Thane Chambers

Conservative management for female urinary incontinence and pelvic organ prolapse review 2013: Summary of the 5th International Consultation on Incontinence

The objective of the 5th International Consultation on Incontinence (ICI) chapter on Adult Conservative Management was to review and summarize the new evidence on conservative management of urinary incontinence (UI) and pelvic organ prolapse (POP) in order to compile a current reference source for clinicians, health researchers, and service planners. In this paper, we present the review highlights and new evidence on female conservative management.

Falls risk reduction and treatment of overactive bladder symptoms with antimuscarinic agents: a scoping review.

Overactive bladder (OAB) symptoms are associated with falls and fractures in older adults and treatment with antimuscarinic agents may decrease this falls risk. Bladder‐specific antimuscarinic agents may also adversely affect falls risk because of drug‐related cognitive impairment. Thus, a tension between effective treatment, falls risk reduction, and increased falls risk is created. We conducted a scoping review to determine whether sufficient studies exist to warrant a full systematic review of falls risk reduction through treatment of OAB and to identify gaps in current research.

Parenting Practices of African Immigrants in Destination Countries: A Qualitative Research Synthesis

Problem While studies have discussed the parenting practices and challenges of African immigrants, no paper has synthesized the results of these qualitative studies. We conducted a qualitative synthesis of the literature to summarize and interpret knowledge of African immigrants’ parenting practices and challenges in destination countries to identify future directions for research, policy, and practice. Eligibility We used a qualitative research synthesis method involving meta‐summary and meta‐synthesis of the literature. A research librarian assisted in searching ten databases. Two members of the research team independently reviewed 1794 articles. We included articles that: (a) reported a qualitative research study; (b) was written in English; and (c) provided the perspective of African immigrant parents on their parenting practices and/or challenges. Sample A total of 24 articles met our inclusion criteria. Results Our results indicate that parenting practices of African immigrants include the following: changes in discipline practices across transnational borders and the use of physical discipline, respect as a deeply embedded value of parenting, integration of cultural values into parenting, and integration of religious practices into parenting. We also found gender differences in parenting. Challenges faced by African immigrants in parenting their children in destination countries include lack of informal/community support, access to services and lack of formal support, cultural conflict in parenting, fear related to social services, and language barriers. Conclusion and Implications Our study identifies a need for culturally appropriate policies and practices that build on the strengths of African immigrants in destination countries while addressing their unique challenges. HighlightsAfrican immigrants integrate physical discipline, cultural values, and religious practices into their parenting practices.African immigrant parents highly value respect across generational lines.There are gendered dynamics across transnational lines that affects parenting practices.Parenting challenges include the lack support, cultural conflict in parenting, and language barrier.

Assessing cognitive function in adults during or following chemotherapy: a scoping review

PurposeThe purpose of this scoping review was to determine the feasibility of conducting a systematic review of approaches for screening or assessing cognitive function that were comprehensive and that could be incorporated into clinical settings.MethodsUsing the scoping review approach developed by Arksey and O’Malley, we searched Ovid Embase 1980-, Ovid PsycINFO 1806-, Ovid Health and Psychosocial Instruments 1985-, EBSCOhost CINAHL, ISI Web of Science (Science Citation Index 1900-), Social Sciences Citation Index 1900-, Conference Proceedings Citation Index -Science 1990-, Conference Proceedings Citation Index -Social Science & Humanities 1990-, Scopus 1960-, with no language restrictions. Searches were conducted in April 2009 and updated in February 2013. Studies of adults treated with chemotherapy that included at least seven of the eight domains of cognition were included.ResultsEleven studies met inclusion criteria. No screening tools suitable for inclusion in a clinic were identified. The studies reviewed varied by inclusion/exclusion criteria, design, and instruments for assessing cognitive function, and thus, there are not yet enough studies to warrant a systematic review on this topic.

A protocol for a systematic review of the use of process evaluations in knowledge translation research

BackgroundExperimental designs for evaluating knowledge translation (KT) interventions for professional behavior change can provide strong estimates of intervention effectiveness but offer limited insight how the intervention worked or not. Furthermore, trials provide little insight into the ways through which interventions lead to behavior change and how they are moderated by different facilitators and barriers. As a result, the ability to generalize the findings from one study to a different context, organization, or clinical problem is severely compromised. Consequently, researchers have started to explore the causal mechanisms in complementary studies (process evaluations) alongside experimental designs for evaluating KT interventions. This study focuses on improving process evaluations by synthesizing current evidence on process evaluations conducted alongside experimental designs for evaluating KT interventions.Methods/DesignA medical research librarian will develop and implement search strategies designed to identify evidence that is relevant to process evaluations in health research. Studies will not be excluded based on design. Included studies must contain a process evaluation component aimed at understanding or evaluating a KT intervention targeting professional behavior change. Two reviewers will perform study selection, quality assessment, and data extraction using standard forms. Disagreements will be resolved through discussion or third party adjudication. Data to be collected include study design, details about data collection approaches and types, theoretical influences, approaches to evaluate intervention dose delivered, intervention dose received, intervention fidelity, intervention reach, data analysis, and study outcomes. This study is not registered with PROSPERO.DiscussionThere is widespread acceptance that the generalizability of quantitative trials of KT interventions would be significantly enhanced to other contexts, health professional groups, and clinical conditions through complementary process evaluations alongside trials. This systematic review will serve as a ‘state of the science’ on methodological approaches to process evaluations and will allow us to: 1) take stock of current research approaches and 2) develop concrete recommendations for knowledge users (e.g., quality consultants and health services researchers) designing future KT process evaluations.

