for practice Distrust, unclear roles, and lack of professionalism and consideration must all be addressed. Strategies that address and minimize the occurrences of these three elements need to be developed and implemented in an effort to reduce negative collaborative experiences for midwives and nurses. Postive experiences of teamwork must be acknowleged and celebrated, and the challenges that sharing care present must be understood as a part of the collaborative process. Implications for research More qualitative research is required to explore the collaborative process between midwives and nurses. Further exploration of their interactional dynamics, their relationship between power and collaboration, and the experiences of collaboration in a variety of professional and practice contexts is recommended.

Experiences of emergency department nurses in providing palliative care to adults with advanced cancer: a systematic review protocol.

REVIEW QUESTIONS/OBJECTIVES The objective of this review is to explore the experiences and perceptions of emergency department nurses in providing palliative care to adults with advanced cancer so as to contribute to the developing knowledge base on this phenomenon and, in turn, inform future practice and policy changes. Specifically, the review question for this qualitative review is as follows: what are the experiences and perceptions of emergency department nurses in providing palliative care to adults with advanced cancer?

The experiences of adults with cystic fibrosis in adhering to medication regimens: a systematic review protocol

Review question/objective The review question is: What are the experiences and perceptions of adults with cystic fibrosis and their adherence to a medication regimen? Background Cystic fibrosis (CF) is an autosomal recessive genetic disease, where a child has to inherit a copy of the CF gene from both parents in order to be affected. Cystic fibrosis affects various aspects of physiological function, including fluid secretion in the glands and lining of the respiratory, gastrointestinal, and reproductive tracts. These malfunctions could result in very thick secretions leading to lung infections, malnutrition, liver disease and intestinal obstruction. To aid with secretions, individuals with CF regularly take inhaled medications to decrease the viscosity of respiratory secretions, as well as enzymes that assist with digestion. In addition, these individuals frequently receive antibiotic therapy for infections and may practice regular breathing exercises to assist with the movement of secretions. Up to one third of adults with CF will develop diabetes, which they must also learn to manage.1,2 In general, adults experience more CF complications as they grow older, which increase the complexity of their treatment regimen. Additional complications of CF include: allergic bronchopulmonary aspergillosis, distal intestinal obstruction syndrome (DIOS), hemoptysis, pneumothorax, gastroesopageal reflux disease (GERD), liver disease, portal hypertension, CF‐related arthritis/arthropathy, osteopenia/osteoporosis, nasal polyps, sinusitis, and asthma.3 Anxiety and depression are also more prevalent in the CF population.4 Patients who undergo lung transplants are faced with even more complicated regimens.5 Four thousand Canadian children have CF, and one in 3600 is born with the disease.1 These rates are similar to the US and the European Union, while CF is almost non‐existent in Asia.6 These statistics reveal that CF is the most common life‐limiting autosomal recessive genetic disease among Caucasians.7 In the 1960s, children diagnosed with CF rarely lived long enough to attend school.8 But advances in knowledge and treatment have raised life expectancy; half of the people diagnosed with CF are expected to live into their 40s, and almost 60% of the people in Canada living with CF are adults.1 A slightly higher percentage of males are affected by the disease.1 This is comparable with registry annual reports from other countries such as Australia, Belgium and the USA.9‐11 Since the majority of individuals with CF are adults, this review will focus on adults aged 18 years and over. Despite treatment advances, CF remains a life‐limiting disease that requires a complex daily regimen of preventive and therapeutic interventions, and may require weekly clinic visits, repeated consultations, and frequent hospitalizations for treatment of pulmonary exacerbations and other CF complications.12‐16 CF care is normally delivered through specialist medical centers and multidisciplinary teams that include specialist physicians, nurses, dietitians, physiotherapists, respiratory therapists, and pharmacists.3,17‐19 This review is expected to provide: findings that further understanding of how adults living with CF experience taking medication for CF or related conditions, and strategies that enhance support for adults living with CF and taking prescribed medication. Treatments Cystic fibrosis is a complex disease. Learning to manage all its aspects and treatments can be a daunting task for patients and their caregivers. Individual treatment regimens depend on the stage of the disease and the organs affected. Successful CF management involves not only rigorous daily medication regimens but also a myriad of concurrent critical therapies such as airway clearance, exercise, and nutritional treatments.3,17,18,19‐22 Lung treatments include daily medications such as antibiotics (oral, nebulized, IV) to help treat or control persistent infection, nebulized mucolytics to help break down mucus, making it easier to clear, bronchodilators to open the airways and relieve chest tightness and shortness of breath, and steroids to reduce inflammation in the airways.21 