Adverse effects of a single dose of gentamicin in adults: a systematic review.

AIMS: To systematically review the frequency and type of adverse events associated with a single dose of intravenous or intramuscular gentamicin in adults, for any indication, in studies where a comparator was available. METHODS: A review protocol was developed and registered (PROSPERO: CRD42013003229). Studies were eligible for review if they: recruited participants aged ≥16 years; used gentamicin intramuscularly or intravenously as a single one-off dose; compared gentamicin to another medication or placebo; and monitored adverse events. MEDLINE, EMBASE, Cochrane Library, trial registries, conference proceedings and other relevant databases were searched up to November 2016. Risk of bias was assessed on all included studies. RESULTS: In total, 15 522 records were identified. After removal of duplicates, screening of title/abstracts for relevance and independent selection of full texts by two reviewers, 36 studies were included. Across all the included studies, 24 107 participants received a single one-off dose of gentamicin (doses ranged from 1 mg kg-1 to 480 mg per dose). Acute kidney injury was described in 2520 participants receiving gentamicin. The large majority of cases were reversible. There were no cases of ototoxicity reported in patients receiving gentamicin. A meta-analysis was not performed due to study heterogeneity. CONCLUSIONS: A significant number of patients saw a transient rise in creatinine after a single dose of gentamicin at doses up to 480 mg. Persistent renal impairment and other adverse events were relatively rare.

Negative pressure wound therapy for treating leg ulcers.

BACKGROUND: Leg ulcers are open skin wounds that occur between the ankle and the knee that can last weeks, months or even years and are a consequence of arterial or venous valvular insufficiency. Negative pressure wound therapy (NPWT) is a technology that is currently used widely in wound care and is promoted for use on wounds. NPWT involves the application of a wound dressing to the wound, to which a machine is attached. The machine applies a carefully controlled negative pressure (or vacuum), which sucks any wound and tissue fluid away from the treated area into a canister. OBJECTIVES: To assess the effects of negative pressure wound therapy (NPWT) for treating leg ulcers in any care setting. SEARCH METHODS: For this review, in May 2015 we searched the following databases: the Cochrane Wounds Group Specialised Register (searched 21 May 2015); the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2015, Issue 4); Ovid MEDLINE (1946 to 20 May 2015); Ovid MEDLINE (In-Process & Other Non-Indexed Citations 20 May 2015); Ovid EMBASE (1974 to 20 May 2015); EBSCO CINAHL (1982 to 21 May 2015). There were no restrictions based on language or date of publication. SELECTION CRITERIA: Published or unpublished randomized controlled trials (RCTs) comparing the effects of NPWT with alternative treatments or different types of NPWT in the treatment of leg ulcers. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, risk of bias assessment and data extraction. MAIN RESULTS: We included one study, with 60 randomized participants, in the review. The study population had a range of ulcer types that were venous arteriolosclerotic and venous/arterial in origin. Study participants had recalcitrant ulcers that had not healed after treatment over a six-month period. Participants allocated to NPWT received continuous negative pressure until they achieved 100% granulation (wound preparation stage). A punch skin-graft transplantation was conducted and the wound then exposed to further NPWT for four days followed by standard care. Participants allocated to the control arm received standard care with dressings and compression until 100% granulation was achieved. These participants also received a punch skin-graft transplant and then further treatment with standard care. All participants were treated as in-patients until healing occurred.There was low quality evidence of a difference in time to healing that favoured the NPWT group: the study reported an adjusted hazard ratio of 3.2, with 95% confidence intervals (CI) 1.7 to 6.2. The follow-up period of the study was a minimum of 12 months. There was no evidence of a difference in the total number of ulcers healed (29/30 in each group) over the follow-up period; this finding was also low quality evidence.There was low quality evidence of a difference in time to wound preparation for surgery that favoured NPWT (hazard ratio 2.4, 95% CI 1.2 to 4.7).Limited data on adverse events were collected: these provided low quality evidence of no difference in pain scores and Euroqol (EQ-5D) scores at eight weeks after surgery. AUTHORS' CONCLUSIONS: There is limited rigorous RCT evidence available concerning the clinical effectiveness of NPWT in the treatment of leg ulcers. There is some evidence that the treatment may reduce time to healing as part of a treatment that includes a punch skin graft transplant, however, the applicability of this finding may be limited by the very specific context in which NPWT was evaluated. There is no RCT evidence on the effectiveness of NPWT as a primary treatment for leg ulcers.

