Considering skin-to-muscle depth for successful intramuscular injections in an increasingly obese population.

BACKGROUND: Intramuscular (IM) injection practice is an essential nursing skill. Current practice relies on clinical judgement to determine needle length (unless specified in the medicine's product licence). Obesity is increasing in the global population, but guidelines have largely ignored how to select needle length to meet individual patient need. AIM: The aim of this review was to systematically review the skin-to-muscle depth required to achieve injection into muscle in adults. The objectives were to identify any implications of obesity status when selecting an appropriate needle length and site in clinical practice. Search and review methodology: Studies of subjects above the age of 18 years using observational or experimental designs where the distance from the skin to muscle had been measured at any IM injection site, and obesity status was reported, were included in the search strategy. The primary outcome of interest was the distance from skin surface to muscle penetration. FINDINGS: 14 studies were identified that investigated the dorsogluteal, ventrogluteal, deltoid and vastus lateralis sites, all used cross-sectional observational designs. Ten used ultrasound, three used computed tomography (CT) and one used magnetic resonance imaging. Obesity status was reported as BMI or hip-to-waist ratio. In all studies there was a correlation between obesity status and the distance from skin surface to muscle. In females this exceeded 37 mm at both gluteal sites, independent of obesity status. CONCLUSIONS: There should be an assessment of obesity status before selecting needle length for IM injections in both genders. Needles longer than the standard 37 mm are recommended for all females, whatever their obesity status, for any gluteal site. Injections into gluteal sites should be avoided in females who are obese. Deltoid injections are more likely to achieve muscle penetration in both genders, and in patients who are overweight or obese. Further research is required.

Peer support for people with schizophrenia or other serious mental illness.

BACKGROUND: Peer support provides the opportunity for peers with experiential knowledge of a mental illness to give emotional, appraisal and informational assistance to current service users, and is becoming an important recovery-oriented approach in healthcare for people with mental illness. OBJECTIVES: To assess the effects of peer-support interventions for people with schizophrenia or other serious mental disorders, compared to standard care or other supportive or psychosocial interventions not from peers. SEARCH METHODS: We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials on 27 July 2016 and 4 July 2017. There were no limitations regarding language, date, document type or publication status. SELECTION CRITERIA: We selected all randomised controlled clinical studies involving people diagnosed with schizophrenia or other related serious mental illness that compared peer support to standard care or other psychosocial interventions and that did not involve 'peer' individual/group(s). We included studies that met our inclusion criteria and reported useable data. Our primary outcomes were service use and global state (relapse). DATA COLLECTION AND ANALYSIS: The authors of this review complied with the Cochrane recommended standard of conduct for data screening and collection. Two review authors independently screened the studies, extracted data and assessed the risk of bias of the included studies. Any disagreement was resolved by discussion until the authors reached a consensus. We calculated the risk ratio (RR) and 95% confidence interval (CI) for binary data, and the mean difference and its 95% CI for continuous data. We used a random-effects model for analyses. We assessed the quality of evidence and created a 'Summary of findings' table using the GRADE approach. MAIN RESULTS: This review included 13 studies with 2479 participants. All included studies compared peer support in addition to standard care with standard care alone. We had significant concern regarding risk of bias of included studies as over half had an unclear risk of bias for the majority of the risk domains (i.e. random sequence generation, allocation concealment, blinding, attrition and selective reporting). Additional concerns regarding blinding of participants and outcome assessment, attrition and selective reporting were especially serious, as about a quarter of the included studies were at high risk of bias for these domains.All included studies provided useable data for analyses but only two trials provided useable data for two of our main outcomes of interest, and there were no data for one of our primary outcomes, relapse. Peer support appeared to have little or no effect on hospital admission at medium term (RR 0.44, 95% CI 0.11 to 1.75; participants = 19; studies = 1, very low-quality evidence) or all-cause death in the long term (RR 1.52, 95% CI 0.43 to 5.31; participants = 555; studies = 1, very low-quality evidence). There were no useable data for our other prespecified important outcomes: days in hospital, clinically important change in global state (improvement), clinically important change in quality of life for peer supporter and service user, or increased cost to society.One trial compared peer support with clinician-led support but did not report any useable data for the above main outcomes. AUTHORS' CONCLUSIONS: Currently, very limited data are available for the effects of peer support for people with schizophrenia. The risk of bias within trials is of concern and we were unable to use the majority of data reported in the included trials. In addition, the few that were available, were of very low quality. The current body of evidence is insufficient to either refute or support the use of peer-support interventions for people with schizophrenia and other mental illness.

