Clinical exercise interventions in prostate cancer patients—a systematic review of randomized controlled trials

Introduction  

Urinary incontinence, erectile dysfunction, fatigue as well as fears and depression rank among the most common complaints in patients with prostate cancer, resulting in a reduced participation in daily life and social isolation. Consequently, the quality of life of prostate cancer patients is strongly affected in a negative way. Numerous studies focusing on physical exercise interventions in prostate cancers patients demonstrate positive physiological and psychological effects. Our objective was to evaluate the evidence of randomized controlled studies which examined exercise during medical treatment and in the aftercare of a prostate cancer disease.     

Do educational interventions improve nurses' clinical decision making and judgement? A systematic review

Objectives

Despite the growing popularity of decision making in nursing curricula, the effectiveness of educational interventions to improve nursing judgement and decision making is unknown. We sought to synthesise and summarise the comparative evidence for educational interventions to improve nursing judgements and clinical decisions.

Design

A systematic review.

Data sources

Electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL and PsycINFO, Social Sciences Citation Index, OpenSIGLE conference proceedings and hand searching nursing journals.

Review methods

Studies published since 1960, reporting any educational intervention that aimed to improve nurses’ clinical judgements or decision making were included. Studies were assessed for relevance and quality. Data extracted included study design; educational setting; the nature of participants; whether the study was concerned with the clinical application of skills or the application of theory; the type of decision targeted by the intervention (e.g. diagnostic reasoning) and whether the evaluation of the intervention focused on efficacy or effectiveness. A narrative approach to study synthesis was used due to heterogeneity in interventions, study samples, outcomes and settings and incomplete reporting of effect sizes.

Results

From 5262 initial citations 24 studies were included in the review. A variety of educational approaches were reported. Study quality and content reporting was generally poor. Pedagogical theories were widely used but use of decision theory (with the exception of subjective expected utility theory implicit in decision analysis) was rare. The effectiveness and efficacy of interventions was mixed.

Conclusions

Educational interventions to improve nurses’ judgements and decisions are complex and the evidence from comparative studies does little to reduce the uncertainty about ‘what works’. Nurse educators need to pay attention to decision, as well as pedagogical, theory in the design of interventions. Study design and reporting requires improvement to maximise the information contained in reports of educational interventions.     

Relaxation as treatment for chronic musculoskeletal pain – a systematic review of randomised controlled studies

Abstract

Objectives: To review studies on relaxation treatment for chronic musculoskeletal pain.

Methods: Searches in the databases PubMed, PEDro, CINAHL, Amed, the electronic library information navigator (ELIN), and the British Medical Journal and Science Direct, found 12 relevant studies. Inclusion criteria were: randomised controlled trials (RCTs); studies including a total of at least 25 subjects at the end of intervention; relaxation techniques as single treatment, or combined with education, with the participants being active in the treatment.

Results: A total of 12 studies fulfilled all inclusion criteria and were reviewed. Quality assessment showed that all studies were of medium quality. The relaxation techniques used were: progressive muscle relaxation ad modum Jacobson (most common), autogenic training ad modum Schultz, hypnosis, guided imagery and biofeedback. Positive effects were found regarding decreases in pain intensity, anxiety, depression, and fatigue (in fibromyalgia). Even decreases in medication and health costs were seen. Increased mobility and use of coping strategies were also reported.

Conclusion: Relaxation training could be effective for patients with chronic musculoskeletal pain. The experimental study designs need to be of improved scientific quality and should, for example, include clear self-training relaxation protocols and suitable control groups. RCTs of high quality are necessary.     

Does non-medical prescribing make a difference to patients?

This article examines the literature on non-medical prescribing to establish its impact on UK healthcare. It discusses how better access to medication through non-medical prescribing can improve patient safety and patient-centred care, and how nurse prescribing can help ensure quality of care in the NHS during the current financial crisis.     

