Nursing and Midwifery - Journal Articles

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Acknowledging the resilience of student nurses during COVID-19
(Elsevier Inc., 2021-06-17) Goodwin, John
Acute surgical wound-dressing procedure: Description of the steps involved in the development and validation of an observational metric
(Wiley, 2019-04-01) Hegarty, Josephine; Howson, Victoria; Wills, Teresa; Creedon, Sile A.; Mc Cluskey, Pat; Lane, Aoife; Connolly, Aine; Walshe, Nuala; Noonan, Brendan; Guidera, Fiona; Gallagher, Anthony G.; Murphy, Siobhan; University College Cork
The aim of this study was to develop an observational metric that could be used to assess the performance of a practitioner in completing an acute surgical wound-dressing procedure using aseptic non-touch technique (ANTT). A team of clinicians, academics, and researchers came together to develop an observational metric using an iterative six-stage process, culminating in a Delphi panel meeting. A scoping review of the literature provided a background empirical perspective relating to wound-dressing procedure performance. Video recordings of acute surgical wound-dressing procedures performed by nurses in clinical (n = 11) and simulated (n = 3) settings were viewed repeatedly and were iteratively deconstructed by the metric development group. This facilitated the identification of the discrete component steps, potential errors, and sentinel (serious) errors, which characterise a wound dressing procedure and formed part of the observational metric. The ANTT wound-dressing observational metric was stress tested for clarity, the ability to be scored, and interrater reliability, calculated during a further phase of video analysis. The metric was then subjected to a process of cyclical evaluation by a Delphi panel (n = 21) to obtain face and content validity of the metric. The Delphi panel deliberation verified the face and content validity of the metric. The final metric has three phases, 31 individual steps, 18 errors, and 27 sentinel errors. The metric is a tool that identifies the standard to be attained in the performance of acute surgical wound dressings. It can be used as both an adjunct to an educational programme and as a tool to assess a practitioner's performance of a wound-dressing procedure in both simulated and clinical practice contexts.
Advance care planning within survivorship care plans for older cancer survivors: a systematic review
(Elsevier, 2017-06-23) O'Caoimh, Rónán; Cornally, Nicola; O'Sullivan, Ronan; Hally, Ruth; Weathers, Elizabeth; Lavan, Amanda H.; Kearns, Tara; Coffey, Alice; McGlade, Ciara; Molloy, D. William
Advances in the medical treatment of cancer have increased the number of survivors, particularly among older adults, who now represent the majority of these. Survivorship care plans (SCPs) are documents that cancer patients receive summarising their care, usually at the end of treatment but preferably from initial diagnosis. These may increase patient satisfaction and represent an opportunity to initiate preventative strategies and address future care needs. Advance care planning (ACP), incorporating advance healthcare decision-making, including formal written directives, increases satisfaction and end-of-life care. This paper systematically reviews evaluations of ACP within SCPs among older (≥65 years) cancer survivors. No studies meeting the inclusion criteria were identified by search strategies conducted in PubMed/MEDLINE and the Cochrane databases. One paper examined cancer survivors’ mainly positive views of ACP. Another discussed the use of a SCP supported by a ‘distress inventory’ that included an advance care directive (living will) as an issue, though no formal evaluation was reported. Although ACP is important for older adults, no study was found that evaluated its role within survivorship care planning. Despite the risk of recurrence and the potential for morbidity and mortality, especially among older cancer survivors, ACP is not yet a feature of SCPs.
Advanced practice nursing for enduring health needs management: a global perspective
(Elsevier, 2012-07) Koskinen, Liisa; Mikkonen, Irma; Graham, Iain; Norman, Linda D.; Richardson, Jim; Savage, Eileen; Schorn, Mavis
Advanced practice nursing expertise has been acknowledged worldwide as one response to the challenges arising from changes in society and health care. The roots of advanced practice nursing education are at the University of Colorado where the first known programme started in 1965. In many countries advanced practice nurses (APNs) have taken responsibility for routine patient care formerly carried out by physicians in order to reduce their workload. However, more and more, APNs have taken responsibility for new service areas and quality programmes not previously provided. Chronic disease management is one of these new service areas because long-term diseases are increasingly challenging service systems globally. This article is based on an international APN partnership. The aim of the article is to describe how the partnership will design a 15 ECTS credit course on Enduring Health Need Management as a cross-cultural collaborative endeavour. The adaptation of an inquiry based learning framework will be described drawing on four main principles of the theory: authentic learning communities; student encouragement in analysing gradually more complicated problems; networking in knowledge creation and; student engagement and activity. The cross-cultural online course aims to increase APNs' intercultural competence as well as their global and international work orientation.