Family building using embryo adoption: relationships and contact arrangements between provider and recipient families-a mixed-methods study.

STUDY QUESTION: What contact arrangements are established between providers and recipients of embryos using Snowflakes® Embryo Adoption Program? SUMMARY ANSWER: Contact arrangements varied considerably and were generally positively described, although some challenges were acknowledged. WHAT IS KNOWN ALREADY: Reproductive technologies create new and diverse family forms, and the ways in which families created by embryo adoption are negotiated in practice have not been extensively investigated. STUDY DESIGN, SIZE, DURATION: This exploratory, mixed-methods study had two phases: (i) an online survey (open May-September 2013) and (ii) qualitative semi-structured interviews by email (conducted between 2014 and 2015), exploring participants' experiences of contact with their embryo provider or recipient. PARTICIPANTS/MATERIALS, SETTING, METHODS: Phase I included 17 providers (14 women and 3 men) and 28 recipients (27 women and 1 man). Phase II included 8 providers (5 women and 3 men) and 12 recipients (10 women and 2 men). All participants, except one, were located in the US. MAIN RESULTS AND THE ROLE OF CHANCE: This study illustrates how embryo adoption in the US, as a form of conditional donation, can operate and how the participants define and negotiate these emerging relationships. All families were open with their children about how they were conceived and early contact between recipients and providers (frequently before birth) was valued. On the whole, participants were happy with the amount and type of contact they had, and where the current contact did not involve the children, it was seen as a way of keeping the channels open for future contact when the children were older. Participants often portrayed the opportunities for contact as being in the best interests of the child. LIMITATIONS, REASONS FOR CAUTION: The study participants are a particular group who had chosen to either receive or give their embryos via a conditional embryo adoption agency in the US and had established contact. Therefore, this is not a representative sample of those who provide or receive embryos for family building. WIDER IMPLICATIONS OF THE FINDINGS: This embryo adoption model clearly fulfils a need; some people want to use a conditional embryo donation programme such as Snowflakes®. Some form of 'ongoing support mechanism' such as counselling could be useful for those negotiating the complex sets of new kinship patterns and balancing these relationships with their children's welfare. STUDY FUNDING/COMPETING INTEREST(S): The authors have no conflict of interest to declare. Snowflakes is a commercial adoption agency and the authors have no relation to the organization, other than requesting that they participate in this research project. TRIAL REGISTRATION NUMBER: N/A.

A systematic review and meta-analysis of factors that relate to aggression perpetrated against nurses by patients/relatives or staff.

AIMS AND OBJECTIVES: The aim of this meta-analysis was to identify the factors that related to aggression (verbal abuse or physical abuse/assault) perpetrated against the nurse or other health professionals by patients/relatives or staff. In the light of the paucity of systematic reviews on this common issue in nursing, the objective was to present a comprehensive systematic review and meta-analysis of these papers. BACKGROUND: Aggression towards nurses is common around the world and can be the impetus for nurses leaving the profession or developing anxiety when working in particular settings. DESIGN: Systematic review with meta-analysis. METHODS: Meta-analyses were conducted to assess the effect of the factors of gender and context (dichotomised as mental health/psychiatric or nonmental health/psychiatric). The databases of Medline (1966-2015), CINAHL (1982-2015) and PsychInfo (1920-2015). RESULTS: A total of 1571 papers were screened by two reviewers. At the final decision 14 were selected for analysis. A higher proportion of female nurses than male nurses were reported to be the victims of verbal abuse, with the difference in proportions being statistically significant. A statistically significant higher proportion of male nurses than female nurses were reported to be the victims of physical abuse. There was a significantly higher proportion of mental health nurses reported experiencing physical abuse as compared to nonmental health nurses. CONCLUSIONS: The analysis reveal female nurses have greater odds of verbal abuse than male nurses and male nurses have greater odds of physical abuse than female nurses. Overall mental health nurses had three times higher odds of physical assault than other nurses. RELEVANCE TO CLINICAL PRACTICE: In the light of the findings it is recommended organisational support improve in high aggression potential clinical areas and for nursing curriculums to incorporate education about the management of challenging behaviours in undergraduate programmes.

