"Safety Means Everything": An ethnographic methodology to explore the formation of professional identity in nursing students.

AIM: The aim of this qualitative study is to explore how various conditions within educational contexts impact nursing students' experiences of becoming professional nurses and how these conditions affect their agency and the formation of their professional identities. BACKGROUND: Nursing education is essential to becoming professional and competent in caring for patients. A strong professional identity in nursing contributes to better patient outcomes and improves the well-being, retention, and recruitment of practitioners in the health care system. At the same time, research indicates that development of a professional identity during education is challenging and needs further investigation. DESIGN: The qualitative research design draws on the theoretical and methodological framework of critical psychology practice research. The practice research design and close collaboration with users ensure the continuous development and implementation of theory and practice. METHODS: The data used in this study originated from ethnographic fieldwork, which involved following two nursing students through their final clinical placement training at the Geriatric Department of a university hospital in Denmark. Additionally, nursing students in two classes were observed as part of their nursing education practice at a university college from April to July 2022. The participant observational design, combined with in-situ interviewing, facilitated a comprehensive understanding of the students' engagement in social practices and interactions within the context of nursing education. RESULTS: Our results show how the conditions of nursing students' everyday lives have a critical impact on their self-understanding and journey to becoming competent and professional nurses. Three main themes emerged from the analysis: (1) Perception of safety, (2) Motivation for learning in different communities of practice, and (3) The meaning of learning culture and role models. CONCLUSION: The development of nursing students into professionals is profoundly influenced by factors affecting their ontological safety that are deeply embedded in socio-cultural and educational contexts. The results underscore the need to foster ontological safety in nursing education. Creating safe, participatory, and supportive learning environments is essential to the holistic development of students into caring, competent nurses. Educators and stakeholders must remember their crucial role in this context and focus on establishing these environments to facilitate students' sense of belonging in the nursing profession. TWEETABLE ABSTRACT: The development of professional identity in nursing starts with safety. Ontological Safety in learning environments ensures competent and professional nurses. #NursingEducation#Safety#ProfessionalIdentity.

Interprofessional diagnostic management teams: a scoping review protocol.

BACKGROUND: Diagnostic errors are a major problem in healthcare. In 2015, the report "Improving Diagnosis in Health Care" by the National Academies of Sciences, Engineering, and Medicine (NASEM) stated that it is likely that most people will experience at least one diagnostic error in their lifetime. The report suggests implementing diagnostic management teams, including patients and their relatives, diagnosticians, and healthcare professionals who support the diagnostic process, to limit diagnostic error and improve patient safety. Implementing interprofessional diagnostic management teams (IDMT), however, is not an easy task due to the complexity of the diagnostic processes and the traditional organization of healthcare with divided departments and healthcare professional who operate in different geographic locations. As this topic is still emerging, a scoping review is ideal to determine the scope of the body of literature on IDMT, indicate the volume of literature and studies available and identify any gaps in knowledge. In a long-term perspective, this scoping review will contribute to prevent diagnostic errors and improve patient safety, for adults and children with physical health issues. METHODS: We will conduct this scoping review in accordance with the JBI methodology and report it based on the PRISMA-ScR. We will systematically search six databases (EMBASE, PubMed, CINAHL, Academic Search Premier, SCOPUS and Web of Science) for papers published between 1985 and 2023 that describe the use of interprofessional diagnostic management teams. The participants included will be adults and children seeking diagnostic care for physical health issues. The concept studied will be interprofessional diagnostic management teams, and the context will be the diagnostic process in the healthcare system. Studies examining the diagnostic process in psychiatry, odontology or complementary medicine will be excluded. Data extraction, including key study characteristics and findings, will be done by two reviewers independently. Any disagreement will be resolved by discussion and eventually by including the two remainder reviewers. DISCUSSION: To our knowledge, this will be the first scoping review regarding IDMT and the derived effects on diagnostic safety and can therefore be a very important contribution to improve patient safety significantly during the diagnostic process. PROTOCOL REGISTRATION: The project is registered at Open Science Framework (OSF) with ID: osf.io/kv2n6.

