Evidence for Nursing: new evidence and resources – Autumn 2020

The latest evidence and resources for nurses and clinical support workers. You can either scroll through this page, or click on the topics below to jump straight to a particular section.

COVID-19

Care of pre-term infants

Central venous catheter management

Chronic Kidney Disease

Healthcare worker safety and wellbeing

Older adults and medication-taking ability and adherence

Organisation and delivery of care

Stroke

Respiratory health

Women’s health

Coming up…

Cochrane is producing reviews and resources for the COVID-19 pandemic. We have blogged about many of them and this blog Cochrane evidence on COVID-19: a round-up brings together a large collection of evidence and resources, starting from when this evidence was first being produced in spring 2020. Like the reviews themselves, all our blogs are updated to reflect new evidence.

You may be interested in our blog Personal protective equipment (PPE) for healthcare workers: new Cochrane evidence which discusses the evidence from two Cochrane Reviews and some innovative ideas.

Take-home points • An updated review and a new rapid review on PPE have been produced as part of Cochrane’s organizational effort to meet the need for up-to-date summaries of evidence to support decision-making in combating the effects and impact of COVID-19. • These reviews contribute to the evidence base about a range of considerations in PPE use, including barriers and facilitators to healthcare workers adherence to infection prevention and control guidelines. There are some new, creative solutions being developed to address some of the issues associated with wearing PPE.

Could antimicrobial mouthwashes and nasal sprays offer protection to healthcare workers, and also patients? Three Cochrane Reviews looked for evidence on this and were published in September 2020. It is disappointing that no completed studies were found, but there are studies underway and these will be considered for future updates of the reviews.

Cochrane Special Collections

Cochrane Special Collections assemble Cochrane Reviews on important topics for the prevention and treatment of COVID-19. They are developed with experts from our global Cochrane network. They are based on World Health Organization interim guidance, and continuously updated.

You can find Coronavirus (COVID-19) Special Collections here.

Cochrane Clinical Answers

Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically-focused entry point to rigorous research from Cochrane Reviews. They are designed to be actionable and to inform point-of-care decision-making. Each CCA contains a clinical question, a short answer, and data for the outcomes from the Cochrane Review deemed most relevant to practising healthcare professionals. The evidence is displayed in a user-friendly tabulated format that includes narratives, data, and links to graphics.

You can find Cochrane Clinical Answers related to COVID-19 here.

A Cochrane Review (July, 2020) has looked at Early fortification of human milk versus late fortification to promote growth in preterm infants.

For preterm infants, adding fortifier to human milk earlier, rather than later, may have little or no effect on growth outcomes including time to regain birth weight, linear growth, or head growth during the initial hospitalisation period. Early fortification may also have little or no effect on the risk of necrotising enterocolitis (a severe gut disorder), growth failure at discharge, the risk of interrupted feeds, or the time taken to reach full enteral feeds (all low-certainty evidence). There is not enough information about possible adverse effects of early versus late fortification. Cochrane Review (published July 2020); two studies with 237 preterm infants in neonatal units with very low birth weight (< 1500g). Studies compared early fortification (when the infant’s daily feed volume had reached 20 or 40 mL/kg body weight) with late fortification (when the infant’s daily feed volume had reached 100 mL/kg body weight).

Cochrane Clinical Answers are available for the following questions:

What are the effects of multi‐nutrient fortification of human milk for preterm infants?

How does early compare with late parenteral nutrition for critically ill term and late preterm infants?

For parenterally fed preterm infants, how do medium‐chain triglyceride (MCT)‐olive‐fish‐soybean oil‐lipid emulsions (MOFS‐LEs) compare with soybean oil lipid emulsions (S‐LEs)?

In preterm infants, what are the effects of probiotics for preventing necrotizing enterocolitis?

Evidently Cochrane blog for nurses: Central venous catheter (CVC) management: evidence round-up.

Take-home points: The management of central venous catheters (CVCs) varies a great deal between and within countries, in guidelines and clinical practice. There are several Cochrane Reviews on different aspects of managing CVCs in adults and children. These reviews provide evidence to guide practice, but also highlight gaps in the evidence; sometimes around ‘everyday’ questions, such as whether the frequency of dressing changes for CVCs has an impact on important outcomes such as the incidence of catheter-related infection.  

Cochrane Clinical Answer: What are the effects of eHealth interventions for people with chronic kidney disease?

Please see the above section on COVID-19 for evidence on PPE and support for wellbeing in the healthcare workforce.

Minimising workplace aggression

Featured Review: Education and training for preventing and minimizing workplace aggression directed toward healthcare workers.

Fostering resilience

Cochrane Clinical Answer: For healthcare professionals, do psychological interventions help foster resilience?

