What are examples of policies, protocols, and safety measures for waterbirths in hospitals?

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Dahlen, Hannah G Maternal and perinatal outcomes amongst low risk women giving birth in water compared to six birth positions on land. A descriptive cross sectional study in a birth centre over 12 years. Midwifery (MIDWIFERY), 2013; 29 (7): 759-64.

UKCC statement on waterbirth. The current position. Midwives (13558404) (Midwives (13558404)), 1995 Jan; 108 (1284): 12.

US WATERBIRTH STUDY. Midwives (MIDWIVES), 2014; 17 (3): 11.

Chapman B Waterbirth protocols: five North Island hospitals in New Zealand. New Zealand College of Midwives Journal (NZ COLL MIDWIVES J), 2004 Apr; 30: 20-4.

Nutter, Elizabeth; Waterbirth: An Integrative Analysis of Peer-Reviewed Literature. Journal of Midwifery & Women’s Health (J MIDWIFERY WOMENS HEALTH), 2014 May; 59 (3): 286-319.

Benko A Waterbirth: is it a real choice? Midwifery Matters (MIDWIFERY MATTERS), 2009 Autumn (122): 9-12. (32 ref)

Maznin, Nur Liyanna Bt. Creedy, Debra Kay. A comprehensive systematic review of factors influencing women’s birthing preferences. The JBI Library of Systematic Reviews. 10(4):232-306, 2012.

Click here to run a PubMed search on your topic

What is the evidence for quality and safety benefits of a bedside shift report?

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1. Go to http://health.library.emory.edu and then click on the PubMed link on right side of page.
2. When PubMed opens, copy/paste this search strategy in the search box and click “Search:”
bedside AND ((shift AND (report OR reports OR reporting)) OR (handoff OR handoffs)) AND (quality OR safety) NOT 22157495[uid] NOT 24264936 [uid] NOT 18989136[uid] NOT 17102266[uid] NOT 19540761[uid] NOT 21041119[uid]

The search will find at least 31 articles.

 

What is the evidence for oral care of a patient on a ventilator?

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The systematic reviews identified below include slightly different findings, so a review of the objective of each review, as well as the patient populations in the included studies, will be important for extrapolating results to a specific setting.  Guidelines were identified in DynaMed and in PubMed.

Evidence summary resources

From Mechanical Ventilation entry.  In:  DynaMed Plus.
Under Adjunctive Therapies > Other Supportive Care

  • A systematic review (JAMA 2014) found that oral care with chlorhexidine may reduce lower respiratory tract infections in adults following cardiac surgery, but is not associated with reduction in VAP in non-cardiac surgery patients.  The review was limited by the heterogeneity of the settings/populations.

JAMA Intern Med. 2014 May;174(5):751-61. Klompas M, et al. Reappraisal of routine oral care with chlorhexidine gluconate for patients receiving mechanical ventilation: systematic review and meta-analysis.

  • A systematic review (with heterogeneity) of 6 RCTs concluded that toothbrushing may not reduce risk of ventilator-associated pneumonia in critically ill patients
  • Society for Healthcare Epidemiology of America (SHEA) guideline on strategies to prevent ventilator-associated pneumonia in acute care hospitals Infect Control Hosp Epidemiol 2008 Oct;29 Suppl 1:S31

From Joanna Briggs

Oral Hygiene Care: Acute Care Setting.  Chu WH.  [Evidence Summaries], AN: JBI5215, 2013.
References a systematic review (Cochrane 2013) concluded that use of chlorhexidine was associated with reduction in rate of VAP in adult, but not pediatric, patients.

Cochrane Database Syst Rev. 2013 Aug 13;8:CD008367.   Shi Z, et al. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia.

Oral Care.  [Recommended Practices, AN: JBI5264, 2013.
References a systematic review (Am J Crit Care 2007) concluding that toothbrushes can be a source of contamination and should be kept clean.

PubMed

View the results of a search for relevant systematic reviews and meta-analyses:
(“Pneumonia, Ventilator-Associated/prevention and control”[Mesh] OR “Respiration, Artificial/adverse effects”[Mesh]) AND (“Anti-Infective Agents, Local”[nm] OR “oral hygiene”[MeSH Terms]) AND (Meta-Analysis[ptyp] OR systematic[sb])

Additional guideline

Berry AM, et al. Consensus based clinical guideline for oral hygiene in the critically ill. Intensive Crit Care Nurs. 2011 Aug;27(4):180-5.

What is the evidence on family members being present during cardiopulmonary resuscitation?

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A search of DynaMed and Joanna Briggs did not identify RCTs or other documents that referenced  RCTs evaluating family presence during resuscitation.