Clinical application of EOS imaging system: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to examine and map the existing literature on the clinical application of the EOS imaging system and to identify related evidence gaps. INTRODUCTION: The EOS imaging system was originally developed to conduct imaging for medical conditions, such as scoliosis and anisomelia. However, recent research suggests that the modality has other clinical uses that may benefit patients via reduced radiation dose and, thus, improve patient safety. INCLUSION CRITERIA: This scoping review will consider all quantitative study designs, including systematic reviews and meta-analyses. Imaging phantom studies and conference abstracts will be excluded. METHODS: Databases that will be searched include Embase, MEDLINE, CINAHL Complete, Scopus, Cochrane Library, Academic Search Premier, and OpenGrey. Relevant secondary material will be identified using citation searching (backwards and forwards) of included studies through Google Scholar. In addition, we will search by author name where more than 3 included studies from the same first author are identified. Articles published from 2003 in English, Danish, Norwegian, Swedish, French, and German will be included. Two independent reviewers will perform title/abstract screening, followed by full-text screening. Data extraction will include study type and design, age of participants, anatomical/physiological region, pathology, clinical endpoint, outcome measures, sample size, and clinical application. Data will be presented in tabular format and as a narrative summary. DETAILS OF THE REVIEW AVAILABLE AT: Open Science Framework https://osf.io/yc85j/.

Nursing care and nurses' understandings of grief and bereavement among patients and families during cancer illness and death - A scoping review.

PURPOSE: Grief and bereavement is often present among patients and families during courses of cancer. Offering support for both patients and families is essential in the context of cancer nursing. Present scoping review offers an overview of existing knowledge, which can be used for inspiration in cancer-nursing. Hence, the objective of this study was to identify understandings of grief and bereavement, which is present in a cancer-nursing context and to develop insight on existing knowledge about nursing interventions targeted patients and their families' experiences of grief and bereavement due to cancer illness. METHOD: The scoping review is conducted, inspired by the methodology of Joanna Briggs Institute. Sources of evidence are retrieved from a large number of databases and resources. RESULTS: Twenty-two studies are included in the scoping review. The studies are retrieved from eight different countries. Findings are mapped in nine categories. Eight categories related to nursing care targeted patients and/or families experiencing grief and/or bereavement; One category related to understandings of grief and/or bereavement targeted patients and families. CONCLUSION: Nursing interventions to support patients and their families during grief and bereavement covers a broad spectrum of interventions. E.g. communication; using artwork; cultural and spiritual care; bereavement care; supporting coping strategies. Different models and theoretical understandings were identified. E.g. The dual process model of coping with bereavement; A Divorced Family-focused Care Model; Family Strengths-Oriented Therapeutic Conversation (Fam-SOTC); and understandings of children's grieving process.

Best practice guidance and reporting items for the development of scoping review protocols.

OBJECTIVE: The purpose of this article is to clearly describe how to develop a robust and detailed scoping review protocol, which is the first stage of the scoping review process. This paper provides detailed guidance and a checklist for prospective authors to ensure that their protocols adequately inform both the conduct of the ensuing review and their readership. INTRODUCTION: Scoping reviews are a common approach to evidence synthesis for researchers, clinicians, and policymakers across a variety of fields. Scoping reviews are not concerned with making analytical comparisons based on pooling results data from multiple primary sources of evidence, but rather on collating and describing the evidence and presenting the summation in a clearly illustrated format. Methods for undertaking and reporting scoping reviews continue to be refined. Some prospective reviewers may be uncertain how to plan, structure, and report scoping review protocols, as there is little or no specific guidance for scoping review protocols yet available. METHODS: This guidance was developed by members of the JBI Scoping Review Methodology Group based on previous experience and expertise in developing scoping review and evidence synthesis methodologies, protocols, and reviews, as well as through experiences working with and guiding authors to develop scoping review protocols. Elements of a comprehensive scoping review protocol are outlined and explained in detail. CONCLUSION: Knowledge users of evidence syntheses rely on clear and transparent reporting to understand and use the results of published work to drive evidence-based improvements within health care and beyond. It is hoped that readers will be able to use this guidance when developing protocols to assist them in planning future scoping reviews and to carry them out with a high degree of transparency.

