Instruments evaluating the quality of the clinical learning environment in nursing education: A systematic review of psychometric properties

BackgroundThe clinical learning environment is fundamental to nursing education paths, capable of affecting learning processes and outcomes. Several instruments have been developed in nursing education, aimed at evaluating the quality of the clinical learning environments; however, no systematic review of the psychometric properties and methodological quality of these studies has been performed to date.ObjectivesThe aims of the study were: 1) to identify validated instruments evaluating the clinical learning environments in nursing education; 2) to evaluate critically the methodological quality of the psychometric property estimation used; and 3) to compare psychometric properties across the instruments available.DesignA systematic review of the literature (using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines) and an evaluation of the methodological quality of psychometric properties (using the COnsensus-based Standards for the selection of health Measurement INstruments guidelines).Data sourcesThe Medline and CINAHL databases were searched. Eligible studies were those that satisfied the following criteria: a) validation studies of instruments evaluating the quality of clinical learning environments; b) in nursing education; c) published in English or Italian; d) before April 2016.Review methodsThe included studies were evaluated for the methodological quality of the psychometric properties measured and then compared in terms of both the psychometric properties and the methodological quality of the processes used.ResultsThe search strategy yielded a total of 26 studies and eight clinical learning environment evaluation instruments. A variety of psychometric properties have been estimated for each instrument, with differing qualities in the methodology used. Concept and construct validity were poorly assessed in terms of their significance and rarely judged by the target population (nursing students). Some properties were rarely considered (e.g., reliability, measurement error, criterion validity), whereas others were frequently estimated, but using different coefficients and statistical analyses (e.g., internal consistency, structural validity), thus rendering comparison across instruments difficult. Moreover, the methodological quality adopted in the property assessments was poor or fair in most studies, compromising the goodness of the psychometric values estimated.ConclusionsClinical learning placements represent the key strategies in educating the future nursing workforce: instruments evaluating the quality of the settings, as well as their capacity to promote significant learning, are strongly recommended. Studies estimating psychometric properties, using an increased quality of research methodologies are needed in order to support nursing educators in the process of clinical placements accreditation and quality improvement.     

Clinical and cost effectiveness of nurse-led self-management interventions for patients with copd in primary care: A systematic review

Background and objectiveChronic obstructive pulmonary disease is increasing in prevalence and constitutes a major cause of morbidity and mortality globally. As well as contributing to a significant decline in health status in many patients, this condition creates a considerable burden on healthcare providers. Self-management interventions are frequently implemented in community settings to limit the impact of chronic obstructive pulmonary disease on everyday life of individuals and to manage pressure on health systems. Nurses are the most likely professional group to provide self-management support. This systematic review aims to evaluate the clinical and cost effectiveness of nurse-led self-management for patients with chronic obstructive pulmonary disease in primary care.DesignA systematic review was conducted to identify randomized controlled studies comparing nurse-led self-management interventions to usual careData sourcesSeven electronic databases, including British Nursing Index, MEDLINE, CINAHL, AMED, EMBASE, Cochrane Library and NHS Economic Evaluation Database, were searched for relevant studies.Review methodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to guide the structure of the review. The relevance of citations was assessed based on inclusion criteria, with full texts retrieved as required to reach a decision. Data extraction was performed independently by two reviewers. The Cochrane risk of bias tool was used to undertake a quality review. A narrative summary method was used to describe review findings.ResultsTwenty-six articles describing 20 randomised controlled trials were included in the analysis. Self-management interventions were heterogeneous, with a variable number of components, level of support, mode of delivery and length of follow up. The review demonstrated that nurse-led self-management programmes may be associated with reductions in anxiety and unscheduled physician visits and increases in self-efficacy, but definitive conclusions could not be reached. Few studies addressed economic outcomes and the diverse perspectives, time frames and settings made comparisons difficult. Evidence on cost-effectiveness was inconclusive.ConclusionsSome nurse-led self-management programmes in this systematic review produced beneficial effects in terms of reducing unscheduled physician visits, lowering patients’ anxiety and increasing self-efficacy, but there is insufficient evidence to reach firm conclusions on the clinical or cost-effectiveness of the interventions. Further research should aim to identify the optimal components of these programmes and to identify those patients most likely to benefit. The inclusion of economic analyses in future studies would facilitate decisions by policy makers on the implementation of self-management interventions.     

A systematic review of community-based parenting interventions for adolescents with challenging behaviours

Parenting skills training is an established means of treating challenging behaviours among young children, but there has been limited research on its efficacy when used to treat challenging adolescent behaviour. The aim of this systematic review was to evaluate the efficacy and effectiveness of community-based parenting interventions designed for families with adolescents, as judged in terms of increased knowledge and skills among parents, improvements in adolescent behaviour, and program feasibility within community settings. Results indicated that intervention group parents typically made greater gains than did control group parents on measures of good parenting, with positive flow-on effects to some aspects of challenging adolescent behaviours. Limited evidence suggests that group and individual intervention formats may be equally effective and that there is no advantage to the participation of the target adolescent in the intervention.     