A PubMed search of resuscitation AND family – Filtered by Randomized Controlled Trial only identified one RCT.  Removing the filter and adding “randomized OR random” as search terms did not identify additional studies.
Family presence during cardiopulmonary resuscitation.
Jabre P, et al. N Engl J Med. 2013 Mar 14;368(11):1008-18. doi: 10.1056/NEJMoa1203366.
PMID: 23484827

Family presence during resuscitation: a randomised controlled trial of the impact of family presence. Holzhauser K; Finucane J; De Vries SM; Australasian Emergency Nursing Journal, 2006; 8 (4): 139-47.

There are also quasi-experimental studies included in these search results.

What is the evidence of the effects of electrolyte imbalances and fluid resuscitation on outcomes for patients undergoing surgery? Of particular interest is the population of cardiac surgery patients.

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ELECTROLYTE IMBALANCES

A review of evidence in DynaMed identified the following:

Hyponatremia, Prognosis Section Large cohort study (N=950,000+ patients having major surgery).  Patients with preoperative hyponatremia had statistically significantly higher rates of 30-day all-cause mortality,perioperative major coronary events,wound infections, and pneumonia as compared to patients with normal sodium levels.  Arch Intern Med 2012 Oct 22;172(19):1474,

Hypokalemia, Complications Section.  A large prospective cohort study of patients undergoing elective coronary artery bypass grafting showed that patients with hypokalemia may have increased odds of having a perioperative arrhythmia and need for CPR.  JAMA 1999 Jun 16;281(23):2203

A PubMed search (“hypocalcemia”[mesh] OR “hypercalcemia”[mesh] OR “hyperkalemia”[mesh] OR “hypokalemia”[mesh] OR “hypophosphatemia”[mesh] OR “hyperphosphatemia”[mesh]) AND (“Surgical Procedures, Operative”[Mesh]) AND (case-control OR cohort study OR retrospective) identified several additional studies which are available in this MyNCBI Collection.

FLUID RESUSCITATION

Consult the book “Clinical Fluid Therapy in the Perioperative Setting”, 2011.  It is available in the EUH Library and cites evidence for fluid therapy in various settings.

In PubMed, this search will include reports of clinical trials that address fluid therapy in perioperative care of cardiac surgery patients:

(“Isotonic Solutions”[Mesh] OR “Fluid Therapy”[Mesh] OR “Ringer’s solution, potassium-free” [Supplementary Concept] OR “Ringer’s lactate” [Supplementary Concept] OR “bicarbonated Ringer’s solution” [Supplementary Concept] OR “Ringer’s solution” [Supplementary Concept] OR “crystalloid solutions” [Supplementary Concept] OR “Plasmalyte A” [Supplementary Concept] OR “Plasmalyte R” [Supplementary Concept] OR hetastarch) AND “Perioperative Care”[Mesh] AND ( “Thoracic Surgery”[Mesh] OR “Cardiac Surgical Procedures”[Mesh] ) Limits: Clinical Trials, Meta-analysis, Systematic Review

Effectiveness of music therapy as an adjunct to pharmacological pain relief in post-operative patients

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Relevant articles will be found in PubMed using the search strategy listed below. To execute the search:
1. Go to www.health.library.emory.edu and then click on the PubMed link on right side of page.
2. When PubMed opens, copy/paste this search strategy in the search box (articles):
(“perioperative care”[Mesh] OR “perioperative care” [all fields] OR postoperative) AND (“music therapy”[Mesh] OR “music therapy”[all fields]) AND pain

impact of use of diapers in development of pressure ulcer and other skin related issues

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Articles dated within the last ten years that are specific to the topic based on skimming the full text:

Sugama, Junko, et al. “Efficacy of an improved absorbent pad on incontinence-associated dermatitis in older women: cluster randomized controlled trial.” BMC Geriatrics 12(2012):22-22.

Shannon, Ronald J, LynneBrown, and DebashishChakravarthy. “Pressure Ulcer Prevention Program Study: a randomized, controlled prospective comparative value evaluation of 2 pressure ulcer prevention strategies in nursing and rehabilitation centers.” Advances in Skin & Wound Care 25.10 (2012):450-464.

Fader, Mandy, et al. “Management of night-time urinary incontinence in residential settings for older people: an investigation into the effects of different pad changing regimes on skin health.” Journal of clinical nursing 12.3 (2003):374-386.

Shigeta, Yoshie, et al. “Factors influencing intact skin in women with incontinence using absorbent products: results of a cross-sectional, comparative study.” Ostomy/Wound Management 56.12 (2010):26-28, 30-33.

Schindler, Christine A, et al. “Protecting fragile skin: nursing interventions to decrease development of pressure ulcers in pediatric intensive care.” American journal of critical care 20.1 (2011):26-34.

Nix, Denise. “Prevention and treatment of perineal skin breakdown due to incontinence.” Ostomy/Wound Management. 52.4 (2006):26-28.