Nursing workloads and activity in critical care: A review of the evidence.

OBJECTIVES: To review current methods for informing nurse workforce decisions in critical care. Many clinical outcomes are worse if staffing is inadequate. Workforce planning is usually according to guidelines developed from the opinions of expert groups. Objective systems for planning and distributing staff have been developed but their value is unclear. DESIGN: A rapid review methodology was employed. REVIEW METHODS: The search included research studies, guidelines and surveys within and outside United Kingdom since 1995. FINDINGS: Thirty-two studies met eligibility criteria. Studies originated worldwide, with considerable work undertaken in the United Kingdom and Brazil. Two were large multicentre studies. Tools examined fell into three groups: those focused on the condition and needs of the patient, those focused on the number and time for nursing activities and those that also took account of psycho-social factors. Many tools were not used beyond their country of origin. CONCLUSION: There is limited experience of using tools to determine nurse staffing. No one tool is likely to suit every application. More information is needed to clarify the practicalities of using the tools.

Migrants and HIV stigma: findings from the Stigma Index Study (UK).

This paper is based on data collected in 2009 for the international Stigma Index Study which measured the experiences of stigma among participants living with HIV in the UK. Data were collected using a self-completed survey questionnaire and focus group discussions. Quantitative data were analysed using SPSS, while qualitative data were subjected to thematic analysis. The Stigma Index attempts to establish a baseline for documenting the experience of stigma and discrimination by people living with HIV while also acting as an advocacy tool whose power lay in the involvement of people living with HIV in the design of study instruments and data collection. Participants were recruited through collaborations with a broad range of UK HIV support organisations. The ethics protocols used were those described in the Stigma Index guidebook. A total of 867 people living with HIV took part, of whom 276 described themselves as 'immigrants'. Most of this 'migrant' subsample (70%) was women. Nearly, all (91%) identified as heterosexual, while 9% were attracted to someone of the same sex as them. Socioeconomic deprivation was a key theme and they reported other stigmatised chronic conditions in addition to HIV. It is not possible to ascertain from the questionnaire, the migrants' countries of origin and length of stay in the UK. Control of information about HIV was critically managed, with respect to family and partners. Felt stigma increased anxieties about personal safety, particularly among men. Strategies for safeguarding against the negative impact of stigma included avoiding social gatherings, intimacy, and clinical and HIV social care settings. Most participants were unaware of policies and declarations that protected them as persons living with HIV. Specific recommendations include creating awareness about rights as enshrined in various legal frameworks that protect the right of people living with HIV, which has been reconfigured as a 'disability'.

What is the evidence of the experience of having a fall across the life course? A qualitative synthesis.

BACKGROUND: Alleviating the economic and human impacts of falls and fear of falling are critical health and social care issues. Despite some proven effectiveness of a number of falls prevention intervention programmes, uptake remains low and attrition high. There is a need for greater understanding of social, cultural and individual, life course positioning of falling, actual or perceived. OBJECTIVE: To address the question: what is the evidence of the experience of having a fall across the life course? METHOD: A qualitative evidence synthesis with key electronic databases searched from 1990 to 2011 using terms related to the experience of falls and falling. Selected papers presented data from the perspective of the person who had fallen. Synthesis included collaborative coding of 'incidents' related to falling, theoretical sampling of studies to challenge emerging theories, and constant comparison of categories to generate explanations. RESULTS: The initial focus was to access and assess the evidence for the experiences of a fall across the life course but the authors' systematic search revealed that the vast majority of the published literature focuses on the experience of a fall in later life. Only 2 of the 16 studies included, provided perspectives of falling from a life stage other than that of older adults. However older adults' perceptions of their falls experiences are likely to be influenced by lifelong attitudes and beliefs about falling and older age. Synthesis identified that a falls incident or fear of falling induces explicit or implicit 'Fear.' Consequences are related to notions of 'Control' and 'Social standing.' Recovery work involves 'Adaptation,' 'Implications,' 'Social standing' and 'Control.' 'Explanation' is sought. CONCLUSIONS: How and why people make sense of falling across the life course should have positive impacts on developing falls intervention programmes that people will want to engage with and adhere to.

Scoliosis in patients with Prader Willi Syndrome - comparisons of conservative and surgical treatment.

