Michelle Maden

Systematic review of systematic reviews for the management of urinary incontinence and promotion of continence using conservative behavioural approaches in older people in care homes.

AIM To synthesize evidence from systematic reviews on the management of urinary incontinence and promotion of continence using conservative/behavioural approaches in older people in care homes to inform clinical practice, guidelines and research. BACKGROUND Incontinence is highly prevalent in older people in care home populations. DESIGN Systematic review of systematic reviews with narrative synthesis. DATA SOURCES Electronic searches of published systematic reviews in English using MEDLINE and CINAHL with no date restrictions up to September 2013. Searches supplemented by hand searching and electronic searching of Cochrane Library and PROSPERO. REVIEW METHODS PRISMA statement was followed, as were established methods for systematic review of systematic reviews. RESULTS Five systematic reviews of high quality were included, three specific to intervention studies and two reviewed descriptive studies. Urinary incontinence was the primary outcome in three reviews with factors associated with the management of urinary incontinence the primary outcome for the other reviews. CONCLUSION Toileting programmes, in particular prompted voiding, with use of incontinence pads are the main conservative behavioural approach for the management of incontinence and promotion of continence in this population with evidence of effectiveness in the short term. Evidence from associated factors; exercise, mobility, comorbidities, hydration, skin care, staff perspectives, policies and older peoples experiences and preference are limited. The majority of evidence of effectiveness are from studies from one country which may or may not be transferable to other care home populations. Future international studies are warranted of complex combined interventions using mixed methods to provide evidence of effectiveness, context of implementation and economic evaluation.Aim To synthesize evidence from systematic reviews on the management of urinary incontinence and promotion of continence using conservative/behavioural approaches in older people in care homes to inform clinical practice, guidelines and research. Background Incontinence is highly prevalent in older people in care home populations. Design Systematic review of systematic reviews with narrative synthesis. Data sources Electronic searches of published systematic reviews in English using MEDLINE and CINAHL with no date restrictions up to September 2013. Searches supplemented by hand searching and electronic searching of Cochrane Library and PROSPERO. Review methods PRISMA statement was followed, as were established methods for systematic review of systematic reviews. Results Five systematic reviews of high quality were included, three specific to intervention studies and two reviewed descriptive studies. Urinary incontinence was the primary outcome in three reviews with factors associated with the management of urinary incontinence the primary outcome for the other reviews. Conclusion Toileting programmes, in particular prompted voiding, with use of incontinence pads are the main conservative behavioural approach for the management of incontinence and promotion of continence in this population with evidence of effectiveness in the short term. Evidence from associated factors; exercise, mobility, comorbidities, hydration, skin care, staff perspectives, policies and older peoples experiences and preference are limited. The majority of evidence of effectiveness are from studies from one country which may or may not be transferable to other care home populations. Future international studies are warranted of complex combined interventions using mixed methods to provide evidence of effectiveness, context of implementation and economic evaluation.

How do respiratory patients perceive oxygen therapy? A critical interpretative synthesis of the literature

Oxygen therapy is a common intervention in health care worldwide; yet, despite universal use, it is evident through poor practice that oxygen is often prescribed and administered injudiciously. It is proposed that possibly an influencing culture presides, whereby oxygen is often poorly understood and uncertainty regarding its use exists. It is unclear where the origins of this culture lie but exploring perceptions may enlighten the problem. A review of the literature was undertaken to establish what is already known about this elusive phenomenon. The paucity of any direct evidence regarding perceptions of oxygen directed the review to utilize a critical interpretative synthesis (CIS). The aim of this study was to explore how respiratory patients perceive oxygen therapy. A systematic search in Medline, Cinahl, Embase, British Nursing Index and PsychInfo yielded 1514 studies of which 42 were selected to consider the review question. The CIS allowed evidence from across studies to synthesize existing and new interpretations of data related to patients’ perceptions of oxygen therapy. Synthetic constructs then informed the synthesizing arguments, namely positive – feeling safe, enabler and comforter; negative – fear, oxygen versus self, restriction and embarrassment; and impartiality – mixed blessings. The findings are divergent, and at times contradictory. There appears uncertainty among patients regarding the purpose and benefits of oxygen therapy, though an underlying faith in health-care professionals is apparent. This faith seems to foster acceptance of a life-changing therapy, despite the impact, burden and incomplete understanding. There is a clear need for further research regarding these elusive perceptions in order to improve clinical practice in respect of oxygen.