A validation study of a smartphone application for functional mobility assessment of the elderly.

BACKGROUND: To minimize the reaction time and position judgment error using stopwatch-timed measures, we developed a smartphone application to measure performance in the five-time sit-to-stand (FTSTS) and timed up-and-go (TUG) tests. OBJECTIVE: This study aimed to validate this smartphone application by comparing its measurement with a laboratory-based reference condition. METHODS: Thirty-two healthy elderly people were asked to perform the FTSTS and TUG tests in a randomized sequence. During the tests, their performance was concurrently measured by the smartphone application and a force sensor installed in the backrest of a chair. The intraclass correlation coefficient [ICC(2,1)] and Bland-Altman analysis were used to calculate the measurement consistency and agreement, respectively, between these two methods. RESULTS: The smartphone application demonstrated excellent measurement consistency with the lab-based reference condition for the FTSTS test [ICC(2,1) = 0.988] and TUG test [ICC(2,1) = 0.946]. We observed a positive bias of 0.27 seconds (95% limits of agreement, -1.22 to 1.76 seconds) for the FTSTS test and 0.48 seconds (95% limits of agreement, -1.66 to 2.63 seconds) for the TUG test. CONCLUSION: We cross-validated the newly developed smartphone application with the laboratory-based reference condition during the examination of FTSTS and TUG test performance in healthy elderly.

Psychosocial interventions for pregnant women in outpatient illicit drug treatment programs compared to other interventions.

BACKGROUND: Illicit drug use in pregnancy is a complex social and public health problem. The consequences of drug use in pregnancy are high for both the woman and her child. Therefore, it is important to develop and evaluate effective treatments. There is evidence for the effectiveness of psychosocial interventions in drug treatment but it is unclear whether they are effective in pregnant women. This is an update of a Cochrane review originally published in 2007. OBJECTIVES: To evaluate the effectiveness of psychosocial interventions in pregnant women enrolled in illicit drug treatment programmes on birth and neonatal outcomes, on attendance and retention in treatment, as well as on maternal and neonatal drug abstinence. In short, do psychosocial interventions translate into less illicit drug use, greater abstinence, better birth outcomes, or greater clinic attendance? SEARCH METHODS: We conducted the original literature search in May 2006 and performed the search update up to January 2015. For both review stages (original and update), we searched the Cochrane Drugs and Alcohol Group Trial's register (May 2006 and January 2015); the Cochrane Central Register of Trials (CENTRAL; the Cochrane Library 2015, Issue 1); PubMed (1996 to January 2015); EMBASE (1996 to January 2015); and CINAHL (1982 to January 2015). SELECTION CRITERIA: We included randomized controlled trials comparing any psychosocial intervention vs. a control intervention that could include pharmacological treatment, such as methadone maintenance, a different psychosocial intervention, counselling, prenatal care, STD counselling and testing, transportation, or childcare. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by the Cochrane Collaboration. We performed analyses based on three comparisons: any psychosocial intervention vs. control, contingency management (CM) interventions vs. control, and motivational interviewing based (MIB) interventions vs. MAIN RESULTS: In total, we included 14 studies with 1298 participants: nine studies (704 participants) compared CM vs. control, and five studies (594 participants) compared MIB interventions vs. CONTROL: We did not find any studies that assessed other types of psychosocial interventions. For the most part, it was unclear if included studies adequately controlled for biases within their studies as such information was not often reported. We assessed risk of bias in the included studies relating to participant selection, allocation concealment, personnel and outcome assessor blinding, and attrition.The included trials rarely captured maternal and neonatal outcomes. For studies that did measure such outcomes, no difference was observed in pre-term birth rates (RR 0.71, 95% confidence interval (CI) 0.34 to 1.51; three trials, 264 participants, moderate quality evidence), maternal toxicity at delivery (RR 1.18, 95% CI 0.52 to 2.65; two trials, 217 participants, moderate quality evidence), or low birth weight (RR 0.72, 95% CI 0.36 to 1.43; one trial, 160 participants, moderate quality evidence). However, the results did show that neonates remained in hospital for fewer days after delivery in CM intervention groups (RR -1.27, 95% CI -2.52 to -0.03; two trials, 103 participants, moderate quality evidence). There were no differences observed at the end of studies in retention or abstinence (as assessed by positive drug test at the end of treatment) in any psychosocial intervention group compared to control (Retention: RR 0.99, 95% CI 0.93 to 1.06, nine trials, 743 participants, low quality evidence; and Abstinence: RR 1.14, 95% CI 0.75 to 1.73, three trials, 367 participants, low quality evidence). These results held for both CM and MIB combined. Overall, the quality of the evidence was low to moderate. AUTHORS' CONCLUSIONS: The present evidence suggests that there is no difference in treatment outcomes to address drug use in pregnant women with use of psychosocial interventions, when taken in the presence of other comprehensive care options. However, few studies evaluated obstetrical or neonatal outcomes and rarely did so in a systematic way, making it difficult to assess the effect of psychosocial interventions on these clinically important outcomes. It is important to develop a better evidence base to evaluate psychosocial modalities of treatment in this important population.