For this recent Cochrane Review Interventions for improving medication‐taking ability and adherence in older adults prescribed multiple medications there is an Evidently Cochrane blog What helps older people take their medication correctly?

What helps older people take their medication correctly?” Take-home points Not taking medicines as prescribed is a common problem among older people. Physical and cognitive problems can make it difficult and they can be overwhelmed with the work of managing their health and their health care. A Cochrane Review has highlighted a lack of reliable evidence on interventions to help older people take multiple medications as prescribed. Efforts to help older people take their medicines correctly should consider the evidence-base but also individual factors including the person's preferences. Chapman S. “What helps older people take their medication correctly?”. Evidently Cochrane blog, 05 June 2020. https://www.evidentlycochrane.net/take-medication-correctly

Cochrane podcast: Interventions for helping older adults prescribed multiple medications to use and take their medications

Cochrane Clinical Answer For older adults prescribed multiple medications, do educational and behavioral interventions improve medication‐taking ability and adherence?

Patient-initiated appointments

Cochrane Podcast: Patient-initiated appointments for people with chronic conditions managed in hospital outpatient settings.

mHealth-based technologies

mHealth‐based technology aims to provide health care and health education via mobile and wireless technologies.

Primary healthcare services

Cochrane Podcast: Health workers’ perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis.

Cochrane Clinical Answer: What are health workers’ perceptions and experiences of using mHealth technologies to deliver primary healthcare services?

mHealth-delivered education for people with heart failure

Cochrane Clinical Answer: For people with heart failure, what are the effects of mHealth‐delivered education?

Acute respiratory distress syndrome

Featured Review: Oxygen therapy in adult intensive care patients with acute respiratory distress syndrome.

Patients with acute respiratory distress syndrome (ARDS) and receiving oxygen through a breathing tube in intensive care may be more likely to survive beyond 90 days if they receive higher volumes of oxygen, compared with lower volumes. Whether patients receive a higher or lower volume of oxygen may make little or no difference to the number of days ventilated; the need for inotropic support (to stabilise circulation and optimise oxygen supply); or the likelihood of needing renal replacement therapy. However the evidence is very uncertain (all very low-certainty evidence). Effects on quality of life were not reported. The evidence is very uncertain about the potential harms of higher versus lower oxygen targets (very low-certainty evidence). Cochrane Review (published September 2020); one study with 205 mechanically ventilated patients in an intensive care setting, comparing conservative oxygen therapy with liberal oxygen therapy for seven days. (Evidence for nursing summary).

Cochrane Clinical Answer: For people with acute respiratory distress syndrome (ARDS) requiring mechanical ventilation, how do conservative and liberal oxygen targets compare?

Asthma

Featured Review: Interventions for acute severe asthma attacks in children: an overview of Cochrane Reviews.

COPD

Cochrane Clinical Answer: Do smart technology interventions facilitate self‐management for people with chronic obstructive pulmonary disease (COPD)?

Cochrane Clinical Answer: What are the effects of psychological interventions for preventing depression after stroke? 

We have a blog on Living and dying well after stroke in which Scott Murray and Marilyn Kendall talk about the rich evidence from their in-depth interviews, which could guide provision of person-centred care after major stroke and support people in living and dying well. Many people have left comments below the blog, sharing their own experiences, and both the blog and the comments have valuable insights. Several stroke survivors have written or contributed to other Evidently Cochrane blogs. All our blogs on stroke are here.

Interventions for heavy menstrual bleeding

Pandemics disrupt healthcare provision and, with this in mind, a Cochrane overview of reviews (July 2020) has been done on interventions commonly available during pandemics for heavy menstrual bleeding. You can see summaries of the review here, including an infographic to help women make choices about treatment. There is also a podcast about this review and two Cochrane Clinical Answers. 

The first World Evidence Based Healthcare Day will take place on 20 October 2020. This is an initiative launched by Cochrane and six other leaders in the field, to create awareness of the need for better evidence to inform healthcare policy, practice and decision making in order to improve health outcomes globally.

You can find information and resources on the World Evidence Based Healthcare Day website and look out for content on social media #WorldEBHCDay  #EvidencetoImpact.

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The next collection of evidence will be published here in January 2021. We may have new blogs and blogshots on individual reviews meanwhile.  You can find all our blogs relevant to nursing here and blogshots here.

Join in the conversation on Twitter with @CochraneUK or leave a comment on the blog. Please note, we will not publish comments that link to commercial sites or appear to endorse commercial products. We welcome diverse views and encourage discussion but ask that comments are respectful and reserve the right to not publish comments we consider offensive.

References (pdf)



Evidence for Nursing: new evidence and resources – Autumn 2020 by Sarah Chapman

is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International

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