Age, job characteristics and coronary health
(Oxford University Press, 2012-08-27) McCarthy, Vera J. C.; Perry, Ivan J.; Greiner, Birgit A.
Background: Workplace demographics are changing in many European countries with a higher proportion of older workers in employment. Research has shown that there is an association between job strain and cardiovascular disease, but this relationship is unclear for the older worker. Aims: To investigate the association between job strain and a coronary event comparing younger and older male workers. Methods: Cases with a first-time coronary event were recruited from four coronary/intensive care units (1999-2001). Matched controls were recruited from the case's general practitioner surgery. Physical measurements were taken and self-administered questionnaires completed with questions on job characteristics, job demands and control. Unconditional logistic regression was carried out adjusting for classical cardiovascular risk factors. Results: There were 227 cases and 277 matched controls. Age stratified analyses showed a clear difference between younger (= 50 years) workers with regard to the exposure of job strain (job demands and control) and the association between these factors and cardiovascular disease. Older workers who had a coronary event were four times as likely to have high job strain [OR = 4.09 (1.29-13.02)] and more likely to report low job control [ OR = 0.83 (0.72-0.95)]. Conclusions: Job control emerged as a potential protective factor for heart disease and this evidence was stronger in the older male worker. Nevertheless, they were significantly more likely to have job strain. These results suggest that older workers may be more susceptible to job strain.
Anxiety in fathers in the perinatal period: a systematic review
(Elsevier, 2019-05-28) Philpott, Lloyd F.; Savage, Eileen; FitzGerald, Serena M.; Leahy-Warren, Patricia
Background: Fatherhood in the perinatal period can be a time of great excitement, happiness and joy. However, a growing body of literature indicates that fathers are at risk for elevated levels of anxiety symptoms during the perinatal period. Purpose: The purpose of this systematic review is to determine the prevalence and levels of anxiety in fathers during the perinatal period, identify the risk factors and impact of anxiety, and establish if there are effective interventions that reduce father's anxiety. Design: Systematic review. Methods: A systematic review protocol was developed and registered with PROSPERO (reference number: CRD42017073760). The review was guided by the PRISMA reporting process. Electronic databases Medline, CINAHL, Embase, the Cochrane Library, PsycARTICLES, PsycINFO, and Psychology were searched to identify eligible studies. Studies that researched fathers during the perinatal period were included if anxiety was the primary focus of the research or was an outcome or dependent variable. Data were extracted and presented in narrative form including tables and figures. Findings: Thirty-four studies met the inclusion criteria. Findings from these studies indicate that fathers experience anxiety in the perinatal period, particularly at the time of birth. Anxiety increased from the antenatal period to the time of birth, with a decrease in anxiety from the time of birth to the later postnatal period. The prevalence of anxiety ranged between 3.4% and 25.0% during the antenatal period and 2.4% and 51.0% during the postnatal period. Factors contributing to anxiety included lower education levels, lower income levels, lower co-parenting support, lower social support, work-family conflict, a partner’ anxiety and depression, and being present during a previous birth. Anxiety had a negative impact on fathers’ mental health, physical health, social relationships and parenting skills. Anxiety contributed to stress, depression, fatigue and lower paternal self-efficacy. Five studies reported on interventions to reduce anxiety and all the studies found that anxiety significantly decreased following the intervention. Key conclusion: Fathers experience increased anxiety from the antenatal period to the time of birth, with a decrease in anxiety from the time of birth to the later postnatal period. Anxiety during the perinatal period that can impact negatively on fathers physical and mental health, and social relationships.