Economic evaluations of comprehensive geriatric assessment in surgical patients: a systematic review

BACKGROUND Seniors presenting with surgical disease face increased risk of postoperative morbidity and mortality and have increased treatment costs. Comprehensive Geriatric Assessment (CGA) is proposed to reduce morbidity, mortality, and the cost after surgery. METHODS A systematic review of CGA in emergency surgical patients was conducted. The primary outcome was cost-effectiveness; secondary outcomes were length of stay, return of function, and mortality. Inclusion and exclusion criteria were predefined. Systematic searches of MEDLINE, Embase, Cochrane, and National Health Service Economic Evaluation Database were performed. Text screening, bias assessment, and data extraction were performed by two authors. RESULTS There were 560 articles identified; abstract review excluded 499 articles and full-text review excluded 53 articles. Eight studies were included; one nonorthopedic trauma and seven orthopedic trauma studies. Bias assessment revealed moderate to high risk of bias for all studies. Economic evaluation assessment identified two high-quality studies and six moderate or low quality studies. Pooled analysis from four studies assessed loss of function; loss of function decreased in the experimental arm (odds ratio 0.92, 95% confidence interval [CI]: 0.88-0.97). Pooled results for length of stay from five studies found a significant decrease (mean difference: -1.17, 95% CI: -1.63 to -0.71) after excluding the nonorthopedic trauma study. Pooled mortality was significantly decreased in seven studies (risk ratio: 0.78, 95% CI: 0.67-0.90). All studies decreased cost and improved health outcomes in a cost-effective manner. CONCLUSIONS CGA improved return of function and mortality with reduced cost or improved utility. Our review suggests that CGA is economically dominant and the most cost-effective care model for orthogeriatric patients. Further research should examine other surgical fields.

Non-pharmacological cancer pain interventions in populations with social disparities: a systematic review and meta-analysis

IntroductionGlobal advances in pain relief have improved the quality of life of cancer populations. Yet, variation in cancer pain outcomes has been found in populations with social disparities compared to mainstream groups. Populations with social disparities bear an inequitable distribution of resources such as ethnic minorities, low income individuals, and women in vulnerable circumstances.Research purposeA systematic review and meta-analysis of the effect of non-pharmacological cancer pain interventions in cancer populations with social disparities of income, ethnicity, or gender.MethodsRandomized controlled trials, controlled trials, and before and after studies were targeted through comprehensive multidatabase searches. Two reviewers independently screened titles/abstracts for potentially relevant studies and reviewed the full text of relevant articles for inclusion. Data were extracted from included studies by one reviewer and verified by another reviewer. Four reviewers independently completed quality assessment. Studies were grouped by intervention. Effects were evaluated for heterogeneity and pooled.ResultsThe search found 5219 potential records. Full text of 26 reports was evaluated. Three randomized controlled trials (RCTs) met inclusion criteria, targeting ethnic minorities and underserved populations and/or women. Interventions included education, coaching, and online support groups. Studies found no significant differences in pain reduction between intervention and control groups or between ethnic minorities and their counterparts. A high risk of bias was found in all studies. Meta-analysis found no statistically significant difference on pain intensity among underserved groups, ethnic minorities, or between ethnic minorities and white counterparts.ConclusionResults show the need to examine supportive care interventions particularly in populations with social disparities.

Help seeking by health professionals for addiction: A mixed studies review

BACKGROUND When health professionals practice with active and untreated addiction, it is a complex occupational and professional issue impacting numerous stakeholders. Health professionals are responsive to evidence-based addiction interventions and their return-to-work has been demonstrated to be achievable, sustainable and safe. Facilitating help seeking in health professionals with addiction is a priority for reducing associated risks to their health and to patient safety. AIM The purpose of this study was to identify the process by which health professionals seek help for addiction, and factors that facilitate and deter help seeking, through a review of the qualitative and quantitative literature. METHODS Both phases of this sequential mixed studies review followed the standard systematic review steps of: (1) identifying the review question, (2) defining eligibility criteria, (3) applying an extensive search strategy, (4) independent screening of titles and abstracts, (5) selecting relevant studies based on reviewing the full text, (6) appraising the quality of included studies, and (7) synthesizing the study findings. Our two searches of five databases from 1995 to 2015 resulted in the inclusion of eight qualitative and twenty-three quantitative studies. We first conducted a meta-synthesis of the qualitative literature to garner an understanding of the help seeking process for health professionals for addiction. We then conducted a narrative synthesis of the quantitative studies to generalize these findings through examining the data for convergent, complementary or divergent results. RESULTS Synthesis of the included qualitative studies revealed that the professional and experiential context of healthcare compromised the health professionals readiness to seek help for addiction. Typically, a pivotal event initiated the help seeking process. The studies in the quantitative review identified that help seeking most often resulted from reports of adverse events to formal organizations such as their employer and regulatory bodies. This process does not adequately address the scope of health professionals requiring help for addiction. Informal sources such as colleagues and family, often aware of the addiction earlier, preferred referral to voluntary, confidential treatment programs. CONCLUSIONS Facilitating the help seeking process for health professionals with addiction in as effective strategy to reduce the associated risks to the health professional, their families and colleagues, their employers and regulatory bodies, and to the general public. Our findings suggest that intervention is possible at multiple points in the help seeking process for health professionals with addiction. Confidential, compassionate and supportive alternatives offer potential for closing this gap.