UNLABELLED: In children with Prader Willi syndrome (PWS), besides growth hormone (GH) therapy, control of the food environment and regular exercise, surgical treatment of scoliosis deformities seems the treatment of choice, even though the risks of spinal surgery in this specific population is very high. Therefore the question arises as to whether the risks of spinal surgery outweigh the benefits in a condition, which bears significant risks per se. The purpose of this systematic review of the Pub Med literature was to find mid or long-term results of spinal fusion surgery in patients with PWS, and to present the conservative treatment in a case study of nine patients with this condition. METHODS: Types of studies included; all kinds of studies; retrospective and prospective ones, which reported upon the outcome of scoliosis surgery in patients with PWS.Types of participants included: patients with scoliosis and PWS.Type of intervention: surgery.Search strategy for identification of the studies; Pub Med; limited to English language and bibliographies of all reviewed articles.Nine patients with PWS from our data-base treated conservatively have been found, being 19 years or over at the time this study has been performed. The results of conservative management are described and related to the natural history and treatment results found in the Pub Med review. RESULTS: From 2210 titles displayed in the Pub Med database with the key word being "Prader Willi syndrome", 5 different papers were displayed at the date of the search containing some information on the outcome of surgery and none appeared to contain a mid or long-term follow-up. The PWS patients treated conservatively from our series all stayed below 70 degrees and some of which improved. DISCUSSION: If the curve of scoliosis patients with PWS can be kept within certain limits (usually below 70 degrees) conservatively, this treatment seems to have fewer complications than surgical treatments. The results of our retrospective study of nine patients demonstrate that scoliosis in this entity plays only a minor role and surgery is unnecessary when high quality conservative management exists. CONCLUSION: There is lack of the long follow-up studies in post-surgical cases in patients with PWS and scoliosis. The rate of complications of spinal fusion in patients with PWS and scoliosis is very high and the death rates have been found to be higher than in patients with Adolescent Idiopathic Scoliosis (AIS). The long-term side-effects of the intervention are detrimental, so that the risk-benefit ratio favours the conservative approaches over spinal fusion surgery.

Adolescent idiopathic scoliosis - to operate or not? A debate article.

Adolescent idiopathic scoliosis (AIS) represents a rare condition with a potentially detrimental impact on young patients. Despite vast clinical research and published treatment guidelines and algorithms, the optimal therapeutic choice for these patients remains highly controversial. While advocates of early surgery emphasize the benefits of surgical deformity correction with regard to physical and psychological outcome, the opponents base their arguments on the high risk of complications and a lack of documented subjective long-term outcome. In the present paper, the authors were invited to debate the opposite positions of "pro" versus "contra" surgical treatment of AIS, based on the currently available evidence and published guidelines.

Rate of complications in scoliosis surgery - a systematic review of the Pub Med literature.

BACKGROUND: Spinal fusion surgery is currently recommended when curve magnitude exceeds 40-45 degrees. Early attempts at spinal fusion surgery which were aimed to leave the patients with a mild residual deformity, failed to meet such expectations. These aims have since been revised to the more modest goals of preventing progression, restoring 'acceptability' of the clinical deformity and reducing curvature.In view of the fact that there is no evidence that health related signs and symptoms of scoliosis can be altered by spinal fusion in the long-term, a clear medical indication for this treatment cannot be derived. Knowledge concerning the rate of complications of scoliosis surgery may enable us to establish a cost/benefit relation of this intervention and to improve the standard of the information and advice given to patients. It is also hoped that this study will help to answer questions in relation to the limiting choice between the risks of surgery and the "wait and see - observation only until surgery might be recommended", strategy widely used. The purpose of this review is to present the actual data available on the rate of complications in scoliosis surgery. MATERIALS AND METHODS: Search strategy for identification of studies; Pub Med and the SOSORT scoliosis library, limited to English language and bibliographies of all reviewed articles. The search strategy included the terms; 'scoliosis'; 'rate of complications'; 'spine surgery'; 'scoliosis surgery'; 'spondylodesis'; 'spinal instrumentation' and 'spine fusion'. RESULTS: The electronic search carried out on the 1st February 2008 with the key words "scoliosis", "surgery", "complications" revealed 2590 titles, which not necessarily attributed to our quest for the term "rate of complications". 287 titles were found when the term "rate of complications" was used as a key word. Rates of complication varied between 0 and 89% depending on the aetiology of the entity investigated. Long-term rates of complications have not yet been reported upon. CONCLUSION: Scoliosis surgery has a varying but high rate of complications. A medical indication for this treatment cannot be established in view of the lack of evidence. The rate of complications may even be higher than reported. Long-term risks of scoliosis surgery have not yet been reported upon in research. Mandatory reporting for all spinal implants in a standardized way using a spreadsheet list of all recognised complications to reveal a 2-year, 5-year, 10-year and 20-year rate of complications should be established. Trials with untreated control groups in the field of scoliosis raise ethical issues, as the control group could be exposed to the risks of undergoing such surgery.