Identifying and exploring physical and psychological morbidity and patient and family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery: a systematic review.

The aim of this article was to identify the literature that examined and explored physical and psychological morbidity and patient and family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery. A systematic review of the literature using the databases MEDLINE, CINAHL and EMBASE was undertaken. The papers were examined using title and abstract for relevance to the primary and secondary outcomes. The primary outcome of interest was family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery. The search yielded 275 records after removing any duplicates; eight studies were considered eligible and were reviewed as full text. Following full review, none of the studies was included in this article. To conclude, there were no papers that investigated or examined the concept of resilience in relation to the management of acute post-surgical orthopaedic wounds. Four of the papers identified, following the review process, did discuss quality of life outcomes and how these may be improved following wound development; most papers focused on the management of chronic wounds. It is apparent from the review that there is no evidence currently available that explores patient and family caregiver resilience following acute wound development and/or wound blistering post orthopaedic surgery.

Nursing and aggression in the workplace: a systematic review.

Personal experiences of aggression or violence in the workplace lead to serious consequences for nurses, their patients, patient care and the organisation as a whole. While there is a plethora of research on this topic, no review is available that identifies types of aggression encountered, individuals perceived to be most at risk and coping strategies for victims. The aim of this systematic review was to examine occupational anxiety related to actual aggression in the workplace for nurses. Databases (MEDLINE, CINAHL and PsycINFO) were searched, resulting in 1543 titles and abstracts. After removal of duplicates and non-relevant titles, 137 papers were read in full. Physical aggression was found to be most frequent in mental health, nursing homes and emergency departments while verbal aggression was more commonly experienced by general nurses. Nurses exposed to verbal or physical abuse often experienced a negative psychological impact post incident.

Exploring the impact of experiencing a long lie fall on physical and clinical outcomes in older people requiring an ambulance: A systematic review.

BACKGROUND: The long term impacts of experiencing a 'long lie' following a fall in the older person are poorly understood. This systematic review explored the impact of a long lie fall on physical and clinical outcomes in older people requiring an ambulance. METHODS: PRISMA guidelines were followed. RESULTS: 70 studies were identified. Nine studies were suitable for full review. Four studies meeting the inclusion criteria were included. The Critical Appraisal Skill Programme (CASP) assessed the quality of all included studies. Three studies reported on people aged 65 years and older. One study reported on people aged over 90 years. Personal alarm use was examined in two studies. One study explored patient characteristics of people confirmed to have fallen by paramedics at the scene. One study examined re-contact and characteristics of fallers referred to a falls prevention service. DISCUSSION: Cognitive impairment and long lie were a caveat for falls and repeated falls. Personal alarm use was infrequent, suggesting a need for supporting the older patient in appropriate alarm use and exploration of newer technologies to alleviate their need. Future research should focus on interventions for wearable, smart and e-technology for automatic fall detection and qualitative exploration of the lived experience.

Can interprofessional research enhance health care students' understanding and knowledge towards evidence based practice: A cross sectional study.

