Evidence for Nursing: new evidence and resources – September 2022

The latest evidence and resources for nurses and clinical support staff.

You can scroll through this page to see the following topics:

  • News and events
  • Asthma
  • Bell’s palsy
  • Central venous catheter management
  • Communicating with young people in hospital
  • COVID-19
  • Decision aids
  • Dementia
  • End of life care – communication
  • Exercise for adults having maintenance dialysis
  • Heavy periods
  • Hip protectors
  • Physical restraints in hospital
  • PTSD
  • Treating urinary incontinence in women

News and events

A free webinar for anyone making health decisions

Join us for a free webinar for anyone making health decisions on Thursday 20th October 2022, 7-8pm (BST) – Making health decisions: what’s best for you?

Brian, Heather and Sarah, who have had to make some big health decisions, in different circumstances, and Becky, a doctor and former GP, discuss their experiences and some important elements of making health choices. This session will be facilitated by our Patient Co-ordinator Emma Doble and Dr Rufaro Ndokera, a former Cochrane UK Fellow.

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Asthma

The Cochrane Review Anti‐IL‐5 therapies for asthma (published July 2022) has found that anti‐IL‐5 treatments as an adjunct to standard care in people with severe eosinophilic asthma and poor symptom control  roughly halve the rate of asthma exacerbations. Improvements in health related quality of life scores and lung function may not meet clinically detectable levels. For adverse events, the authors say “The studies did not report safety concerns for mepolizumab or reslizumab, or any excess serious adverse events with benralizumab, although there remains a question over adverse events significant enough to prompt discontinuation.”

The Cochrane Review Pulmonary rehabilitation versus usual care for adults with asthma (published August 2022) found that “shows that pulmonary rehabilitation is probably associated with clinically meaningful improvements in functional exercise capacity and quality of life upon programme completion in adults with asthma.” The o=impact on asthma control and on maximal exercise capacity is uncertain.

Bell’s palsy

Our blog Bell’s palsy: facing up to uncertainty has been revised and republished to include NICE guidance, along with the evidence and patient experience.

Bell’s palsy is a temporary weakness or lack of movement, due to paralysis of the facial nerve, affecting one side of the face. It improves at different rates and maximum recovery can take several months. This blog includes Olivia's story of her son Max's experience of Bell's palsy, including how they navigated different treatment options and the challenges of returning to school. There is Cochrane evidence and guidance from NICE on managing Bell's palsy, including support for treatment with corticosteroids within 72 hours of symptoms starting.

Central venous catheter management

The Cochrane Review Heparin versus 0.9% sodium chloride locking for prevention of occlusion in central venous catheters in adults (published July 2022) found that it remains uncertain how intermittent locking with heparin or normal saline compare (low-certainty evidence) and that heparin may have little or no effect on catheter patency (low-certainty evidence).

The review authors also say that while there may be little or no difference between them in terms of sepsis, mortality, or haemorrhage, the evidence is very uncertain and the combined trials are not powered to detect rare adverse events such as heparin‐induced thrombocytopaenia.

You can read more about this and other evidence in our updated blog Central venous catheter 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.  

Communicating with young people in hospital

We have updated our blog Communicating with young people in hospital: what matters? to include NICE guidance, developed with young people, and other resources.

Anne's reflections on the hospital experiences of her daughter J-J, a young adult with a mild learning disability, include the importance of the patient's perspective, and of the parent's role in advocating for their child's needs and wishes. Sylvia recalls good communication from those caring for her teenaged son Matthew during his cancer treatment and how with members of the family they managed their different needs and preferences for information. Young people have been involved in producing resources aimed at improving communication with children and young people in hospital, and in recent guidance from NICE.

COVID-19

Cochrane is continuing to produce new and updated reviews in response to the pandemic. We have blogged about many of them and this blog COVID-19 evidence: a Cochrane round-up brings together a large collection of evidence and resources, starting from when this evidence was first being produced in spring 2020.

Plus, we have two blogs on COVID-19 treatments:

  1. Treatments for mild COVID-19
  2. Treatments for moderate to severe COVID-19: Cochrane evidence.

Like the reviews themselves, all our blogs are updated to reflect new evidence.

The lead author of the recently-updated Cochrane Review on the accuracy Rapid, point‐of‐care antigen tests for diagnosis of SARS‐CoV‐2 infection (published July 2022) has blogged about it in Covid tests: how accurate are LFTs? 