Is yoga considered exercise within systematic reviews of exercise interventions? A scoping review

ObjectiveYoga is an increasingly popular choice of exercise for the Western population, with people engaging in yoga for a range of physical and mental health and well-being reasons. The aim of this scoping review is to examine whether yoga is considered an exercise modality within relevant leading journals, as evidenced by its consideration in systematic reviews (SRs) of exercise interventions for health-related outcomes.MethodsDesign: Scoping review.Data sources: Three leading sources (Sports Medicine, British Journal of Sports Medicine and Cochrane Collaboration) were searched.Eligibility criteria for selecting studies: The ten most recently published systematic reviews of exercise interventions for health-related outcomes from each journal were included (N = 30) that met these criteria: systematic review studying humans participating in general exercise and measuring a health-related outcome. Exercise interventions with any specific qualifying terms (e.g. aquatic, strength, aerobic) were excluded.ResultsThe articles retrieved were published between 2007 and 2019, and collectively included 991 interventions. Seven reviews explicitly stated that yoga was to be included/excluded while twenty-three studies made no mention of how yoga was being considered in the methodology. Five studies included yoga in the search strategy, implying its inclusion. Post-hoc analyses found that the definitions of exercise in general were also variable. Exercise definition specificity was not associated with whether or not yoga was assessed for inclusion.ConclusionsSystematic reviews of exercise and physical activity interventions for health-related outcomes do not consistently make clear whether or not they include or exclude yoga as a form of exercise.     

Do the parents of the youth abusing substances need to be supported? A literature review study

BackgroundSubstance abuse negatively affects the youth who use substances, their families and especially their parents. The use of substances impairs the health of the youth and is linked to an increase in noncommunicable diseases. Parents become stressed and they need help. Parents fail to carry out daily plans and routines because they are not sure what the substance abuser can do or what can happen to the substance abuser. When the parents’ well-being is taken care of, they will be able to take care of their youth when they need help. Unfortunately, little is known about the psychosocial needs of the parents, especially when their child abuses substances.ObjectivesThis article aims to review the literature to explore the need for support for parents of youth abusing substances.MethodThe study adopted the narrative literature review (NLR) methodology. Literature was retrieved from the following databases and search engines: electronic databases, search engines and hand searches.ResultsSubstance abuse has been found to affect the youth abusing substances and their families negatively. The parents, being the most affected, need support. The involvement of health professionals can assist the parents in feeling supported.ConclusionParents need support programmes that will give support and strength to their existing abilities.ContributionFocusing on the support needs of the parents of youth abusing substances will help to ensure parents are supported and mentally healthy.     

Do blood transfusions make a difference when you are dying?

Recent blood transfusion guidelines published by the UK National Institute for Health and Care Excellence (2015) recommend restrictive single unit transfusion practices with a threshold haemoglobin level of 70?g/l. While these guidelines do not specifically relate to palliative care patients, neither do they exclude them. Prompted by these guidelines, and studies questioning the costs and benefits of red cell transfusions, a retrospective review of the electronic patient records was undertaken to explore the use and impact of blood transfusions over a 54-month period on the in-patient unit of a 14-bedded hospice in the UK. The objective was to identify the reasons for transfusion and documented evidence of benefit and outcome. Results showed that transfusions were infrequent, the reason given for transfusion was fatigue in 84% of cases, benefit was reported in 39%, and 50% died within 4 weeks of transfusion. These findings are similar to those of other studies highlighting the low level of benefit and short survival time post-transfusion. Anaemia is common in the palliative population and fatigue is increasingly prevalent in the final weeks of life. It has been postulated that fatigue may provide protection from suffering at this time, suggesting that appropriate selection of patients for transfusion is important to prevent the potential to do harm. The use of validated tools, goal setting conversations, and an algorithm for the management of fatigue have now been implemented to support more rational transfusion decisions in the hospice.     