Negative pressure wound therapy for treating pressure ulcers.

BACKGROUND: Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. Negative pressure wound therapy (NPWT) is a treatment option for pressure ulcers; a clear, current overview of the evidence is required to facilitate decision-making regarding its use. OBJECTIVES: To assess the effects of negative pressure wound therapy for treating pressure ulcers in any care setting. SEARCH METHODS: For this review, we searched the following databases in May 2015: the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions based on language or date of publication. SELECTION CRITERIA: Published or unpublished randomised controlled trials (RCTs) comparing the effects of NPWT with alternative treatments or different types of NPWT in the treatment of pressure ulcers (stage II or above). DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, risk of bias assessment and data extraction. MAIN RESULTS: The review contains four studies with a total of 149 participants. Two studies compared NPWT with dressings; one study compared NPWT with a series of gel treatments and one study compared NPWT with 'moist wound healing'. One study had a 24-week follow-up period, and two had a six-week follow-up period, the follow-up time was unclear for one study. Three of the four included studies were deemed to be at a high risk of bias from one or more 'Risk of bias' domains and all evidence was deemed to be of very low quality. Only one study reported usable primary outcome data (complete wound healing), but this had only 12 participants and there were very few events (only one participant healed in the study). There was little other useful data available from the included studies on positive outcomes such as wound healing or negative outcomes such as adverse events. AUTHORS' CONCLUSIONS: There is currently no rigorous RCT evidence available regarding the effects of NPWT compared with alternatives for the treatment of pressure ulcers. High uncertainty remains about the potential benefits or harms, or both, of using this treatment for pressure ulcer management.

Barriers to questionnaire completion: understanding the AIDS/HIV patient's perspective.

AIM: To determine what encourages or discourages AIDS/HIV patients from completing questionnaires. BACKGROUND: Data from surveys can provide important information but response rates can be poor. Factors that affect this in an HIV clinic population have not been assessed previously. REVIEW METHODS: The researchers used a qualitative approach and a structured interview schedule. Ten patients were recruited and participated in one-to-one interviews. DISCUSSION: Most patients saw the potential value of completing a questionnaire in the clinic. Lack of privacy during completion was raised as a concern, particularly if there were sensitive questions to respond to. Lack of technical competence was identified by some as a barrier to participation in electronic surveys. Tickboxes were preferred over rating scales or open answers. Participants did not expect a cash incentive or entry in a prize draw when asked to complete a questionnaire in-clinic. CONCLUSION: Generally, AIDS/HIV patients were willing to participate in surveys. Availability of a private area to complete the questionnaire, avoiding complex electronic systems, completion in the clinic, tickbox answers and a length of under two sides of A4 were the most important features that improved acceptability of the questionnaire to patients. Implications for research Surveys that evaluate care need to be short, easy to complete and have clear relevance to the patients' experience.

An evaluation of the reasons why patients attend a hospital Emergency Department.

This survey evaluates the attendance patterns of people who responded to a two part questionnaire (before and after treatment) regarding the reasons they had presented at a hospital Emergency Department co located with an Urgent Care Centre. A total 485 people responded before treatment and 163 people responded after completing treatment. People have deep rooted convictions that the 'hospital' is the best place to be seen for the treatment of their accident or perceived emergency, together with a considerable loyalty and emotional attachment to it. Few people knew that Urgent Care facilities existed within the Emergency Department and fewer what they were for. Some were frustrated at the apparent speed of access to care by those with apparently trivial problems, not understanding that they were accessing a different service. On the whole people who attended were happy with the advice and treatment they received.

Cross-cultural validity of the Individualised Care Scale - a Rasch model analysis.