Lateral flow tests (LFTs, also called rapid antigen tests) are most accurate when they are used in people who have signs or symptoms of COVID-19, especially during the first week of illness. People who test negative may still be infected. LFTs are considerably less accurate when they are used in people with no signs or symptoms of infection but do perform better in people who have been in contact with someone who has confirmed COVID-19. The accuracy of LFTs varies between tests that are produced by different manufacturers and there is a lack of evidence for many commercially available tests.

There is also a shorter version – Covid tests: how good are LFTs? A short blog.

Interventions to increase COVID‐19 vaccine uptake: a scoping review (published August 2022) has identified and mapped a variety of interventions for increasing COVID‐19 vaccine uptake or decreasing vaccine hesitancy. The authors say “Our results demonstrate that this is an active field of research with 61 published studies and 35 studies still ongoing. This review gives a comprehensive overview of interventions to increase COVID‐19 vaccine uptake and can be the foundation for subsequent systematic reviews on the effectiveness of interventions to increase COVID‐19 vaccine uptake.”

Other Cochrane resources on COVID-19

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

Cochrane COVID-19 Podcasts offer short summaries of Cochrane COVID-19 reviews from the authors themselves. A good way to hear the latest Cochrane evidence in under 5 minutes each.

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

Decision aids

Our blog Decision aids: helping people make better healthcare choices has been revised and republished to include recent evidence and resources.

Shared decision making in healthcare involves discussions between clinician and patient which draw on the clinician's expertise, the evidence for the different treatments, and personal factors such as the patient's preferences and circumstances, to work out the best option for them. This blog includes Joanna's story of navigating an important treatment decision without the benefit of constructive discussions with her surgeon. There is Cochrane evidence that decision aids, which provide evidence-based information on treatment options, including the likely outcomes, benefits, harms and uncertainties, can be helpful. The blog includes links to more information and resources on decision aids and shared decision making.

Dementia

On the page Dementia: evidence, experience and resources you can find our blogs about different aspects of preventing and living with dementia. Many of them include research evidence and also reflections from people affected by dementia themselves or in supportive roles as carers, family members or health professionals. There are also links to helpful resources.

End of life care – communication

In the blog Talking about dying: better conversations at the end of life, Sarah Chapman, whose Mum died during the first lockdown, reflects on the text conversations she had with her Mum’s carer about her dying. She also talks about recent evidence on effective communication between health professionals, those who are dying and their families and about our need for knowledge of ordinary dying when many of us don’t witness a death until we are older adults ourselves. The blog also contains sources of information and support for both non-medical people and health professionals.

•Many people lack knowledge about ordinary dying. This can add to our distress when faced with our own dying or that of someone we love. It’s helpful to talk about it, and to make use of some of the good resources now available. •Good communication between healthcare professionals and people who are dying and those close to them is fundamentally important. •Evidence-based recommendations for healthcare professionals having end-of-life conversations with patients/families include: find out their perspectives before offering your own; mirror their words; make opportunities to discuss the future; be clear about uncertainties; show sensitivity. •It is now considered best practice for all clinicians to have training in end-of-life communication and there are tools to help, such as the REDMAP (Ready, Expect, Diagnosis, Matters, Actions, Plan) framework.

Exercise for adults having maintenance dialysis

Dr Rebecca Gould has written this blog Exercise training for adults having maintenance dialysis looking at recent evidence on exercise for adults having maintenance dialysis.

Physical activity is recommended for most people who have chronic kidney disease, including those having maintenance dialysis. Some people having maintenance haemodialysis are concerned that exercise may cause tiredness or pain and, if done during haemodialysis itself, risk damaging their fistula or intra-venous access. There is evidence that, for some people having maintenance haemodialysis, exercise programmes probably improve symptoms of depression and capacity to perform activities and tasks. They may also improve some aspects of quality of life and may reduce fatigue. Some people having dialysis may have questions about exercise, safety and how to look after their access (fistula, intra-venous or peritoneal catheter depending on the type of dialysis) during exercise. Local dialysis teams and charities are a good source of advice and support.

Heavy periods

The authors of a Cochrane overview of reviews  ‘Interventions for heavy menstrual bleeding; overview of Cochrane reviews and network meta-analysis’ (published May 2022) studied the evidence for different types of heavy period treatments. Read more in the blog Heavy periods: evidence to help you weigh up treatment options, by Dr Stuart Spencer and Dr Martin Hirsch.