However, medications alone cannot keep CF lungs healthy. Daily airway clearance techniques (ACT) are essential to help move mucus out of the lungs (e.g. percussion and postural drainage, breathing techniques, autogenic drainage, positive expiratory pressure, high frequency chest wall oscillation and exercise). In addition, patients need to remember the recommended sequence for their lung treatments, change nebulizer sets for certain drugs, and spend time cleaning and disinfecting equipment every day. This is time consuming; however, if these treatments are not followed, there is an increased risk for infection, lung damage, and diminished lung function.22 Nutritional regimens are also critical. There is a link between body mass index and optimal lung function in people with CF.11 These treatments may include: a special diet (high caloric), pancreatic enzymes at every meal to help digest food, daily fat soluble vitamins, nutritional supplements (oral, or via tube), treatment or prevention of DIOS, increased fluids to prevent dehydration, medication for GERD.20 Many also need to perform blood glucose monitoring and insulin injections if they have CF‐related diabetes. Cystic fibrosis drastically impacts on the lives of both the affected adults and the family members who provide support and assist with disease management. Family members take on the role of policing medication and treatment regimens which can add to existing responsibilities substantially.23,12,24 Additionally, patients form partnerships with a myriad of providers, including physicians, nurses, dietitians, physiotherapists, pharmacists, respiratory therapists, social workers, and researchers.10 Despite the complexity and acuity of their disease, adults with CF are expected to become experts in their own care, manage their medications and treatments, and balance the rigorous demands that CF places on the rest of their lives.16,24‐27 This is a substantial and arduous responsibility, given the propensity of medication‐related adverse events in the Canadian health care system.28 In addition, the medications typically prescribed for these patients are pivotal to minimizing the adverse and life‐threatening effects of their disease such as malnutrition, airway constriction, reduced pulmonary function, respiratory infection, and ultimately, survival.29 Adherence The CF literature invariably reports patient non‐adherence with medications and treatments yet does not define the concept of adherence.30 A comprehensive definition was found within the concept analysis of adherence,31 with the following deemed as the most widely used: “adherence is the extent to which patients follow the instructions they are given for prescribed treatments”.31(p.635) The concept analysis described the transition from the use of the term compliance to adherence. This coincided with the World Health Organizations adoption of adherence in 2003,32 in an attempt to move away from the tone of blame imposed on patients labeled non‐compliant. The term adherence was believed to imply the patient was in agreement with the prescribed treatment and not simply following orders.31 However, Bissonnette31 noted that no definition of adherence truly recognized the patient as a partner in managing care, and called for exploration of the perceptions and understandings of individuals with CF and providers related to adherence. Adherence rates in the CF population have been studied over several decades with reports dating to the 1950s. Conway, et al.33 reported treatment compliance at 50% in adults with CF responding to a self‐report questionnaire. More recently, variations in rates by treatment have been reported, with adherence to digestive medications at 88.2%, respiratory medications at 61.8%, physiotherapy treatments at 41.2%, and nutritional supplements at 59%.34 Likewise, Latchford et al.35 reported adherence to nebulized antibiotics at around 50%. These two groups of researchers had conflicting reports of adherence by age, with Arias Llorente et al.34 reporting greater adherence in younger patients and Latchford et al.35 finding the opposite. More than a decade ago, Abbott and Gee reviewed the literature related to barriers to CF treatment adherence and grouped their findings under four categories: 1) patients reported feeling well and therefore not appreciating the need for treatment; 2) treatments interfered with the social life of people with CF; 3) treatments were too time consuming; and 4) constant treatments make people with CF feel different than others.36 Further to this, the National Collaborating Centre for Primary Care (NCCP) Guideline30 reported communication failure as a source of non‐adherence. More recent research on this topic confirms and extends this work. George et al.26 and Bregnballe et al.37 reported barriers that included treatment burden, social demands, work demands, forgetting, absence of perceived benefit, fatigue, and feeling embarrassed. Depression and anxiety have also been reported as barriers to adherence.4 Consequences of medication non‐adherence in CF are significant and well‐supported, including disease progression, increased infection rates, and increased direct (e.g. medication waste) and indirect costs (e.g. lost productivity of patients and families).36 A recent longitudinal retrospective pharmacy medication review of patients aged six and older measured adherence to respiratory medication to predict infection requiring intra‐venous (IV) antimicrobials. This study was considered to be the first to demonstrate that non‐adherence to respiratory medication can predict infectious exacerbations of CF symptoms.29 In 2010, 1,173 people with CF spent 23,146 days in hospital, and 749 courses of home IV antimicrobials were administered for respirat