AIMS AND OBJECTIVES: The aim of this study was to investigate, using Rasch model analysis, the measurement invariance of the item ratings of the Individualised Care Scale. BACKGROUND: Evidence of reliability is needed in cross-cultural comparative studies. To be used in different cultures and languages, the items must function the same way. DESIGN: A methodological and comparative design. METHODS: Secondary analysis of data, gathered in 2005-2006 from a cross-cultural survey using the Individualised Care Scale from Finnish, Greek, Swedish and English predischarge hospitalised orthopaedic and trauma patients (n = 1093), was used. The Rasch model, which produces calibrations (item locations and rank) and item fit statistics, was computed using the Winstep program. RESULTS: The rank of average Individualised Care Scale item calibrations (-2·26-1·52) followed a generally similar trend (Infit ≤ 1·3), but slight differences in the item rank by country were found and some item misfit was identified within the same items. There was some variation in the order and location of some Individualised Care Scale items for individual countries, but the overall pattern of item calibration was generally corresponding. CONCLUSIONS: The Rasch model provided information about the appropriateness, sensitivity and item function in different cultures providing more in-depth information about the psychometric properties of the Individualised Care Scale instrument. Comparison of the four versions of the Individualised Care Scale - patient revealed general correspondence in the item calibration patterns although slight differences in the rank order of the items were found. Some items showed also a slight misfit. Based on these results, the phrasing and targeting of some items should be considered. RELEVANCE TO CLINICAL PRACTICE: The Individualised Care Scale - Patient version can be used in cross-cultural studies for the measurement of patients' perceptions of individualised care. Information obtained with the use of the Individualised Care Scale in clinical nursing practice is important, and valid measures are needed in evaluating patients' assessment of individualised care, one indicator of care quality.

Patient satisfaction in three clinics managing long-term conditions.

People with long-term conditions are frequent visitors to outpatient clinics. In order that they get the best out of their visits, the health professionals taking care of them need to understand their experiences and work towards service improvements. A survey of 3 clinics (HIV, rheumatology, diabetes) was undertaken using a set of three simple, open questions. A total of 147 people responded that, above all, care, attention, friendliness and efficiency were their most valued experiences. Shorter waiting times and cheaper car parking came up most frequently as sources of dissatisfaction. The study concludes that there were no distinct differences in the experiences of the patients in each clinic. All care needs were relatively simple and, on the whole, met.

How to assess quality in your sexual health service.

Previous improvements in NHS have largely focused on increasing service capacity to ensure the provision of universal, comprehensive healthcare at the point of need in the UK. However, public expectations of the NHS are changing, triggered by increased access to information and media coverage of a series of lapses in quality and geographical inequity of care. The NHS also faces the challenges posed by a changing family structure, an ageing population, advancing technology and economic uncertainty. To meet these challenges, improvements in quality rather than just quantity have become a focus of the new NHS. This article provides an overview of quality and how to measure it in sexual health services.

Impact of patient characteristics on orthopaedic and trauma patients' perceptions of individualised nursing care.

RATIONALE AND OBJECTIVES: Relatively few studies have investigated the relationship between patient characteristics and individualised care, in relation to the improvement of care efficiency, efficacy and quality. Individualised care is a key concept in health strategy and policy in Western countries. The aim of this exploratory study was to identify orthopaedic and trauma patients' characteristics relating to their perceptions of individualised nursing care in Western hospital settings. METHODS: A cross-sectional questionnaire survey was conducted among orthopaedic and trauma patients (n=1126) from acute care in hospitals from five countries: Finland, Greece, Sweden, the UK and the USA, in 2005-06. The data were analysed using descriptive statistics, one-way analysis of variance and a multivariate analysis of variance (manova) of the main effects. RESULTS: The separate examination of each background factor showed statistically significant differences between patients' perceptions of individualised care. In the multivariate analysis the statistically significant main effects, associated with patients' perceptions, were age, gender, education and type of admission. These explained 13% of the variance in the support of patient individuality in care and 19% in perceived individuality in care received. CONCLUSIONS: These results can be used in individualising care to different patient groups and in prioritising and focusing quality programs to improve care. Detailed questions about specific aspects of patients' experiences are likely to be more useful in monitoring hospital performance from the patients' perspective.

Adapting the Individualized Care Scale for cross-cultural comparison.

