Ginger for health care: An overview of systematic reviews

ObjectivesTo summarize the evidence from systematic reviews (SRs) and meta-analyses that evaluated the efficacy of ginger in treating any conditions and critically assess the quality of these evidence.MethodsA systematic search of the literature was conducted from inception until February 28, 2019 using the PubMed, EMBASE, Web of science, Cochrane library, and four Chinese databases. Literature selection and data extraction were conducted by two independent reviewers. The quality of SRs was evaluated using the AMSTAR-2 tool. The GRADE system was used to assess the quality of evidence.ResultsTwenty-seven SRs were included. The number of included studies were various, range from 3 to 27. The condition with the most included SRs was nausea and vomiting (n = 12, 44.4%). Many SRs showed a promising efficacy of ginger, including nausea and vomiting, metabolic syndrome and pain, while the effect of ginger for platelet aggregation failed to draw a certain conclusion. The quality of SRs was heterogeneous. All of included SRs well complied with the Item 1 (“research questions included the components of PICO”) and Item 3 (“explained selection of the study designs for inclusion”). Twenty review failed to provide registration information. Only one SR reported the sources of funding for studies included.ConclusionsIn our overview, most of SRs suggest ginger is a promising herbal medicine for health care, which is beneficial for nausea and vomiting, metabolic syndrome and pain. However, considering the limited quality of included evidence and heterogeneity of different clinical trials, more well-design studies are required to confirm the conclusion further.     

Advancing the clinical nurse leader model through academic-practice-policy partnership

The nursing profession is tasked with identifying and evaluating models of care with potential to add value to health care delivery. In consideration of this goal, we describe the Clinical Nurse Leader (CNL) initiative and the activities of a national-level CNL research collaborative. The CNL initiative, launched by the American Association of Colleges of Nursing in collaboration with education and healthcare leaders, has delineated CNL education curriculum and practice competencies, and fostered the creation of academic-practice-policy partnerships to pilot CNL integration into frontline nursing care delivery. The partnership has evolved into an Agency for Healthcare Research and Quality affiliate practice-based research network, the CNL Research Collaborative, which links research, policy, education, and practice stakeholders to advance the CNL evidence base. We summarize foundational CNLRC research to explain CNL practice, quantify CNL effectiveness, and bring clarity to how CNLs can be implemented to consistently influence care, quality, and safety.     

Improving organizational capacity to address health literacy in public health: a rapid realist review

Objectives

Despite the growing significance of health literacy to public health, relatively little is known about how organizational capacity may be improved for planning, implementing and sustaining health literacy interventions. This study aimed to connect decision makers in a public health agency with evidence of how organizational capacity may be improved for delivering health literacy services.

Study design

A rapid realist review of published and grey literature was conducted by a partnership between the Public Health Agency of Canada (PHAC) and the InSource Research Group.

Methods

Realist review methodology attempts to understand what works for whom under what circumstances, and is characterized by its focus on strategies/interventions, contexts, mechanisms and their relationship to outcome. This review was completed in collaboration with a reference panel (comprised of a broad range of PHAC representatives) and an expert panel. Literature searching was conducted using three databases supplemented with bibliographic hand searches and articles recommended by panels. Data were extracted on key variables related to definitions, strategies/interventions associated with increased organizational capacity, contextual factors associated with success (and failure), mechanisms activated as a result of different strategies and contexts, key outcomes, and evidence cited.

Results

Strategies found to be associated with improved organizational capacity for delivering health literacy services may be classified into three domains: (1) government action; (2) organizational/practitioner action; and (3) partnership action. Government action includes developing policies to reinforce social norms; setting standards for education; conducting research; and measuring health literacy levels. Organizational/practitioner action relates to appropriate models of leadership (both high-level government engagement and distributed leadership). Innovative partnership action includes collaborations with media outlets, those producing electronic materials, community organizations and school-based programs. Contextual factors for success include positive leadership models, interorganizational relationships, and a culture committed to experimentation and learning. Potential mechanisms activated by strategies and contextual factors include increased visibility and recognition of health literacy efforts, enthusiasm and momentum for health literacy activities, reduced cognitive dissonance between vision and action, a sense of ownership for health literacy data, and creation of a common language and understanding.