Risk factors for hospital readmission in adult patients with heart failure with reduced ejection fraction: a systematic review.

OBJECTIVE: The objective of this review was to identify and synthesize evidence on risk factors associated with hospital readmission within the first year after heart failure hospitalization among patients with heart failure with reduced left ventricular ejection fraction. INTRODUCTION: Heart failure is associated with a high risk of hospital readmission. Readmissions are associated with higher mortality and health care costs. It is a high health care priority to identify vulnerable patients with heart failure who may potentially benefit from targeted personalized care interventions aiming to reduce readmissions. INCLUSION CRITERIA: This review considered studies including adult patients who had heart failure with a reduced left ventricular ejection fraction ≤ 40% who were discharged after a heart failure hospitalization. The authors included studies with experimental and observational designs evaluating risk factors for i) all-cause hospital readmission, ii) heart failure hospital readmission, and iii) composite outcomes within seven, 15, 30, 60, 90, 180, and 365 days after hospital discharge. Composite outcomes included end points where all-cause readmission and/or heart failure readmission were part of a defined end point (i.e. all-cause readmission or mortality; heart failure readmission or mortality; cardiovascular readmission; cardiovascular readmission or mortality; and readmission, mortality, or cardiac transplant). Studies reporting all-cause readmission and/or heart failure readmission as a primary outcome, secondary outcome, or part of a composite outcome were included. METHODS: PubMed, Embase, CINAHL, Cochrane CENTRAL, PsycINFO, OpenGrey, MedNar, DART-Europe, ProQuest Dissertations and Theses, and the Grey Literature Report in Public Health were searched to find both published and unpublished studies in English, Swedish, Norwegian, or Danish from 2000 to June 2018. Study selection, critical appraisal, data extraction, and data synthesis followed the JBI approach for systematic reviews. Statistical pooling was not possible due to clinical and methodological heterogeneity of the studies included and the lack of risk factors reported more than once. A narrative summary of the findings was performed. RESULTS: Fifty-two studies, including one randomized controlled trial and 51 cohort studies with a total of 128,186 participants, were included. Risk factors for readmission were reported for 30-day outcome in 16 studies, 60-day in three studies, 90-day in 15 studies, 180-day in 12 studies, and 365-day outcome in 15 studies. Based on multivariable analyses from 43 cohort studies and results from one randomized controlled trial, the authors identified several factors associated with higher risk of all-cause readmission, heart failure readmission, and composite outcomes (e.g. readmission or death) within 30, 60, 90, 180, and 365 days after discharge for a heart failure hospitalization. CONCLUSIONS: This review provides a comprehensive overview of factors associated with a clinical outcome after a heart failure hospitalization in patients with heart failure with left ventricular ejection fraction ≤ 40%. Owing to the heterogeneity of variables investigated and the lack of comparability of findings, the clinical impact of the identified risk factors remains uncertain. This review highlights research gaps and the need for a standardized way to define and measure all-cause readmission, heart failure readmission, and composite end points in clinical research to improve study quality and enable comparison of findings between studies.

Parents' and nurses' experiences of partnership in neonatal intensive care units: A qualitative review and meta-synthesis.