Barriers and facilitators to the choice of active surveillance for low-risk papillary thyroid cancer in China: A qualitative study examining patient perspectives
(Mary Ann Liebert Inc., 2023-01-31) Zhu, Pingting; Zhang, Qianqian; Wu, Qiwei; Shi, Guanghui; Wang, Wen; Xu, Huiwen; Zhang, Li; Qian, Meiyan; Hegarty, Josephine; National Natural Science Foundation of China; Yangzhou University
Background: Internationally, several clinical practice guidelines recommend active surveillance as a non-surgical management strategy for select patients with low-risk papillary thyroid carcinoma. However, patient's decision making when choosing active surveillance as a management approach is not well understood. Thus, our aim was to examine the barriers and facilitators to selecting active surveillance amongst patients with low-risk papillary thyroid carcinoma in China. Methods: Thirty-nine participants diagnosed with low-risk papillary thyroid carcinoma were purposively recruited between July-Nov 2021 for semi-structured interviews; 24 of whom rejected and 15 patients chose 'active surveillance' as a management approach in our sample. Inductive content analysis illustrated emerging themes. Audit trails, member checks and thematic discussions were used to assert rigor. Results: Barriers and facilitators were classified as patient-related, disease-related, and external factors. Patient-related factors included patient's knowledge, attitudes and emotions. Disease-related factors included the response to having cancer, the constant state of being diseased and perceived value of the thyroid gland. External factors included the residual effects of surgery, the active surveillance protocol and physicians' recommendations. Conclusions: Patient's the acceptability of the active surveillance as a management approach are complex with many influencing factors. The public acceptance of active surveillance as a disease management approach needs to be improved, through the presentation of active surveillance as an evidence-based and optimized dynamic management strategy. Clinicians must address their patients' psychological struggles when patients choosing active surveillance and patients require more attention and supportive intervention.
Birth as a neuro-psycho-social event: an integrative model of maternal experiences and their relation to neurohormonal events during childbirth
(Public Library of Science, 2020-07) Olza, Ibone; Uvnas-Moberg, Kerstin; Ekstrom-Bergstrom, Anette; Leahy-Warren, Patricia; Karlsdottir, Sigfridur Inga; Nieuwenhuijze, Marianne; Villarmea, Stella; Hadjigeorgiou, Eleni; Kazmierczak, Maria; Spyridou, Andria; Buckley, Sarah; European Commission
Background: Psychological aspects of labor and birth have received little attention within maternity care service planning or clinical practice. The aim of this paper is to propose a model demonstrating how neurohormonal processes, in particular oxytocinergic mechanisms, not only control the physiological aspects of labor and birth, but also contribute to the subjective psychological experiences of birth. In addition, sensory information from the uterus as well as the external environment might influence these neurohormonal processes thereby influencing the progress of labor and the experience of birth. Methodology: In this new model of childbirth, we integrated the findings from two previous systematic reviews, one on maternal plasma levels of oxytocin during physiological childbirth and one meta-synthesis of women's subjective experiences of physiological childbirth. Findings: The neurobiological processes induced by the release of endogenous oxytocin during birth influence maternal behaviour and feelings in connection with birth in order to facilitate birth. The psychological experiences during birth may promote an optimal transition to motherhood. The spontaneous altered state of consciousness, that some women experience, may well be a hallmark of physiological childbirth in humans. The data also highlights the crucial role of one-to-one support during labor and birth. The physiological importance of social support to reduce labor stress and pain necessitates a reconsideration of many aspects of modern maternity care. Conclusion: By listening to women's experiences and by observing women during childbirth, factors that contribute to an optimized process of labor, such as the mothers' wellbeing and feelings of safety, may be identified. These observations support the integrative role of endogenous oxytocin in coordinating the neuroendocrine, psychological and physiological aspects of labor and birth, including oxytocin mediated. decrease of pain, fear and stress, support the need for midwifery one-to-one support in labour as well as the need for maternity care that optimizes the function of these neuroendocrine processes even when birth interventions are used. Women and their partners would benefit from understanding the crucial role that endogenous oxytocin plays in the psychological and neuroendocrinological process of labor.