How do health-care professionals perceive oxygen therapy? A critical interpretive synthesis of the literature

Oxygen is one of the commonest health-care interventions worldwide. This might suggest that health-care professionals (HCPs) would be knowledgeable and familiar with its uses and limitations. Yet it is apparent, through clinical audit, that oxygen is probably misunderstood by many HCPs. The aim of this critical interpretive synthesis (CIS) is to explore qualitative and quantitative literature in relation to HCPs beliefs and perceptions of oxygen therapy. A systematic search in Medline, Cinahl, Embase, British Nursing Index and PsychInfo using search terms, such as, oxygen therapy, chronic respiratory disease, HCPs and perceptions yielded 1514 studies of which 12 contained data relevant to the review question. Two reviewers independently screened the articles for eligibility against inclusion and exclusion criteria, and data were selected and synthesized with an integrative and interpretive approach using CIS. This allowed diverse empirical evidence to be synthesized to develop existing and new interpretations of data.Three synthetic constructs were interpreted from the available literature, namely, oxygen for symptom relief, levels of knowledge and understanding and oxygen as a therapy for HCPs. The literature alludes to deep-seated beliefs that exist. In order to enhance practice, these beliefs and cultures need to be challenged. Further research is needed to explore HCPs’ perceptions of oxygen therapy in order to inform the seemingly resistant adoption of evidence based practice in relation to oxygen.

The impact of clinical librarian services on patients and health care organisations.

BACKGROUND Systematic reviews have found limited evidence of effectiveness and impact of clinical librarians (CLs) due to the poor quality of reporting, scale and design of previous studies. OBJECTIVES To measure specific CL impact on organisational and patient outcomes using a robust approach that helps CLs develop research skills. METHODS Questionnaire and interviews. RESULTS Clinical librarians contribute to a wide range of outcomes in the short and longer term reflecting organisational priorities and objectives. These include direct contributions to choice of intervention (36%) diagnosis (26%) quality of life (25%), increased patient involvement in decision making (26%) and cost savings and risk management including avoiding tests, referrals, readmissions and reducing length of stay (28%). DISCUSSION Interventions provided by CLs are complex and each contributes to multiple outcomes of importance to health care organisations. CONCLUSION This study is unique in taking a wide view of potential and specific impacts to which CLs contribute across health care organisations. It is the largest UK evaluation of CL services to date and demonstrates CLs affect direct patient care, improve quality and save money. Future researchers are urged to use the tools presented to collect data on the same outcomes to build a significant and comprehensive international evidence base about the effectiveness and impact of clinical librarian services.

Consideration of health inequalities in systematic reviews: a mapping review of guidance