AIM: To explore how inter-professional collaboration in the teaching and learning of research skills prepares undergraduate students for their professional roles in healthcare via an evaluation of inter-professional research modules from the student perspective. PARTICIPANTS AND SETTINGS: Participants were selected from a university in the North of England where all undergraduate Healthcare students were taught Research and Evidence Based Practice (EBP) through interprofessional education (n = 400). METHODS: Quantitative data was collected using an adapted Attitudes Towards Interprofessional Education Scale and internally-designed pilot instruments. Qualitative data was also collected via open comment to evaluate the taught research module. RESULTS: 50 students completed the survey pre-module and 49 students completed the survey post-module. The participants' views towards inter-professional education (IPE) are generally positive: the median responses of 4 single-item measures assessing inter-professional learning on 7-point Likert scales were 5 or above (where higher scores represented more positive perceptions). Scores on the Attitudes towards Interprofessional Education scale also generally represented positive opinions, with a mean post-test score of 58.8 on a scale from 5 to 75, with higher scores indicating greater levels of positivity. No evidence for a statistically significant improvement from the pre- to post- 3rd year experience of the IPE/research theme was revealed. Qualitative data identified six themes: promoting team working, developing awareness of other health care professional's roles, polarising research and practice, multidisciplinary team (MDT) working or not working, logistical issues and developing research skills. CONCLUSIONS: This study raised questions about the appropriateness of "unnatural" pairings for undertaking research projects. Whilst the students valued working together in the research process, they do not appear to have perceived a universal benefit to their inter-professional clinical practice.

The demands of the extra-time period of soccer: A systematic review.

OBJECTIVE: Soccer match-play is typically contested over 90 min; however, in some cup and tournament scenarios, when matches are tied, they proceed to an additional 30 min, which is termed "extra-time" (ET). This systematic review sought to appraise the literature available on 120-min of soccer-specific exercise, with a view to identifying practical recommendations and future research opportunities. METHODS: The review was conducted according to the PRISMA guidelines. Independent researchers performed a systematic search of PubMed, CINAHL, and PsycINFO in May 2019, with the following keywords entered in various combinations: "soccer", "football", "extra-time", "extra time", "extratime", "120 minutes", "120 min", "additional 30 minutes", and "additional 30 min". RESULTS: The search yielded an initial 73 articles. Following the screening process, 11 articles were accepted for analyses. Articles were subsequently organized into the following 5 categories: movement demands of ET, performance responses to ET, physiological and neuromuscular response during ET, nutritional interventions, and recovery and ET. The results highlighted that during competitive match-play, players cover 5%-12% less distance relative to match duration (i.e., meters per minute) during ET compared to the preceding 90 min. Reductions in technical performance (i.e., shot speed, number of passes and dribbles) were also observed during ET. Additionally, carbohydrate provision may attenuate and improve dribbling performance during ET. Moreover, objective and subjective measures of recovery may be further compromised following ET when compared to 90 min. CONCLUSION: Additional investigations are warranted to further substantiate these findings and identify interventions to improve performance during ET.

Heterogeneity in search strategies among Cochrane acupuncture reviews: is there room for improvement?

OBJECTIVE: Given the international focus and rigorous literature searches employed in Cochrane systematic reviews, this study was undertaken to evaluate strategies employed in Cochrane reviews and protocols assessing acupuncture as a primary or secondary intervention. METHODS: The Cochrane Collaboration of systematic reviews was searched in February 2009 for all reviews and protocols including information on acupuncture. Information was abstracted from all retrieved articles on review status, type and number of English and Chinese language databases searched, participation of at least one Chinese speaking author and language restriction. Frequencies were calculated and bivariate analyses were performed stratifying on interventions of interest to assess differences in search strategy techniques, language restrictions and results. RESULTS: The search retrieved 68 titles, including 48 completed reviews, 17 protocols and three previously withdrawn titles. Acupuncture was the primary intervention of interest in 44/65 (67.7%) of the retrieved reviews and protocols. While all articles searched at least one English language database, only 26/65 (40.0%) articles searched Chinese language databases. Significantly more articles where acupuncture was the primary intervention of interest searched Chinese language databases (53% vs 9%, p<0.01). Inconclusive findings as to the effectiveness of acupuncture were found in 28/48 (58.3%) of all completed reviews; this type of finding was more common in reviews which did not search any Chinese language databases. CONCLUSIONS: It is important for reviews assessing the effectiveness of acupuncture to search Chinese language databases. The Cochrane Collaboration should develop specific criteria for Chinese language search strategies to ensure the continued publication of high-quality reviews.