Born too soon: preterm birth in Europe trends, causes and prevention
(World Health Organization Regional Office for Europe, 2015) Murphy, Margaret M.; McLoughlin, Geraldine; United Nations Population Fund, United States
It is estimated that 15 million babies annually are born too soon, which is before 37 completed weeks of gestation and that this number is rising (1). Complications of preterm birth are the leading cause of death among children less than 5 years of age and this accounted for nearly one million preventable deaths in 2013 (1). The United Nations Millennium Development Goal (MDG) 4 targeted a two-thirds’ reduction of under five deaths by 2015 and recommended interventions to prevent preterm birth and to improve survival for preterm newborns (2). While infant and maternal mortality rates have witnessed some improvements, the burden of mortality and morbidity in the perinatal period remains a major concern (3). This is due in part to the high number of births per year, the young age of the maternal and infant population harmed by adverse perinatal events and the long-term sequelae of adverse pregnancy events such as very preterm birth or severe hypoxia (4).
Bowel symptom experiences and management following sphincter saving surgery for rectal cancer: A qualitative perspective
(Elsevier, 2012-07) Landers, Margaret; McCarthy, Geraldine; Savage, Eileen; Health Research Board
The aim of this research was to explore participants’ qualitative perspectives on bowel symptom experiences and management strategies following sphincter saving surgery for rectal cancer. Methods and sample The data presented in this paper were gleaned from a semi-structured question that formed part of a larger multi-site quantitative correlational study. From a sample of 143 participants, a total of 77 (62.6%) males and 46 (37.3%) females provided qualitative comments. Participants were aged 30–70 years and over, had undergone sphincter saving surgery for rectal cancer in the past 3–42 months. Data were analysed using pre-determined semi-structured categories. Key results The study demonstrated the subjective nature of the bowel symptoms experienced. It also highlighted the bowel symptoms that were most problematic and the effect of these symptoms on participants’ daily lives. In addition, the self-care strategies that worked best for individual participants in the management of bowel symptoms were identified. Conclusions There is a need to educate patients on the short-term as well as the long-term bowel symptoms experienced following sphincter saving surgery for rectal cancer. Nurses have an important contribution to make in facilitating patients to choose from a range of self-care strategies to help them manage their bowel symptoms postoperatively.
Bullying in schools: an evaluation of the use of drama in bullying prevention
(Taylor & Francis Group, 2019-06-18) Goodwin, John; Bradley, Stephen K.; Donohoe, Peadar; Queen, Katie; O'Shea, Maev; Horgan, Aine M.
Bullying can have a severe effect on the physical and mental health of young people. This qualitative descriptive research aimed to develop an understanding of young peoples? experiences of an educational, interactive theatre-based workshop (the Bullying Prevention Session) which focused on developing strategies to address school bullying. Focus group interviews were conducted with students from six schools. Students reported that the workshop improved their understanding of the complexities of bullying, including appreciating the situation from the perspectives of both bullies and bystanders. Students noted their dissatisfaction with the schools? efforts to implement bullying reduction strategies that they suggested at the workshop.
Caesarean wound care for midwives
(Medical Education Solutions Ltd, 2013-10) Murphy, Margaret M.
With a rise in caesarean births there is a rise in wound care management issues for midwives and the potential for surgical site infections (SSIs). The burden of SSIs include increases in maternal mortality, morbidity, length of hospital stay and cost. Sepsis is currently the leading cause of maternal mortality, with 50 per cent of the women who die having had a caesarean birth (Centre for Maternal and Child Enquiries (CMACE) 2011). Wound management and the prevention of sepsis are therefore issues of great concern to midwives. This article considers the incidence of wound infections and presents the guidance available to help address this problem.
