Prognostic factors for risk stratification of adult cancer patients with chemotherapy‐induced febrile neutropenia: A systematic review and meta‐analysis

Chemotherapy‐induced febrile neutropenia patients are heterogeneous in their risk of adverse outcomes. Management strategies are tailored according to level of risk. Many emerging predictors for risk stratification remain controversial being based on single studies only. A systematic review was conducted to determine the strength of association of all identified predictors. Studies were obtained from electronic databases, grey literatures and reference lists. Methodological quality of studies was assessed for internal validity and representativeness. Seven studies (four prospective and three retrospective cohorts) investigating 22 factors were reported. Fixed effects meta‐analysis showed: hypotension and thrombocytopenia were significant predictors for high‐risk. Additional predictors that might enhance performance of current models include: tachypnoea, presence of central venous catheter, duration and severity of neutropenia. Further research to investigate new factors/markers is needed to develop a robust prognostic model, which is the key to enhance patient safety.     

Issues and challenges of curriculum reform to competency‐based curricula in Africa: A meta‐synthesis

Although in recent decades reforms to undergraduate nursing and midwifery education have increasingly been guided by the concept of competency‐based curriculum in a drive to produce competent graduates in the African context, the topic remains poorly researched in‐depth. The related issues and challenges need to be explored in the interest of evidence‐based practice. This article stems from a systematic review of qualitative literature on the design and implementation of competency‐based curriculum. Data was inductively analyzed using constant comparison. The two categories that emerged were: (i) the need for a paradigm shift to competency‐based curriculum; and (ii) the associated issues and challenges, such as a shift from informative to transformative learning, lack or limited of involvement of key stakeholders in curriculum development, focus on hospital‐oriented education, lack of preparation of educators, and inappropriate resources. While ongoing reform of nursing and midwifery education continues, much still needs to be done – in particular, extensive financial investment to increase the capacity of educators, mentors and infrastructure, and the development of collaborative frameworks between nursing and midwifery and higher educational councils.