RATIONALE: Cross-cultural comparative studies using reliable and valid instruments can increase awareness of the differences and similarities between health worker's ability to respond to patients' individual needs within different health systems. This will enable a better understanding of cultural perspectives in individualized nursing care. AIM: To describe the translation and adaptation process of the Individualized Care Scale (ICS) and examine its reliability and validity in a cross-cultural study. DESIGN: A cross-sectional comparative study. SETTINGS: Twenty-seven orthopaedic and trauma in-patient units at 14 hospitals in 5 countries. PARTICIPANTS: A total of 1126 patients were included in the study: Finland (n = 425), Greece (n = 315), Sweden (n = 218), UK (n = 135) and USA (n = 33). METHODS: A systematic forward- and back-translation procedure using bilingual techniques, a committee approach, pretest techniques and pilot testing were used with a convenience sample to produce a valid ICS for each participating group. Psychometric evaluation of the adapted ICS was based on means, SD, missing data analysis, Cronbach's alpha coefficients and average inter-item correlations. Construct validity was examined using sub-scale correlations to total scales and principal components analysis. RESULTS: The use of the range of options and the sub-scale mean scores ranging from 2.72 to 4.30 demonstrated the sensitivity of the scale. Cronbach's alpha coefficients (0.77-0.97) and average inter-item correlations (0.37-0.77) were acceptable. The sub-scale correlations to total scales were high (0.83-0.97). The underlying theoretical construct of the ICS was demonstrated by the explained variances ranging from 58% to 79%. CONCLUSIONS: The ICS shows promise as a tool for evaluating individualized care in European cultures. The international expansion of an existing instrument developed for one country facilitates comparative studies across countries. There is a need to further test the construct validity and appropriateness of the ICS in different settings in European and nonwestern cultures.

European orthopaedic and trauma patients' perceptions of nursing care: a comparative study.

AIM: To compare English, Finnish, Greek and Swedish orthopaedic and trauma patients' perceptions of nursing care received during hospitalisation. BACKGROUND: Patient perceptions are important when evaluating nursing care delivery. Evaluations usually take place sub-nationally though European citizens may be treated throughout the European Union. International comparative studies are possible because of the universal nature and philosophical roots of quality in nursing care. They are needed to assist in improving care outcomes. DESIGN: A cross-sectional, comparative study design was used. METHOD: The Schmidt Perception of Nursing Care Survey was used to obtain data from orthopaedic and trauma patients in acute hospitals in four countries: Finland (n = 425, response rate 85%), Greece (n = 315, 86%), Sweden (n = 218, 73%) and UK (n = 135, 85%). Data were first analysed using descriptive statistics, then between-country comparisons were computed inferentially using a one-way analysis of variance and a univariate analysis of covariance. RESULTS: Between-country differences were found in patients' perceptions of the nursing care received. Over the whole Schmidt Perception of Nursing Care Survey the Swedish and Finnish patients gave their care the highest assessments and the Greek patients the lowest. The same trend was seen in each of the four sub-scales: Seeing The Individual Patient, Explaining, Responding and Watching. Responding was given the highest assessments in each participating country and Seeing the Individual Patient the lowest except in Greece. CONCLUSIONS: Further research is needed to consider whether the between-country differences found are caused by differences between cultures, nursing practices, roles of healthcare personnel or patients in the different countries. The Schmidt Perception of Nursing Care Survey is suitable for the assessment of European orthopaedic and trauma patients' perceptions of nursing care received during hospitalisation. RELEVANCE TO CLINICAL PRACTICE: The results are useful in evaluating and developing nursing care in hospitals from different European countries.

Topical negative pressure for treating chronic wounds.

BACKGROUND: Chronic wounds mainly affect the elderly and those with multiple health problems. Despite the use of modern dressings, some of these wounds take a long time to heal, fail to heal, or recur, causing significant pain and discomfort to the person and cost to health services. Topical negative pressure (TNP) is used to promote healing of surgical wounds by using suction to drain excess fluid from wounds. OBJECTIVES: To assess the effects of TNP on chronic wound healing. SEARCH STRATEGY: For this second update of this review we searched the Cochrane Wounds Group Specialised Register (December 2007), The Cochrane Central Register of Controlled Trials (CENTRAL) - The Cochrane Library Issue 4, 2007, Ovid MEDLINE - 1950 to November Week 2 2007, Ovid EMBASE - 1982 to 2007 Week 50 and Ovid CINAHL - 1980 to December Week 1 2007. In addition, we contacted authors, companies, manufacturers, and distributors to identify relevant trials and information. SELECTION CRITERIA: All randomised controlled trials which evaluated the effects of TNP on people with chronic wounds. DATA COLLECTION AND ANALYSIS: Selection of the trials, quality assessment, data abstraction, and data synthesis were done by two authors independently. Disagreements were solved by discussion. MAIN RESULTS: Two trials were included in the original review. A further five trials were included in this second update resulting in a total of seven trials involving 205 participants. The seven trials compared TNP with five different comparator treatments. Four trials compared TNP with gauze soaked in either 0.9% saline or Ringer's solution. The other three trials compared TNP with hydrocolloid gel plus gauze, a treatment package comprising papain-urea topical treatment, and cadexomer iodine or hydrocolloid, hydrogels, alginate and foam. These data do not show that TNP significantly increases the healing rate of chronic wounds compared with comparators. Data on secondary outcomes such as infection rate, quality of life, oedema, hospitalisation and bacterial load were not reported. AUTHORS' CONCLUSIONS: Trials comparing TNP with alternative treatments for chronic wounds have methodological flaws and data do demonstrate a beneficial effect of TNP on wound healing however more, better quality research is needed.