Cancer and breast cancer awareness interventions in an intellectual disability context: A review of the literature
(SAGE Publications, 2019-05-19) Walsh, Susan; O'Mahony, Mairin; Lehane, Elaine; Farrell, D.; Taggart, L.; Kelly, L.; Sahm, Laura; Byrne, A.; Corrigan, M.; Caples, Maria; Martin, Anne-Marie; Tabirca, Sabin; Corrigan, M. A.; Hegarty, Josephine
Background: Women with an intellectual disability (ID) have a similar risk of developing breast cancer as women in the general population yet present with later stage breast cancers, which have poorer outcomes. Aim: To identify whether there is a need to develop a breast cancer awareness intervention for women with an ID. Methods: Interventions aimed at increasing cancer awareness and breast cancer awareness for people with an ID were identified and critically appraised. Results: Five interventions to increase cancer awareness or breast cancer awareness in people with an ID were identified. Conclusion: The review highlighted the paucity of theoretically underpinned breast cancer awareness interventions specifically aimed at women with an ID. Facilitating breast cancer awareness for women with an ID could potentially lead to earlier presentation of potential symptoms of breast cancer, earlier treatment, better prognosis and ultimately, improved survival. This article establishes that there is a need for an intervention underpinned by theory to increase breast cancer awareness in women with an ID.
Cancer-related fatigue and self-care agency: A multicentre survey of patients receiving chemotherapy
(John Wiley & Sons, Inc., 2019-08-14) O'Regan, Patricia; McCarthy, Geraldine; O'Reilly, Seamus; Power, Derek; Healey Bird, Brian; Murphy, Conleth G.; Hegarty, Josephine
Aims and objectives: To measure cancer-related fatigue (CRF), self-care agency (SCA) and fatigue self-care strategies, and to explore the relationship between CRF and SCA. Background: Cancer-related fatigue has been consistently rated as the most elusive, common and severe of symptoms that patients with cancer undergoing chemotherapy experience. Despite its frequency and severity, CRF is poorly managed. A renewed focus on supporting self-care among patients with cancer has been found to reduce symptom burden, empower patients and improve patient satisfaction. Understanding the link between self-care agency (i.e. capability and willingness to self-care) and CRF levels will help practitioners to better support individuals on the cancer journey. Design: A descriptive, correlational survey design was employed. Methods: Patients (n = 362) undergoing chemotherapy with a primary diagnosis of breast, colorectal, Hodgkin's and non-Hodgkin's lymphoma cancers were recruited from four oncology centres in one city in the South of Ireland. Participants completed the Piper Fatigue Scale-Revised, Appraisal of Self-care Agency Scale and a researcher-developed Fatigue Self-Care Survey. Multivariate logistic regression was used to examine the relationship between CRF and self-care agency using a dichotomous dependent variable score of four as the cut-off between those deemed to be fatigued (≥4) and those not fatigued (<4). As recommended by the EQUATOR Network, the STROBE checklist of items for cross-sectional studies is used to report the study. Results: The incidence of CRF was high with 75% of participants scoring clinically relevant CRF. Higher SCA (OR = 0.96, 95% CI = 0.93–0.99, p = .011) was associated with decreased odds of developing CRF. Having non-Hodgkin's lymphoma (OR = 3.02, 95% CI = 1.29–7.07, p = .011) was associated with increased odds of developing CRF. Conclusions: Patient's undergoing chemotherapy experience significant fatigue. Higher capability for self-care is associated with lower fatigue. The promotion of SCA and self-care strategies can impact on CRF. Relevance to clinical practice: Understanding the link between self-care abilities and fatigue can lead to more individualised and tailored approaches to CRF.
Care accommodation in the acute care setting: Missed care or not?
(John Wiley & Sons, Inc., 2020-04-07) O'Donnell, Claire; Andrews, Tom
To explain how nurses care for patients with stroke in the acute setting, when working within constraints. Internationally, healthcare environments are experiencing constraints such as reduced staffing levels, lack of time and resources. In such circumstances patient care is often of poorer quality or missed entirely. Classic grounded theory methodology was used to explain how care is provided within the acute care setting for patients following stroke. Data were collected using unstructured interviews with 32 nurses. Care accommodation a typology of caring was generated consisting of; functional caring, assisted self-caring and ideal caring. Depending on the degree of constraint, nurses consciously or subconsciously prioritise care, potentially leading to missed care. Care accommodation elucidates what happens to care delivery with limited resources. Missed care may result on engaging with care accommodation, a factor nurses and managers need to consider in care delivery. Care accommodation provides new insight and understanding for management of the daily challenges nurses face thus, informing nursing management supports nurses, advocating at higher levels for resources to provide necessary environments and strategies to reduce missed care.