Experiences of unpaid family/friend caregivers of community-dwelling adults with dementia: a systematic review protocol

REVIEW QUESTION/OBJECTIVE The objective of the review is to synthesize evidence regarding the experiences of unpaid caregivers of community-dwelling adults with dementia. Specifically, the review question is: What are the experiences and perceptions of unpaid caregivers providing care for community-dwelling adults with dementia?

Measuring Knowledge Translation Uptake Using Citation Metrics: A Case Study of a Pan-Canadian Network of Pharmacoepidemiology Researchers

ABSTRACT Collecting citation metric data is important, as research funders are increasingly demanding impact assessment, but there is limited consensus on the most rigorous and accurate approach. We compared three sources of citation counts (Google Scholar, Web of Science, Scopus) to determine their reliability, comprehensiveness, and currency. We identified each tool’s strengths and limitations, particularly when considering team outputs. Citation counts varied, with poor overall agreement: Fleiss’ kappa, 0.075 (95% CI [0.01, 0.12]). Researchers, funders, and administrators need to understand each tool’s unique strengths and limitations and develop guidelines for use within specific contexts.

The impact of transitional care programs on health services utilization among community-dwelling older adults and their caregivers: a systematic review protocol of quantitative evidence.

REVIEW QUESTION/OBJECTIVE What is the impact of transitional care programs on health services utilization among community-dwelling older adults and their caregivers?

Experiences of adults with cystic fibrosis in adhering to medication regimens: a qualitative systematic review.

BackgroundAdherence of adults with cystic fibrosis (CF) to medication regimens has been documented as problematic. Research related to adherence from the perspectives of adults with CF has been recommended for a further understanding of adherence. This review synthesized the qualitative evidence on adherence of adults with CF to medication regimens and should be of interest to healthcare providers. Review questionThe question addressed in this review is, what are the experiences and perceptions of adults with CF and their adherence to a medication regimen? Types of participantsAdults with CF who are maintaining a medication regimen. Phenomenon of interestThe phenomenon of interest of this review is the experiences and perceptions of CF-affected adults who are taking prescribed medications to treat their CF and related conditions. Types of studiesThis review included qualitative studies with the following designs: naturalistic inquiry, grounded theory, phenomenology and interpretive description. The gray literature was searched; however, no items were retained for the review. Search strategyThe search strategy used a three-step approach and was aimed at locating both published and unpublished studies. Key databases included, but were not limited to, CINAHL, PubMed and PsycINFO. The searches were not limited by date or language because we wanted to capture all existing qualitative studies related to the experiences and perceptions of adults following medication regimens. During the title and abstract screening, only English and French articles were included. Methodological qualityQualitative studies triaged for appraisal were assessed by two Joanna Briggs Institute (JBI)-certified reviewers for methodological quality before inclusion. The reviewers used the JBI critical appraisal instruments, specifically the JBI Qualitative Assessment and Review Instrument (JBI-QARI). Data extractionData were independently extracted from the studies included in the review by two reviewers using the standardized data extraction tool from JBI-QARI. Data synthesisData were synthesized using the JBI process of meta-aggregation, identification of categories and development of a synthesized finding using the JBI-QARI software and methods. ResultsEight studies were included in the review. Twenty-two findings were aggregated into four categories culminating in one synthesized finding. The synthesis revealed that adults with CF carry both a physical and a psychosocial burden to adhere to medication regimens. ConclusionAdults with CF carry a psychosocial burden to adhere to what healthcare providers expect, while trying to live a “normal” life. Consideration needs to be given to exploring with individuals what degree of adherence will assist them in maintaining health, yet be able to enjoy life.