Do healthier nurses make better health promotors? A review of the literature

This discussion paper draws on a review of the literature to explore factors that might promote or inhibit healthier nursing practice. The term healthier nursing practice, used here, refers to the way commitment to health promoting practices at organisational, professional and personal levels is demonstrated and achieved. Health promotion is a holistic concept that calls for the creation of empowered relationships between self, others, and the environment to improve wellness. Nurses have often struggled to achieve this within their patient encounters and even more so within their own personal and professional life experiences. Two factors were identified in the literature review that appear to significantly impact on this situation, the organisational environment within which nurses practice and their educational exposure to health promoting opportunities. There are a number of parallel processes identified that illustrate the difficulties nurses have in their experiences of working with patients and with themselves in promoting healthier lives. Action learning is advocated as an effective way for nurses to address what are sometimes perceived as being insurmountable barriers to developing health promoting opportunities for patients and the individual nurse.     

Do sex differences exist in opioid analgesia? A systematic review and meta-analysis of human experimental and clinical studies

Although a contribution of sex in opioid efficacy has garnered much attention, the confirmation and direction of any such difference remain elusive. We performed a systematic review of the available literature on sex differences in μ and mixed μ/κ opioid effect on acute and experimental pain. Fifty unique studies (including three unpublished studies) were included in the analyses. Across the 25 clinical studies on μ-opioids there was no significant sex-analgesia association. Restricting the analysis to patient-controlled analgesia (PCA) studies (irrespective of the opioid) yielded greater analgesia in women (n = 15, effect size 0.22, 95% c.i. 0.02-0.42, P = 0.028). Further restricting the analysis to PCA morphine studies yielded an even greater effect in women (n = 11, effect size = 0.36, 95% c.i. 0.17-0.56, P = 0.003). Meta-regression indicated that the longer the duration of PCA, the difference in effect between the sexes further increased. Across experimental pain studies on μ-opioids women had greater antinociception from opioids (n = 11, effect size = 0.35; 95% c.i. 0.01-0.69, P = 0.047), which was predominantly due to 6 morphine studies. Female patients had greater μ/κ opioid analgesia (n = 7, effect size 0.84; 95% c.i. 0.25-1.43, P = 0.005), but no sex-analgesia association was present in experimental studies (n = 7). Sex differences exist in morphine-induced analgesia in both experimental pain studies and clinical PCA studies, with greater morphine efficacy in women. The data on non-morphine μ and mixed μ/κ-opioids are less convincing and require further study.     

Effectiveness of rehabilitation interventions to improve paretic propulsion in individuals with stroke – A systematic review

BackgroundStroke survivors often show reduced walking velocity and gait asymmetry. These gait abnormalities are associated with reduced propulsion of the paretic leg. This review aimed to provide an overview of the potential effectiveness of post-stroke rehabilitation interventions to improve paretic propulsion, ankle kinetics and walking velocity.MethodsA systematic search was performed in Pubmed, Web of Science, Embase, and Pedro. Studies were eligible if they reported changes in propulsion measures (impulse, peak value and symmetry ratios) or ankle kinetics (moment and power) following intervention in stroke survivors (group size ≥10). Study selection, data extraction and quality assessment were performed independently by two authors.FindingsA total of 28 studies were included, of which 25 studies applied exercise interventions, two studies focused on surgical interventions, and one on non-invasive brain stimulation. The number of high-quality trials was limited (N = 6; score Downs and Black scale ≥19). Propulsion measures were the primary outcome in eight studies. In general, mixed results were reported with 14 interventions yielding improvements in propulsion and ankle kinetics. In contrast, gains in walking velocity were observed in the vast majority of studies (N = 20 out of 23).InterpretationInterventions that yielded gains in propulsion appeared to have in common that they challenged and/or enabled the utilization of latent propulsive capacity of the paretic leg during walking. Walking speed generally increased, regardless of the observed change in propulsion, suggesting the use of compensatory mechanisms. Findings should, however, be interpreted with some caution, as the evidence base for this emerging focus of rehabilitation is limited.