BackgroundGiven that we know that interventions shown to be effective in improving the health of a population may actually widen the health inequalities gap while others reduce it, it is imperative that all systematic reviewers consider how the findings of their reviews may impact (reduce or increase) on the health inequality gap. This study reviewed existing guidance on incorporating considerations of health inequalities in systematic reviews in order to examine the extent to which they can help reviewers to incorporate such issues.MethodsA mapping review was undertaken to identify guidance documents that purported to inform reviewers on whether and how to incorporate considerations of health inequalities. Searches were undertaken in Medline, CINAHL and The Cochrane Library Methodology Register. Review guidance manuals prepared by international organisations engaged in undertaking systematic reviews, and their associated websites were scanned. Studies were included if they provided an overview or discussed the development and testing of guidance for dealing with the incorporation of considerations of health inequalities in evidence synthesis. Results are summarised in narrative and tabular forms.ResultsTwenty guidance documents published between 2009 and 2016 were included. Guidance has been produced to inform considerations of health inequalities at different stages of the systematic review process. The Campbell and Cochrane Equity Group have been instrumental in developing and promoting such guidance. Definitions of health inequalities and guidance differed across the included studies. All but one guidance document were transparent in their method of production. Formal methods of evaluation were reported for six guidance documents. Most of the guidance was operationalised in the form of examples taken from published systematic reviews. The number of guidance items to operationalise ranges from 3 up to 26 with a considerable overlap noted.ConclusionsAdhering to the guidance will require more work for the reviewers. It requires a deeper understanding of how reviewers can operationalise the guidance taking into consideration the barriers and facilitators involved. This has implications not only for understanding the usefulness and burden of the guidance but also for the uptake of guidance and its ultimate goal of improving health inequalities considerations in systematic reviews.

Use of programme theory to understand the differential effects of interventions across socio-economic groups in systematic reviews—a systematic methodology review

BackgroundSystematic review guidance recommends the use of programme theory to inform considerations of if and how healthcare interventions may work differently across socio-economic status (SES) groups. This study aimed to address the lack of detail on how reviewers operationalise this in practice.MethodsA methodological systematic review was undertaken to assess if, how and the extent to which systematic reviewers operationalise the guidance on the use of programme theory in considerations of socio-economic inequalities in health. Multiple databases were searched from January 2013 to May 2016. Studies were included if they were systematic reviews assessing the effectiveness of an intervention and included data on SES. Two reviewers independently screened all studies, undertook quality assessment and extracted data. A narrative approach to synthesis was adopted.ResultsA total of 37 systematic reviews were included, 10 of which were explicit in the use of terminology for ‘programme theory’. Twenty-nine studies used programme theory to inform both their a priori assumptions and explain their review findings. Of these, 22 incorporated considerations of both what and how interventions do/do not work in SES groups to both predict and explain their review findings. Thirteen studies acknowledged 24 unique theoretical references to support their assumptions of what or how interventions may have different effects in SES groups. Most reviewers used supplementary evidence to support their considerations of differential effectiveness. The majority of authors outlined a programme theory in the “Introduction” and “Discussion” sections of the review to inform their assumptions or provide explanations of what or how interventions may result in differential effects within or across SES groups. About a third of reviews used programme theory to inform the review analysis and/or synthesis. Few authors used programme theory to inform their inclusion criteria, data extraction or quality assessment. Twenty-one studies tested their a priori programme theory.ConclusionsThe use of programme theory to inform considerations of if, what and how interventions lead to differential effects on health in different SES groups in the systematic review process is not yet widely adopted, is used implicitly, is often fragmented and is not implemented in a systematic way.

A systematic evidence synthesis of interventions to engage children and young people in health care consultations about their long-term condition.

Children and young people with long-term conditions are not always provided with opportunities to engage fully in consultations. This systematic review examined the effectiveness or worth of methods used to engage children and young people with long-term conditions in their consultations. Searches were undertaken in October 2016 in eight databases and of the grey literature. Two reviewers independently screened the results, extracted data and assessed the quality of the studies using a validated and reliable checklist. A narrative synthesis of mixed method data was undertaken. Twelve studies were included in the review. Interventions used to engage children and young people mainly focused on face-to-face outpatient consultations, with an emphasis on diabetes and asthma. Most of the interventions focused on either improving health professionals’ communication skills or encouraging children’s and young people’s engagement through providing condition-related information or a structured way to be included in consultations. Fewer interventions were child-led or directed towards developing children’s and young people’s skills to become key reporters of their condition. This review has demonstrated that interventions targeted at children and young people with long-term conditions can improve their levels of engagement in consultations. There is a need for more systematic development and robust evaluation of interventions to improve children’s active participation in consultations.