Biomechanical and Physiological Responses to 120 Min. of Soccer-Specific Exercise.

Purpose: The purpose of the study is to investigate biomechanical and physiological responses to soccer-specific exercise incorporating an extra-time period (ET) and assess the test-retest reliability of these responses. Methods: Twelve soccer players performed 120 min of soccer-specific exercise. Tri-axial (PLTotal) and uni-axial PlayerLoad™ in the vertical (PLV), anterior-posterior (PLA-P), and medial-lateral (PLM-L) planes were monitored using a portable accelerometer. Likewise, respiratory exchange ratio (RER) was recorded throughout exercise. At the end of each 15-min period, players provided differential ratings of perceived exertion for legs (RPE-L), breathlessness (RPE-B) and overall (RPE-O), and capillary samples were taken to measure blood lactate (BLa) concentrations. The soccer-specific exercise was completed twice within 7 days to assess reliability. Results: A main effect for time was identified for PLTotal (p = 0.045), PLV (p = 0.002), PLA-P (p = 0.011), RER (p = 0.001), RPE-L (p = 0.001), RPE-O (p = 0.003), and CMJ (p = 0.020). A significant increase in PLTotal (234 ± 34 au) and decrease in RER (0.87 ± 0.03) was evident during 105-120 versus 0-15 min (215 ± 25 au; p = 0.002 and 0.92 ± 0.02; p = 0.001). Coefficients of variations were <10% and Pearson's correlation coefficient demonstrated moderate-to-very strong (0.33-0.99) reliability for all PL variables, RPE-B, BLa, and RER. Conclusions: These results suggest that mechanical efficiency is compromised and an increased rate of lipolysis is observed as a function of exercise duration, particularly during ET. These data have implications for practitioners interested in fatigue-induced changes during ET.

Pharmacologic interventions for pregnant women enrolled in alcohol treatment.

BACKGROUND: Excessive alcohol use during pregnancy has been associated with adverse maternal and neonatal effects. It is therefore important to develop and evaluate effective interventions during this important time in a woman's life. To our knowledge there have been no systematic reviews of randomised control trials (RCT) in this population. OBJECTIVES: To evaluate the effectiveness of pharmacologic interventions in pregnant women enrolled in alcohol treatment programs for improving birth and neonatal outcomes, maternal abstinence and treatment retention. SEARCH STRATEGY: We searched the Cochrane Drugs and Alcohol Group's Trial register (August 2008) ; MEDLINE (1.1950 to 6.2008) ; EMBASE (1.1974 - 8.2008); CINAHL (1.1982-6.2008); PsycInfo (1.1806-6.2008), and reference lists of articles. SELECTION CRITERIA: We sought to include randomised or quasi-randomised studies comparing any pharmacologic intervention versus other pharmacologic treatment alone or in association with psychosocial treatment, placebo, non-intervention or psychosocial intervention. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion in the review. Included studies were to be assessed using standardized data extraction and quality assessment forms. No suitable trials were identified. MAIN RESULTS: The search strategy identified 793 citations. Twenty-three citations were deemed relevant for full text review; an additional ten articles were retrieved through hand searching references, for a total of thirty-three articles. Following full text review no articles met the inclusion criteria. Data extraction and assessment of methodological quality were therefore not possible. AUTHORS' CONCLUSIONS: The review question remains unanswered as there were no randomised control trials found relevant to the topic. There is a need for high quality research to determine the effectiveness of pharmacologic interventions in pregnant women enrolled in alcohol treatment program.

Psychosocial interventions for women enrolled in alcohol treatment during pregnancy.