AIMS AND OBJECTIVES: To explore how parents and nurses experience partnership in neonatal intensive care units and to identify existing barriers and facilitators to a successful partnership. BACKGROUND: Family-centred care is recommended as a frame of reference for treatment and care in neonatal intensive care units. A key element in family-centred care is partnership. Such partnerships are characterised by complex interpersonal relationships and interactions between nurses and parents/families. Partnerships therefore appear to present a significant challenge. DESIGN: A qualitative review and meta-synthesis. METHODS: Comprehensive searching in ten databases: CINAHL, PubMed (MEDLINE), EMBASE, PsycINFO, Scopus and SweMed+, OpenGrey, MedNar, Google Scholar and ProQuest Dissertations & Thesis Global. A total of 1,644 studies (after removal of duplicates) were critically assessed, and 21 studies fulfilled the inclusion criteria. A meta-aggregation was used to synthesise the findings from the studies and was methodically quality assessed with QUARI/SUMARI and PRISMA. FINDINGS: Through a meta-aggregative approach, two synthesised findings were developed: (a) co-creation of mutual knowledge and (b) developing competencies and negotiating roles. The first synthesis embraced the categories: being respected and listened to, trust and sharing knowledge, and the second synthesis embraced the categories: space to learn with guidance, encouraging and enabling, being in control. In constructing the categories, findings were identified as characteristics, barriers and facilitators to application. CONCLUSION: A successful relationship between parents and nurses can be achieved through co-creation of mutual knowledge and development of competencies and negotiation of roles. Neonatal intensive care unit nurses are in a position where they exercise power, but they can change the culture if they are aware of what seems to facilitate or create a barrier to a partnership with parents. RELEVANCE TO CLINICAL PRACTICE: This new evidence may inform a change in policies and guidelines which could be integrated into nurses' clinical practice in neonatal intensive care units.

Nutritional interventions to reduce symptoms in children and adults with attention deficit hyperactivity disorder: a scoping review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this scoping review is to examine and map reported nutritional interventions and their outcomes in relieving symptoms of attention deficit hyperactivity disorder (ADHD) in the daily lives of children and adults. A further objective is to determine if experiences of people diagnosed with ADHD, their relatives or staff in being on a diet or having to eat or avoid eating specific food items have been reported in the existing literature.Specifically the scoping review questions are.

Effectiveness of structured planned post discharge support to patients with chronic obstructive pulmonary disease for reducing readmission rates: a systematic review.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease, characterized by airflow limitation. The disease has a significant impact on the lives of patients and is a challenge for the health care due to readmissions to hospitals. OBJECTIVES: This review aimed to identify, appraise and synthesize the best available evidence on the effectiveness of discharge interventions that can reduce readmission of patients with COPD. TYPES OF PARTICIPANTS: Hospitalized patients, aged 18 years or over, who had been diagnosed with COPD and were admitted to hospital due to acute exacerbation. TYPES OF INTERVENTIONS: Studies that evaluated discharge interventions that supported patients managing symptoms of COPD. TYPES OF STUDIES: Randomized controlled trials, non-randomized controlled trials, quasi-experimental or cohort studies. OUTCOMES: Readmission, defined as hospitalization to the same or different hospital for any reason within the following year after discharge. SEARCH STRATEGY: Multiple databases (PubMed, Embase, CINAHL, the Cochrane Library, Pedro, Web of Science, Turning Research Into Practice [Trip] and Scopus) were searched from 1990 to June 2015. Studies published in English or Scandinavian. METHODOLOGICAL QUALITY: Two independent reviewers used the standard critical appraisal tool from the Joanna Briggs Institute to assess the methodological quality of studies. All studies were of good methodological quality. DATA EXTRACTION: The process of data extraction was undertaken independently by two reviewers using tools from the Joanna Briggs Institute. DATA SYNTHESIS: A narrative description of each study was performed. Outcomes were reported as the event rate (ER) in the intervention and control groups. Based on the ER relative risk reduction (RRR), absolute risk reduction (ARR), the number needed to treat (NNT), and relative risk (RR) with 95% confidence intervals were calculated. Continuous data were reported in natural units. RESULTS: This review includes ten studies all testing a mix of interventions. A meta-analysis included six studies, four at 30 days follow-up with RR 0.67 (0.45 to 0.98) and 180 days follow-up with RR 0.74 (0.51 to 1.08). The analysis could not identify a single set of interventions that could be recommended. CONCLUSIONS: Post discharge support and interventions in patients with COPD significantly reduce the readmission rate within 30 days after discharge from hospital and the interventions may significantly reduce readmission up to 180 days after initial discharge. This is a significant finding from the clinical and practical perspective.