Conclusions

Government initiated interventions and policies are powerful strategies by which organizational capacity to improve health literacy may be affected. Using the foundations created by the government policy environment, organizations may improve the impact of health literacy interventions through supported distributed leadership.     

低分子肝素皮下注射操作的最佳证据总结

目的 检索、评价和整合低分子肝素皮下注射操作的相关证据。方法 计算机检索国内外数据库、相关专业网站中关于低分子肝素皮下注射操作的临床决策、推荐实践、证据总结、技术报告、指南、专家共识、系统评价,文献检索时限为建库至2021年11月,由2名研究者独立进行文献质量评价后,根据主题对证据进行提取与汇总。结果 根据纳入标准,共筛选出9篇文献,包括2篇证据总结、2篇专家共识、5篇系统评价。通过文献阅读、证据提取和归类,从注射前准备、注射中规范、注射后处置3个方面总结出12条证据。结论 该研究总结了低分子肝素皮下注射操作的最佳证据,可为护理人员开展临床实践提供参考。护理人员应结合临床情境、患者意愿,审慎地选择并应用证据,从而保障注射安全,降低相关并发症的发生率。     

强直性脊柱炎患者运动指导方案的最佳证据总结

目的 总结强直性脊柱炎患者运动指导方案的最佳证据,为对强直性脊柱炎患者实施运动指导提供依据。方法 计算机系统检索UpToDate、BMJ最佳临床实践、OVID、CINAHL、Cochrane Library、Embase、PubMed、Scopus、中国知网、万方数据库、维普数据库、中国生物医学文献数据库、医脉通等指南网及专业协会网站和数据库中关于强直性脊柱炎患者运动方案的指南、系统评价、Meta分析、专家共识、证据总结、最佳临床实践等,检索时限为2012年1月1日—2022年1月1日,由2名护士独立对文献进行筛选、质量评价、提取最佳证据并分级,总结运动指导方案的最佳证据。结果 共纳入文献16篇,包括指南1篇、系统评价6篇、Meta分析4篇、专家共识5篇,总结出运动指导方案的最佳证据包括运动前评估、运动适用范围、不同疾病阶段分期的运动类型、运动项目内容（项目、内容、运动强度、频率、周期）、监督方式、运动监测指标、运动风险评估、注意事项共8个方面,39条证据。结论 该研究总结的强直性脊柱炎患者运动指导方案的最佳证据,规范了强直性脊柱炎患者康复运动的理论、实践,形成科学、规范、基于最佳证据...     

维持性血液透析患者动静脉血管通路穿刺管理的最佳证据总结

目的 检索、评价并汇总维持性血液透析患者动静脉血管通路穿刺管理的证据,为加强临床医护人员动静脉血管通路穿刺规范管理提供循证依据。方法 系统检索UpToDate临床顾问、美国医疗保健研究与质量局、国际指南协作网、苏格兰校际指南网、英国国家卫生与临床优化研究所、加拿大安大略注册护士协会、医脉通等网站、指南库,以及ACP Journal Club、Cochrane Library、PubMed、Web of Science、CINAHL、中国知网、万方数据库、维普数据库、中国生物医学文献服务系统等数据库中关于维持性血液透析患者动静脉血管通路穿刺管理的证据,文献类型包括临床决策、指南、最佳实践、证据总结、系统评价、专家共识。检索时限为2017年1月—2021年12月。循证团队进行文献筛选、质量评价,并提取、汇总证据。结果 最终纳入8篇文献,其中临床决策2篇、指南4篇、系统评价1篇、专家共识1篇。最佳证据包括首次穿刺时机、穿刺前评估及准备、穿刺方法、穿刺成功判定、穿刺并发症处理、穿刺针拔出后按压、穿刺辅助设备、穿刺人员资质及培训8个方面,共25条证据。结论 血液净化医护人员需结合具体临床情境、证据的促进因素、阻碍因素及患者意愿,有针对性地选择最佳证据,提高动静脉血管通路一次穿刺成功率,减少穿刺相关不良事件,延长血管通路使用寿命。     