BACKGROUND: Excessive alcohol use during pregnancy has been associated with adverse maternal and neonatal effects. It is therefore important to develop and evaluate effective interventions during this important time in a woman's life. To our knowledge there have been no systematic reviews of randomised control trials (RCT) in this population. OBJECTIVES: To evaluate the effectiveness of psychosocial interventions in pregnant women enrolled in alcohol treatment programs for improving birth and neonatal outcomes, maternal abstinence and treatment retention. SEARCH STRATEGY: We searched the Cochrane Drugs and Alcohol Group's Trial register (December 2007); MEDLINE (1950 to 2007); PsycINFO (1806 to 2007); EMBASE (1974 to 2007); CINAHL (1982 to 2007) SELECTION CRITERIA: We sought to include randomised or quasi-randomised studies comparing any psychosocial intervention versus pharmacological interventions or placebo or non-intervention or another psychosocial intervention for treating alcohol dependence in pregnancy. DATA COLLECTION AND ANALYSIS: Three review authors independently assessed trials for inclusion in review. Studies were to be assessed using standardized data extraction and quality assessment forms. No suitable trials were identified. MAIN RESULTS: The search strategy identified 958 citations. 17 citations were deemed relevant for full text review, an additional 9 articles were retrieved through hand searching references, for a total of 26 articles. Following full text review no articles met the inclusion criteria. Data extraction and assessment of methodological quality were therefore not possible. AUTHORS' CONCLUSIONS: The review question remains unanswered as there were no randomised control trials found relevant to the topic. There is a need for high quality randomised controlled trials to determine the effectiveness of psychosocial interventions in pregnant women enrolled in alcohol treatment programs.

Negative pressure wound therapy (NPWT) for spinal wounds: a systematic review.

BACKGROUND CONTEXT: The management of postoperative spinal wound complication remains a challenge, with surgical site infection (SSI) incidence rates ranging from 0.4% to 20% after spinal surgery. Negative pressure wound therapy (NPWT) has been highlighted as an intervention that may stimulate healing and prevent SSI. However, the wound healing mechanism by NPWT and its effectiveness in spinal wounds still remain unclear. PURPOSE: To systematically search, critically appraise, and summarize randomized controlled trials (RCTs) and non-RCTs assessing the effectiveness of NPWT in patients with a spinal wound. STUDY DESIGN: Systematic review. METHODS: A systematic review based on search strategies recommended by the Cochrane Back and Wounds Review Groups was undertaken using Cochrane Library, MEDLINE, EMBASE, and CINAHL databases. Any publications between 1950 and 2011 were included. Funding to undertake the review was received from the University of Huddersfield Collaborative Venture Fund ($4,820) and KCI Medical ($4,820). RESULTS: Ten retrospective studies and four case studies of patients with spinal wound complication were included in this systematic review. No RCTs were found. Only one study described more than 50 patients. Generally, a pressure of -125 mm Hg was used in adults. Duration of NPWT in situ ranged from 3 to 186 days. Wound healing was assessed every 2 to 3 days and generally completed between 7 days and 16 months. Negative pressure wound therapy is contraindicated in the presence of active cerebrospinal fluid leak, metastatic or neoplastic disease in the wound or in patients with an allergy to the NPWT dressing and in those with a bleeding diathesis. CONCLUSIONS: Published reports are limited to small retrospective and case studies, with no reports of NPWT being used as a prophylactic treatment. Larger prospective RCTs of NPWT are needed to support the current evidence that it is effective in treating spinal wound complications. In addition, future studies should investigate its use as a prophylactic treatment to prevent infection and report data relating to safety and health economics.

Effective management of acute faecal incontinence in hospital: review of continence management systems.

This paper reviews the scientific literature regarding current systems available for the management of acute faecal incontinence (FI) in hospital patients. The review searched Medline from 1950 to October 2009 using the adapted search strategy, as devised by the Cochrane Incontinence Group, in order to identify studies relevant to this review, yielding 197 records. Ten studies fitted the inclusion criteria with none of the studies being randomised control trials. Characteristics identified from the studies included: duration of the management devices, cost implications, length of patient stay, contraindications and patient assessment. The management of acute FI in acute settings is a relatively ignored problem, with little available evidence to support a standardised approach to its management. The review highlights the need for early identification of contraindications when FI management systems are being used, particularly in patients administered antithrombotic drugs such as aspirin.