Care following stillbirth
(MedMedia Group, 2013-11) Fisher, Kiera; Murphy, Margaret M.
Care in subsequent pregnancies following stillbirth: An international survey of parents
(John Wiley & Sons, Inc., 2016-11-30) Wojcieszek, Aleena M.; Boyle, Frances M.; Belizán, Jose M.; Cassidy, Jillian; Cassidy, Paul; Erwich, Jan Jaap H. M.; Farrales, Lynn; Gross, Mechthild M.; Heazell, Alexander E. P.; Leisher, Susannah Hopkins; Mills, Tracey; Murphy, Margaret; Pettersson, Karin; Ravaldi, Claudia; Ruidiaz, Jessica; Siassakos, Dimitrios; Silver, Robert M.; Storey, Claire; Vannacci, Alfredo; Middleton, Philippa; Ellwood, David; Flenady, Vicki; University of Queensland
Objective: To assess the frequency of additional care, and parents' perceptions of quality, respectful care in pregnancies subsequent to stillbirth. Design: Multi-language web-based survey. Setting: International. Population: 2,716 parents, from 40 high- and middle-income countries. Methods: Data were obtained from a broader survey of parentsâ experiences of stillbirth. Data were analyzed using descriptive statistics and stratified by geographical region. Subgroup analyses explored variation in additional care by gestational age at index stillbirth. Main outcome measures: Frequency of additional care, and perceptions of quality, respectful care. Results: The majority (66%) of parents conceived their subsequent pregnancy within one year of stillbirth. Additional antenatal care visits and ultrasound scans were provided for 67% and 70% of all parents, respectively, although there was wide variation across geographical regions. Care addressing psychosocial needs was less frequently provided, such as visits to a bereavement counsellor (10%) and access to named care provider's phone number (27%). Compared to parents whose stillbirth occurred at 29 weeks' gestation or less, parents whose stillbirth occurred at 30 weeksâ gestation or greater were more likely to receive various forms of additional care, particularly the option for early delivery after 37 weeks. Around half (47-63%) of all parents felt that elements of quality, respectful care were consistently applied, such as spending enough time with parents and involving parents in decision-making. Conclusions: Care in pregnancies subsequent to stillbirth appears inconsistent. Greater attention is required to providing thoughtful, empathic, and collaborative care in all pregnancies following stillbirth. Training for health professionals is needed.
Care prior to and during subsequent pregnancies following stillbirth for improving outcomes
(John Wiley & Sons, Inc., 2018-12-17) Wojcieszek, Aleena M.; Shepherd, Emily; Middleton, Philippa; Lassi, Zohra S.; Wilson, Trish; Murphy, Margaret M.; Heazell, Alexander E. P.; Ellwood, David A.; Silver, Robert M.; Flenady, Vicki; National Institute for Health Research
Background: Stillbirth affects at least 2.6 million families worldwide every year and has enduring consequences for parents and health services. Parents entering a subsequent pregnancy following stillbirth face a risk of stillbirth recurrence, alongside increased risks of other adverse pregnancy outcomes and psychosocial challenges. These parents may benefit from a range of interventions to optimise their short‐ and longer‐term medical health and psychosocial well‐being. Objectives: To assess the effects of different interventions or models of care prior to and during subsequent pregnancies following stillbirth on maternal, fetal, neonatal and family health outcomes, and health service utilisation. Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (6 June 2018), along with ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (18 June 2018). Selection criteria: We included randomised controlled trials (RCTs) and quasi‐randomised controlled trials (qRCTs). Trials using a cluster‐randomised design were eligible for inclusion, but we found no such reports. We included trials published as abstract only, provided sufficient information was available to allow assessment of trial eligibility and risk of bias. We excluded cross‐over trials. Data collection and analysis: Two review authors independently assessed trials for eligibility and undertook data extraction and 'Risk of bias' assessments. We extracted data from published reports, or sourced data directly from trialists. We checked the data for accuracy and resolved discrepancies by discussion or correspondence with trialists, or both. We conducted an assessment of the quality of the evidence using the GRADE approach. Main results: We included nine RCTs and one qRCT, and judged them to be at low to moderate risk of bias. Trials were carried out between the years 1964 and 2015 and took place predominantly in high‐income countries