神经性厌食患者饮食行为管理的最佳证据总结

目的 检索、评价并整合国内外神经性厌食患者饮食行为管理的相关证据,为临床护理提供参考。方法系统检索国内外数据库中有关神经性厌食患者饮食行为管理的临床决策、推荐实践、证据总结、临床实践指南、系统评价/Meta分析和专家共识。检索时限为建库至2022年2月,由3名研究者对文献进行方法学质量评价,并根据主题对证据进行提取和汇总。结果 共纳入16篇文献,其中临床决策2篇,证据总结2篇,指南9篇,系统评价3篇。从多学科团队、管理目标、评估、管理实践、心理治疗、健康教育6个方面汇总26条最佳证据。结论 该研究总结了神经性厌食患者饮食行为管理的最佳证据,在后续证据转化过程中应结合国内临床具体情境,有针对性地选择证据,以规范患者饮食行为,改善其临床结局。     

乳腺癌相关淋巴水肿非药物干预的证据总结

目的 运用循证的方法 整合乳腺癌相关淋巴水肿非药物干预的最佳证据,为临床医护人员对淋巴水肿开展规范化评估和管理提供循证依据。方法 系统检索各指南网站及中英文数据库有关乳腺癌患者淋巴水肿预防和管理的相关指南、专家共识、系统评价等证据,检索时限为2016年1月—2022年1月。结果 共纳入25篇文献,包括6篇指南、4篇专家共识、15篇系统评价,围绕预防性干预、治疗性干预2个方面总结33条最佳证据。结论 该研究总结的证据可用于防治乳腺癌淋巴水肿,医护人员需结合文化背景、临床情境、患者意见,为淋巴水肿患者提供针对性的健康指导。     

造血干细胞移植患者疲乏管理的最佳证据总结

目的 检索、评价并总结国内外关于造血干细胞移植患者疲乏管理的最佳证据,为临床开展相关循证护理实践提供参考。方法 系统检索国内外计算机决策支持系统、指南网站、数据库、相关专业协会网站中关于造血干细胞移植患者疲乏管理的证据,包括指南、临床决策、推荐实践、证据总结、系统评价及专家共识。检索时间为建库至2022年2月10日。由2名研究者独立对文献质量进行评价,并结合专业判断进行资料提取、整合。结果 共纳入24篇文献,其中指南4篇、专家共识1篇、证据总结2篇、系统评价17篇。总结的最佳证据包括疲乏的评估、运动管理、心理社会干预、健康教育、营养管理、补充和替代疗法、合理用药、共同决策和多学科合作8个方面,共24条。结论 临床护理人员需要重视造血干细胞移植患者的疲乏管理,应根据临床实际情况和患者意愿,以规范、有效、安全的方式管理疲乏,以改善其预后和生活质量。     

Agency for Healthcare Research and Quality Evidence-based Practice Center methods for systematically reviewing complex multicomponent health care interventions

ObjectivesThe purpose of this Agency for Healthcare Research and Quality Evidence-based Practice Center methods white paper was to outline approaches to conducting systematic reviews of complex multicomponent health care interventions.Study Design and SettingWe performed a literature scan and conducted semistructured interviews with international experts who conduct research or systematic reviews of complex multicomponent interventions (CMCIs) or organizational leaders who implement CMCIs in health care.ResultsChallenges identified include lack of consistent terminology for such interventions (eg, complex, multicomponent, multidimensional, multifactorial); a wide range of approaches used to frame the review, from grouping interventions by common features to using more theoretical approaches; decisions regarding whether and how to quantitatively analyze the interventions, from holistic to individual component analytic approaches; and incomplete and inconsistent reporting of elements critical to understanding the success and impact of multicomponent interventions, such as methods used for implementation the context in which interventions are implemented.ConclusionWe provide a framework for the spectrum of conceptual and analytic approaches to synthesizing studies of multicomponent interventions and an initial list of critical reporting elements for such studies. This information is intended to help systematic reviewers understand the options and tradeoffs available for such reviews.