Individualised care from the orthopaedic and trauma patients' perspective: an international comparative survey.

BACKGROUND: Although individualised nursing care is considered a core value in nursing in different countries, international comparative studies in this area are rare. In Western countries, common hospitalised patients, e.g. orthopaedic patients, often perceive health care as impersonal rather than individualised; a term which may also have different connotations in different cultures. OBJECTIVES: To describe and compare orthopaedic and trauma patients' perceptions of individuality in their care in four European countries. DESIGN: A cross-sectional comparative study. SETTINGS: 24 orthopaedic and trauma wards in 13 acute care hospitals. PARTICIPANTS: Data were collected from orthopaedic and trauma patients in Finland (n=425, response rate 85%), Greece (n=315, 86%), Sweden (n=218, 73%) and UK (n=135, 58%) between March 2005 and December 2006. METHODS: Questionnaire survey data using the Individualised Care Scale (ICS) were obtained and analysed using descriptive and inferential statistics including frequencies, percentages, means, standard deviations, 95% confidence intervals (CI), one-way analysis of variance (ANOVA), chi2 statistics and univariate analysis of covariance (ANCOVA). RESULTS: Patients perceived that nurses generally supported their individuality during specific nursing interventions and perceived individuality in their care. There were some between-country differences in the results. Patients' individuality in the clinical situation and in decisional control over their care were also generally well supported and taken into account. However, patients' personal life situation was not supported well through nursing interventions and these patients perceived lower levels of individualised care. CONCLUSIONS: North-South axis differences in patients' perceptions of individualised care may be attributed to the way nursing care is defined and organised in different European countries. Differences may be due to the differences in regional samples, and so no firm conclusions can be made. Further research will be needed to examine the effect of patient characteristics' and health care organisation variables in association with patients' perceptions of individualised care.

Fear of social isolation: results of a survey of older adults in Gloucestershire.

A lifestyle survey of older adults living in Gloucestershire was carried out by Birmingham City University (formerly The University of Central England) and Age Concern Gloucestershire last year. Participants were asked to identify three main areas of concern for their retirement and while fears about health topped the list, fear of social isolation was cited by 11 per cent of participants, forced through events such as lack of mobility, loss of their partner and closure of community facilities such as post offices. Public involvement and inclusion schemes, such as befriending, may provide some solutions to this problem, but healthcare professionals need to be aware of these issues and to work towards community-focused solutions to avoid greater demands on health and social care resources.

Developing critical appraisal skills amongst staff in a hospital trust.

This project was designed to encourage health professionals to use available evidence in their practice by facilitating the development of critical appraisal skills and by making them aware of the practical benefits of using evidence in practice. A partn ership was developed to roll out a workshop programme to enable all members of the health care team within a variety of clinical areas locate, appraise and utilise appropriate evidence in their speciality and to provide the Hospital's professional develo pment team with the necessary experience to conduct subsequent programmes. Six different modules were provided including an introductory session and five other modules each covering a portion of the critical appraisal process. 45 staff including 19 nurse s participated and all were surveyed in the post workshop evaluations. Comments were very positive and the sessions appeared to have enthused the participants. There were some limitations to the project, including fluctuating attendance, but the main out come of this project is that the team realised that in order to be more effective in their approach it would be most appropriate to single out clinical specialities and design workshops entirely applicable to their interests.