in Europe. All trials assessed medical interventions; no trials assessed psychosocial interventions or incorporated psychosocial aspects of care. Trials evaluated the use of antiplatelet agents (low‐dose aspirin (LDA) or low‐molecular‐weight heparin (LMWH), or both), third‐party leukocyte immunisation, intravenous immunoglobulin, and progestogen. Trial participants were women who were either pregnant or attempting to conceive following a pregnancy loss, fetal death, or adverse outcome in a previous pregnancy. We extracted data for 222 women who had experienced a previous stillbirth of 20 weeks' gestation or more from the broader trial data sets, and included them in this review. Our GRADE assessments of the quality of evidence ranged from very low to low, due largely to serious imprecision in effect estimates as a result of small sample sizes, low numbers of events, and wide confidence intervals (CIs) crossing the line of no effect. Most of the analyses in this review were not sufficiently powered to detect differences in the outcomes assessed. The results presented are therefore largely uncertain. Main comparisons: LMWH versus no treatment/standard care (three RCTs, 123 women, depending on the outcome): It was uncertain whether LMWH reduced the risk of stillbirth (risk ratio (RR) 2.58, 95% CI 0.40 to 16.62; 3 trials; 122 participants; low‐quality evidence), adverse perinatal outcome (RR 0.81, 95% CI 0.20 to 3.32; 2 trials; 77 participants; low‐quality evidence), adverse maternal psychological effects (RR 1.00, 95% CI 0.07 to 14.90; 1 trial; 40 participants; very low‐quality evidence), perinatal mortality (RR 2.58, 95% CI 0.40 to 16.62; 3 trials; 122 participants; low‐quality evidence), or any preterm birth (< 37 weeks) (RR 1.01, 0.58 to 1.74; 3 trials; 114 participants; low‐quality evidence). No neonatal deaths were reported in the trials assessed and no data were available for maternal‐infant attachment. There was no clear evidence of a difference between the groups among the remaining secondary outcomes. LDA versus placebo (one RCT, 24 women): It was uncertain whether LDA reduced the risk of stillbirth (RR 0.85, 95% CI 0.06 to 12.01), neonatal death (RR 0.29, 95% CI 0.01 to 6.38), adverse perinatal outcome (RR 0.28, 95% CI 0.03 to 2.34), perinatal mortality, or any preterm birth (< 37 weeks) (both of the latter RR 0.42, 95% CI 0.04 to 4.06; all very low‐quality evidence). No data were available for adverse maternal psychological effects or maternal‐infant attachment. LDA appeared to be associated with an increase in birthweight (mean difference (MD) 790.00 g, 95% CI 295.03 to 1284.97 g) when compared to placebo, but this result was very unstable due to the extremely small sample size. Whether LDA has any effect on the remaining secondary outcomes was also uncertain. Other comparisons: LDA appeared to be associated with an increase in birthweight when compared to LDA + LMWH (MD −650.00 g, 95% CI −1210.33 to −89.67 g; 1 trial; 29 infants), as did third‐party leukocyte immunisation when compared to placebo (MD 1195.00 g, 95% CI 273.35 to 2116.65 g; 1 trial, 4 infants), but these results were again very unstable due to extremely small sample sizes. The effects of the interventions on the remaining outcomes were also uncertain. Authors' conclusions: There is insufficient evidence in this review to inform clinical practice about the effectiveness of interventions to improve care prior to and during subsequent pregnancies following a stillbirth. There is a clear and urgent need for well‐designed trials addressing this research question. The evaluation of medical interventions such as LDA, in the specific context of stillbirth prevention (and recurrent stillbirth prevention), is warranted. However, appropriate methodologies to evaluate such therapies need to be determined, particularly where clinical equipoise may be lacking. Careful trial design and multicentre collaboration is necessary to carry out trials that would be sufficiently large to detect differences in statistically rare outcomes such as stillbirth and neonatal death. The evaluation of psychosocial interventions addressing maternal‐fetal attachment and parental anxiety and depression is also an urgent priority. In a randomised‐trial context, such trials may allocate parents to different forms of support, to determine which have the greatest benefit with the least financial cost. Importantly, consistency in nomenclature and in data collection across all future trials (randomised and non‐randomised) may be facilitated by a core outcomes data set for stillbirth research. All future trials should assess short‐ and longer‐term psychosocial outcomes for parents and families, alongside economic costs of interventions.