Risk factors for readmission to hospital in adult patients with heart failure and reduced ejection fraction: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this systematic review is to identify and synthesize the best available evidence on risk factors associated with hospital readmission at different time points within the first year after heart failure (HF) hospitalization in patients suffering from HF with reduced ejection fraction (EF).More specifically, the question is: what are the risk factors for the prediction of hospital readmission within seven, 15, 30, 60, 90, 180 and 365 days of discharge in hospitalized patients with HF with reduced EF aged 18 years or older?

Oral hygiene in patients with chronic obstructive pulmonary disease: a scoping review protocol.

SCOPING REVIEW OBJECTIVE: It is hypothesized that systematic oral hygiene may reduce airway infections in patients with chronic obstructive pulmonary disease (COPD). Before considering doing a systematic review, a scoping review is necessary to explore and map literature on the subject and identify which interventions have been carried out, if there is relevant literature available for a systematic review, or if further research should be initiated.The objective of this scoping review is to comprehensively identify and describe qualitative or quantitative literature reporting of non-invasive interventions that have been carried out to improve oral hygiene and relieve and/or reduce respiratory tract infections, exacerbation and/or hospital readmission in patients with diagnosed with COPD. A further objective is to undertake a comprehensive search to identify qualitative literature reporting on the experiences of oral hygiene in people diagnosed with COPD and/or their relatives and/or healthcare providers (HCPs).Specifically, the scoping review questions are as follows.

Effectiveness of Patient Safety Leadership WalkRounds™ on patient safety culture: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The review objective is to synthesize the effect of Patient Safety Leadership WalkRounds (PSLWs) on patient safety culture (PSC).Specifically, the review question is: What is the effect of PSLWs on the PSC in hospitals, measured with validated surveys?

Living with symptoms of attention deficit hyperactivity disorder in adulthood: a systematic review of qualitative evidence.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) relates to four dimensions of behavior: inattentiveness, restlessness, impulsiveness and hyperactivity. Symptoms affect multiple areas of daily life such as academic performance and social functioning. Despite the negative effects of ADHD, people diagnosed with ADHD do not necessarily regard themselves as being impaired. However, it is unclear how adults with ADHD experience and manage their symptoms. OBJECTIVES: To identify and synthesize the best available evidence on how adults experience living with ADHD. INCLUSION CRITERIA TYPES OF PARTICIPANTS: Adults with confirmed ADHD diagnosis. PHENOMENA OF INTEREST: How adults with ADHD experience and manage the symptoms of ADHD and links between protective factors provided by relatives, friends, fellow students, mentors and colleagues. TYPES OF STUDIES: Studies based on qualitative data, including, but not limited to, designs within phenomenology, grounded theory, content analysis or ethnography. SEARCH STRATEGY: A three-step search strategy identified published and unpublished qualitative studies from 1990 to July 2015. METHODOLOGICAL QUALITY: Studies meeting the inclusion criteria were independently assessed by two reviewers using the standardized critical appraisal instrument from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). DATA EXTRACTION: Data were extracted from 10 included studies using the JBI-QARI. DATA SYNTHESIS: Qualitative research findings were synthesized using the JBI-QARI. RESULTS: A total of 103 findings from 10 studies were aggregated into 16 categories that were meta-synthesized into four synthesized findings: "Adults are aware of being different from others and strive to be an integrated, accepted part of the community;" "Adults with ADHD are creative and inventive;" "Adults with ADHD develop coping strategies in striving for a healthy balance in life" and "For adults with ADHD, accomplishing and organizing tasks in everyday life is a challenge but it can also be rewarding." CONCLUSION: Adults with ADHD have problems stemming from ADHD symptoms in relation to interacting in social relationships, academic functioning and being part of the community at the workplace and performing work tasks; they work harder to perform tasks and strive to be accepted and to be equal members of the community.Protective factors that support their ability to manage daily life with ADHD are personal strategies such as reminders and performing tasks within a given structure. Others close to them can assist by coaching, reminding them of appointments and so on. Superiors can assist by structuring the work tasks and setting up clear rules and limits for the tasks. Medication has proven to be very useful as it leads to less hyperactivity and enhances ability to stay focused and be more organized. Finally, insight into ADHD has a positive impact on the ability to manage the consequences of ADHD.Health professionals should, when advising adults with ADHD, fundamentally see them as persons who have a problem and not as problem persons, emphasize strategies adults themselves can apply such as structuring everyday tasks and informing them about positive effects and possible side effects of medication. Policy-makers could launch campaigns targeted at employers with information about the competencies adults with ADHD possess and how employers can benefit from these by structuring work tasks. When promoting employees with ADHD, it should be to positions with more advanced hands-on functions and not positions with administrative duties.