People with heavy periods have heavy menstrual bleeding that interferes with their quality of life. It is common, affecting around 20-50% of people who menstruate Treatment for heavy periods can include oral medications, a hormone-releasing coil in the womb, or surgery There is Cochrane evidence (published May 2022) that the coil may be the most effective first treatment for reducing bleeding, followed by non-hormonal and hormonal medications. If these treatments don’t work or aren’t suitable, hysterectomy or endometrial ablation (burning the lining of the womb) may be effective alternatives Potential benefits and harms should be considered when making treatment choices, along with your own preferences and priorities. All the treatments may have side effects, and some treatments are more invasive than others. These are all things to discuss with your doctor to help you work out what might be the best option for you

Hip protectors

Our blog Hip protectors: can they help break your fall and not your hip? was recently revised and republished to include NICE guidance along with the Cochrane evidence.

There are many types and brands of hip protectors advertised for sale, but a lack of recent evidence about their effects (either benefits or harms). Cochrane evidence (from 2014) found that, for those in residential care, hip protectors probably slightly reduce the number of hip fractures, without increasing the risk of falling, but may slightly increase the risk of a pelvic fracture. For those living in the community, hip protectors probably make little to no difference to the risk of breaking a hip. In their 2019 surveillance review, NICE (National Institute for Health and Care Excellence) did not find any new evidence relating to hip protectors and no ongoing trials. They conclude that their updated guidance on falls (in progress) should consider whether this intervention remains relevant to clinical practice in the UK. Despite good evidence that few people had side effects (like skin irritation), many people in research studies did not like wearing them. Common reasons given were discomfort, the extra time and effort needed to wear them, problems with incontinence and other physical difficulties or illness.

Physical restraints in hospital

The authors of the Cochrane Review Interventions for preventing and reducing the use of physical restraints of older people in general hospital settings(published August 2022) conclude that:

  • “We are uncertain whether organisational interventions aimed at implementing a least‐restraint policy can reduce physical restraints in general hospital settings.
  • The use of pressure sensor alarms in beds or chairs for people with an increased fall risk has probably little to no effect on the use of physical restraints.”

PTSD (Post-traumatic stress disorder)

The blog PTSD: remembering and recovering with EMDR includes one person’s experience of PTSD and how treatment with EMDR (eye movement desensitisation and reprocessing) helped,  sources of information and support for people with PTSD, and some recent Cochrane evidence on treatments for PTSD.

Post-traumatic stress disorder (PTSD) is an anxiety disorder, caused by very stressful, frightening or distressing events. In this blog, Sandra shares her experiences of PTSD following repeated cancellations of diagnostic surgery, and how EMDR (eye movement desensitisation and reprocessing) helped her. NICE guidance (published in December 2018) includes EMDR as an option in managing PTSD. It sets out recommendations for how it should be delivered, by whom, and for how long. Sources of information and support for people with PTSD include a number of UK charities. 

Treating urinary incontinence in women

A new Cochrane overview of reviews Conservative interventions for treating urinary incontinence in women (published September 2022) has found that:

  • pelvic floor muscle training (PFMT) is more beneficial than control for all types of urinary incontinence for outcomes of cure or improvement and quality of life
  • if PFMT is more intense, more frequent, with individual supervision, with/without combined with behavioural interventions with/without an adherence strategy, it is probably more effective.
  • for cure or improvement, cones are more beneficial than control (but not PFMT) for women with stress urinary incontinence
  • electrical stimulation is beneficial for women with urgency urinary incontinence
  • weight loss results in more cure and improvement than control for women with all types of urinary incontinence combined.

References (pdf)

Join in the conversation on Twitter with @SarahChapman30 and @CochraneUK or leave a comment on the blog.

Please note, we cannot give medical advice and do not publish comments that link to individual pages requesting donations or to commercial sites, or appear to endorse commercial products. We welcome diverse views and encourage discussion but we ask that comments are respectful and reserve the right not to publish any we consider offensive. Cochrane UK does not fact-check – or endorse – readers’ comments, including any treatments mentioned.

Sarah and Selena have nothing to disclose.



Evidence for Nursing: new evidence and resources – September 2022 by Sarah Chapman and Selena Ryan-Vig

is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International

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