A metasynthesis study of family caregivers’ transition experiences caring for community-dwelling persons with advanced cancer at the end of life:

Background: Family caregivers (broadly defined as family and friends) experience multiple concurrent transitions when caring for a person with advanced cancer. Aims: To (a) explore the transition experience of family caregivers caring for persons with advanced cancer living in the community, (b) describe potential triggers for transitions, (c) identify what influences this experience, and (d) develop a conceptual framework of their transition experience. Design: Sandelowski and Barroso’s methodology for synthesizing qualitative research included (a) a comprehensive search of empirical literature, (b) quality appraisal of qualitative studies, (c) classification of studies, and (d) synthesis of the findings. Data sources: Literature was sourced from six electronic data bases. Inclusion criteria were as follows: (a) published qualitative studies (and mixed-method designs) of the caregiving experience of family caregivers of community-living persons with advanced cancer at the end of life, (b) participants (caregivers and care recipients) of 18 years of age and above, (c) studies published in English in any country, and (d) studies published between 2004 and 2014. Results: A total of 72 studies were included in the metasynthesis. Family caregivers experience a “life transition” whereby their lives are permanently altered. The participants described the process of redefining normal which consisted of coming to terms with their situation and connecting with others. Outcomes of these processes were as follows: (a) maintaining a sense of personhood, (b) reframing hope, (c) maintaining self-efficacy, (d) finding meaning, and (e) preparing for the death of their care recipient. Conclusion: The findings provide a framework to guide the development of supportive programs and future research.

The Care of Older Adults Experiencing Cognitive Challenges: How Interprofessional Teams Collaborate

ABSTRACT: We conducted a scoping study to examine how interprofessional health care teams improve the outcomes of older adults experiencing cognitive challenges. We searched Ovid, Medline 1946, and MEDLINE In-Process and other non-indexed citations, using the concepts multi or interdisciplinary care teams, confusion or cognitive impairment, and elderly adults. Of 4,554 articles the review yielded, 34 relevant to our inquiry, using Arksey and O’Malley’s methodological framework. Twenty-nine per cent of authors reported on the processes interprofessional teams use to achieve positive outcomes for older adults. They highlighted the importance of communication, staff strategies, and education interventions in achieving outcomes with older adults and in supporting interprofessional collaboration. The review revealed knowledge gaps about the processes teams use to collaborate in caring for older adults experiencing cognitive challenges, and how to best incorporate older adults and their families’ perspectives in team decisions. More research to understand processes interprofessional teams use is needed. RÉSUMÉ: Nous avons réalisé un examen de portée pour évaluer comment les équipes interprofessionnelles en santé permettent d’améliorer l’état de santé de personnes âgées affectées par des défis cognitifs. Nous avons effectué notre recherche dans les bases Ovid, Medline 1946 et MEDLINE In-Process & other non-indexed citations, en utilisant trois principaux concepts : équipes de soins multidisciplinaires ou interdisciplinaires, confusion ou trouble cognitif, personnes âgées. L’examen de portée a rassemblé 4554 articles. Le cadre méthodologique d’Arksey et O’Malley’s a été utilisé pour examiner 34 articles jugés pertinents pour le sujet à l’étude. Bien que 71 % des auteurs n’ont pas rapporté les processus utilisés par les équipes interprofessionnelles pour atteindre des résultats positifs chez les personnes âgées affectées par des défis cognitifs, cela a été réalisé par 29 % des auteurs, qui ont souligné l’importance de la communication, des stratégies d’implication du personnel et des formations pour appuyer la réussite des soins sur le plan des résultats escomptés chez les personnes âgées et pour fournir un soutien adéquat pour la collaboration interprofessionnelle. L’examen de portée a mis en évidence des lacunes dans les connaissances actuelles concernant les processus utilisés par les équipes interprofessionnelles pour collaborer en vue de la prestation de soins aux personnes âgées affectées par des défis cognitifs, et les défis de l’incorporation optimale des perspectives des personnes âgées et de leur famille dans les décisions d’équipe. Davantage d’études sont nécessaires pour comprendre les processus utilisés par les équipes interprofessionnelles dans le cadre de la communication entre les membres de l’équipe, mais aussi pour celle liée aux autres cliniciens, aux personnes âgées et à leur famille.