Risk Factors for Cholangiocarcinoma in Thailand: A Systematic Review and Meta-Analysis

Background and objective: Cholangiocarcinoma remains a serious public health concern in Thailand. While manyof the risk factors for cholangiocarcinoma in western countries are well-recognized, it remains unclear whether theyare the same in Thailand. We set out to investigate the risk factors for cholangiocarcinoma in Thailand. Methods:Starting March 4, 2016, we reviewed studies found using pre-specified keywords on SCOPUS, Pro Quest ScienceDirect, PubMed, and online public access catalog of Khon Kaen University. Two review authors independently screenedstudies for inclusion criteria, extracted data, and assessed the studied Risk of Bias. The Newcastle-Ottawa Scale and theJoanna Briggs Institute Critical Appraisal Tools were used to assess the quality of included studies. The risk effects offactors were estimated as a pooled adjusted odds ratio with a 95% confidence interval. The heterogeneity of results wasconsidered using the I-square, Tau-square and Chi-square statistics. Results: A strong association was found betweencholangiocarcinoma and age, Opisthorchis viverrini infection, eating raw cyprinoid fish, family history of cancer, liquorconsumption, and taking praziquantel. There was only a mild association found between eating nitrite-containing foods,fresh vegetables, education, smoking behavior, and sex. No association was found between cholangiocarcinoma andeating fermented fish (Pla-ra), northeastern Thai or Chinese sausage, sticky rice, meat, chewing betel nut, or eatingfruit. There were two protective factors including fresh vegetables consumption and education attainment. Conclusion:There are unique risk factors of cholangiocarcinoma in Thailand, including age, Opisthorchis     

混合方法研究评价工具的介绍——MMAT

混合方法研究（MMR）作为第三种研究范式，是指将定量和定性研究混合或结合到一个单一的研究中。近年来，MMR在医疗领域的应用已成为一种趋势。与单独使用定性或定量研究相比，MMR可以用来说明某一特定现象的不同方面或从不同的角度阐明问题，获得各种不同类型的信息。而MMR系统综述（MMSR）也被研究者青睐，因为通过MMSR可以综合与特定主题相关的大量信息，并产生指导决策的证据。严格评价工具使MMSR研究人员能够评估所纳入原始研究的可信度和相关性。混合方法评价工具（MMAT）为MMSR严格评价阶段的一种工具，可以对定性研究、随机对照试验、非随机研究、定量描述研究和MMR 5类研究的方法学质量进行评价。针对每个纳入的研究，在回答两个筛选问题后，选择适当的研究类别进行评估，然后依照所选类别的标准进行评分。本文全面介绍新版MMAT，以进一步规范和完善MMR和MMSR在我国的应用。     

Asthma diagnosis in infants and preschool children: a systematic review of clinical guidelines

Background and aim

The definition and diagnosis of asthma are the subject of controversy that is particularly intense in the case of individuals in the first years of life, due to reasons such as the difficulty of performing objective pulmonary function tests or the high frequency with which the symptoms subside in the course of childhood. Since there is no consensus regarding the diagnosis of asthma in preschool children, a systematic review has been carried out.

The Impact of Age of Transfer on Outcomes in the Transition From Pediatric to Adult Health Systems: A Systematic Review of Reviews

PurposeInternational guidance on health-care transition has existed for over a decade; however, many unanswered questions remain. This systematic review of reviews aimed to answer the question: is a later age of transfer from pediatric to adult health care associated with improved health and health service outcomes?MethodsWe included systematic reviews which considered at least one long-term condition and provided outcome data from adult services. Methodology of primary studies was not an exclusion criterion. We searched multiple databases and conducted an initial search in May 2015 which was repeated in May 2017. All reviews were assessed for quality using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) tool. Reviews that scored less than 22 were excluded.ResultsInitial searches identified 6,149 papers. Forty-three reviews met exclusion and inclusion criteria, and 15 reviews also met quality criteria. With one exception, primary studies from reviews which only considered quantitative evidence found that a delayed age of transfer resulted in improved outcomes. Qualitative and mixed-methods evidence supported the view that age 18 was an appropriate time of transfer.ConclusionWe found moderate evidence that models of transition which transfer young people in late adolescence or early adulthood can improve transition outcomes and patient satisfaction.     

Effect of setting,monitoring intensity and patient experience on anticoagulation control: a systematic review and meta-analysis of the literature

ABSTRACT

Objectives: To investigate the relationship between time spent in the recommended target International Normalised Ratio (INR) range and the setting and intensity of anti­coagulant monitoring, in both treatment-experienced and treatment-naïve atrial fibrillation (AF) patients receiving oral anticoagulation (OAC) therapy for the prevention of ischaemic stroke.

Research design and methods: Systematic review of published studies on participants with atrial fibrillation on anticoagulation therapy. We compared frequent monitoring (well-controlled, according to a strict protocol) versus infrequent monitoring (frequency representative of routine clinical practice), specialised care versus usual care, and naïve versus prior anticoagulant use. Meta-analysis was performed using a random effects model.

Results: 36 studies were included, 22 (primary data) of AF patients managed in line with the consensus guidelines target INR range of 2.0–3.0, and 14 studies (secondary data) of mixed patient groups, including AF, with an INR target of 2.0–3.5. Both data sets were combined for sensitivity analysis. Pooled mean time in INR range was 59.1% (95% CI: 55.5, 62.8%) and 64.3% (95% CI: 60.5, 68.0%) for infrequent monitoring and frequent monitoring, respectively. Significantly more time was spent in range in specialist care settings compared to usual care: +11.3% (95% CI: 0.1–21.7%). Naïve OAC users spent less time in range 56.5% (95% CI: 45.5–67.5%) than existing users 61.2% (95% CI: 57.2–65.2%). All of these differences were found to be significant in the sensitivity analyses.

Conclusions: INR control is variable and dependent on monitoring intensity and duration of anticoagulant therapy.