Challenges in recruiting participants in a multi-centre study on symptom experiences and self care strategies of bowel symptoms following colo-rectal surgery
(Sage Publications, 2012-05) Landers, Margaret; McCarthy, Geraldine; Savage, Eileen; Health Research Board
Aim: The purpose of this paper is to present some of the challenges found to be problematic in recruiting individuals following sphincter saving surgery for rectal cancer for a multicentre study. While the focus of the study is on symptom experiences and management of bowel symptoms following colo-rectal surgery, the paper will concentrate solely on the challenges experienced in recruiting a sample for the study. Background Recruitment of an adequate number of participants is a challenge for researchers in any area of research involving patients. Enrolment of patients treated for rectal cancer poses particular challenges because the total population of this group in a given country can be small. The use of multiple centres was required to obtain the required number of participants for the current study. Findings: In multicentre studies, researchers can encounter substantial challenges in obtaining ethical approval, accessing clinical sites and gaining direct access to patients. These challenges are embedded in a convoluted process involving many systems of communication, which can vary from one centre to another. Conclusions: The process of obtaining ethical approval is prolonged in the absence of a central ethical review committee. A review process based on a standard application for researchers seeking ethical approval for multi- centred studies central is necessary. Establishing and maintaining access to clinical sites requires co-operation from many individuals during the development of the proposal and continuing throughout the data collection process.
Challenges of living with and managing inflammatory bowel disease: A meta-synthesis of patients' experiences
(John Wiley & Sons, Inc., 2019-10-20) Byron, Clodagh; Cornally, Nicola; Burton, Aileen; Savage, Eileen
Aims and objectives: To examine qualitative studies which reported on patients' challenges of living with and managing inflammatory bowel disease (IBD). Background: There is a growing body of qualitative research focusing on the subjective experiences of patients with IBD. This research points to the daily challenges that patients experience which can relate to their physical and psychological health, as well as their social well-being, and may impact negatively on their lives. To date, there has been little attempt to synthesise these studies, and little is known about how patients manage the challenges they experience. Design: A meta-synthesis was conducted, based on guidelines developed by Sandelowski and Barroso (Handbook for synthesizing qualitative research, Springer, New York, NY, 2007) and PRISMA (Int J Surg, 8, 2009, 336). Methods Searches were conducted within the CINAHL, MEDLINE, PsycINFO, Psychology and Behavioural Sciences Collection and SocINDEX databases to locate qualitative and mixed methodology studies. The retrieved articles were screened against predetermined inclusion criteria. Quality appraisal was assessed using the Joanna Briggs Institute critical appraisal tool for qualitative research (Int J Evid Based Healthc, 13, 2015, 179). Results: Thematic analysis resulted in three themes: the unpredictability of living with IBD, the emotional turmoil of living with IBD and striving to maintain a normal life in managing IBD. Conclusion: The greatest challenges for patients identified in this meta-synthesis were the physical symptoms associated with IBD. These impacted negatively on their psychological and social well-being and reduced their quality of life. There is a notable gap in research on patient experiences of managing the challenges identified in everyday life and to what extent they receive support from healthcare professionals. Relevance to clinical practice: The results of this meta-synthesis offer insights into how the physical challenges of living with IBD, particularly in relation to symptoms, impact adversely on patients' psychological and social well-being. These insights are clinically relevant to healthcare professionals as a basis for supporting patients to manage their challenges.

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