Management of Fecal Incontinence in Older People With Dementia Resident in Care Homes: : A Realist Synthesis-The FINCH Study

This document is the Accepted Manuscript version of the Editorial to Journal of the American Medical Directors Association, Vol. 198 (9):750-751. Under embargo. Embargo end date: 21 July 2018. The published version is available online at doi: https://doi.org/10.1016/j.jamda.2017.06.001. Crown Copyright

Delivering a MOOC for literature searching in health libraries: evaluation of a pilot project

In an era when library budgets are being reduced, Massive Online Open Courses (MOOCs) can offer practical and viable alternatives to the delivery of costly face-to-face training courses. In this study, guest writers Gil Young from Health Care Libraries Unit - North, Lisa McLaren from Brighton and Sussex Medical School and Liverpool University PhD student Michelle Maden describe the outcomes of a funded project they led to develop a MOOC to deliver literature search training for health librarians. Funded by Health Education England, the MOOC was developed by the Library and Information Health Network North West as a pilot project that ran for six weeks. In particular, the MOOC target audience is discussed, how content was developed for the MOOC, promotion and participation, cost-effectiveness, evaluation, the impact of the MOOC and recommendations for future development. H. S.

Evaluating Approaches to Quality Assessment in Library and Information Science LIS Systematic Reviews: A Methodology Review

Objective – Systematic reviews are becoming increasingly popular within the Library and Information Science (LIS) domain. This paper has three aims: to review approaches to quality assessment in published LIS systematic reviews in order to assess whether and how LIS reviewers report on quality assessment a priori in systematic reviews, to model the different quality assessment aids used by LIS reviewers, and to explore if and how LIS reviewers report on and incorporate the quality of included studies into the systematic review analysis and conclusions. Methods – The authors undertook a methodological study of published LIS systematic reviews using a known cohort of published systematic reviews of LIS-related research. Studies were included if they were reported as a “systematic review” in the title, abstract, or methods section. Meta-analyses that did not incorporate a systematic review and studies in which the systematic review was not a main objective were excluded. Two reviewers independently assessed the studies. Data were extracted on the type of synthesis, whether quality assessment was planned and undertaken, the number of reviewers involved in assessing quality, the types of tools or criteria used to assess the quality of the included studies, how quality assessment was assessed and reported in the systematic review, and whether the quality of the included studies was considered in the analysis and conclusions of the review. In order to determine the quality of the reporting and incorporation of quality assessment in LIS systematic reviews, each study was assessed against criteria relating to quality assessment in the PRISMA reporting guidelines for systematic reviews and meta-analyses (Moher, Liberati, Tetzlaff, Altman, & The PRISMA Group, 2009) and the AMSTAR tool (Shea et al., 2007). Results – Forty studies met the inclusion criteria. The results demonstrate great variation on the breadth, depth, and transparency of the quality assessment process in LIS systematic reviews. Nearly one third of the LIS systematic reviews included in this study did not report on quality assessment in the methods, and less than one quarter adequately incorporated quality assessment in the analysis, conclusions, and recommendations. Only nine of the 26 systematic reviews that undertook some form of quality assessment incorporated considerations of how the quality of the included studies impacted on the validity of the review findings in the analysis, conclusion, and recommendations. The large number of different quality assessment tools identified reflects not only the disparate nature of the LIS evidence base (Brettle, 2009) but also a lack of consensus around criteria on which to assess the quality of LIS research. Conclusion – Greater clarity, definition, and understanding of the methodology and concept of “quality” in the systematic review process are required not only by LIS reviewers but also by editors of journals in accepting such studies for publication. Further research and guidance is needed on identifying the best tools and approaches to incorporate considerations of quality in LIS systematic reviews. LIS reviewers need to improve the robustness and transparency with which quality assessment is undertaken and reported in systematic reviews. Above all, LIS reviewers need to be explicit in coming to a conclusion on how the quality of the included studies may impact on their review findings.