The effect of involving significant others in chronic pain programs for adult patients with chronic non-malignant pain: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify the effect of the involvement of significant others in chronic pain management programs for adult patients with chronic non-malignant pain on function, self-efficacy and pain.More specifically, the objectives are to identify the effect of involving significant others in chronic management programs for adults with chronic non-malignant pain in primary, secondary or tertiary health care. This is compared to those receiving usual care or other self-management interventions.

The perception of partnership between parents of premature infants and nurses in neonatal intensive care units: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify how parents of premature infants in neonatal intensive care units (NICUs) and nurses perceive their partnership.The review questions are: how do parents of premature infants and nurses perceive their partnership during hospitalization in NICUs? What barriers and facilitators to partnership can be identified?

Effectiveness of respiratory rates in determining clinical deterioration: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this systematic review is to identify, appraise and synthesize the best available evidence on the effectiveness of manually measuring respiratory rates for 60 s or less in detecting clinical deterioration of inpatients. More specifically, the review question is:Is measurement of respiratory rates for 60 s more effective in detecting clinical deterioration than a shorter duration of measurement?

The effectiveness of individual rehabilitation on health status in patients with heart failure: A quasi-experimental study.

Patients with heart failure (HF) live with a serious disease, and need long-term rehabilitation care. Elements in rehabilitation for patients with HF are based on the recommendations from the European Society of Cardiology and focuses on self-care and adherence in general. The aim of this study is to test the effect of individually prepared rehabilitation plans measured on health status (HS). The study design is quasi-experimental. Patients in the control group follow the conventional rehabilitation. For the patients in the intervention group. an individual rehabilitation plan was prepared and followed up by telephone after 4 and 12 weeks. For all patients, HS was measured with Short Form-36. One hundred sixty-two patients are included in the study, of which 137 (84.6%) consented. There were no differences in HS before and after the intervention. There are no significant differences by use of a systematically prepared intervention compared with usual care for patients with HF measured on HS 3 months after discharge from the outpatient clinic.

The effectiveness of systematic perioperative oral hygiene in reduction of postoperative respiratory tract infections after elective thoracic surgery in adults: a systematic review.

BACKGROUND: Nosocomial infections are a significant contributor to patient morbidity and mortality. Nosocomial infections significantly increase hospital length of stay and total hospital costs. Thoracic surgery, mechanical ventilation and/or admission to an intensive care unit are known to increase patients' risk for nosocomial respiratory tract infection. OBJECTIVES: To identify, appraise and synthesize the best available evidence on the effectiveness of systematic perioperative oral hygiene in the reduction of postoperative respiratory airway infections in adult patients undergoing elective thoracic surgery. INCLUSION CRITERIA: Patients over the age of 18 years who had been admitted for elective thoracic surgery, regardless of gender, ethnicity, diagnosis severity, co-morbidity or previous treatment.Perioperative systematic oral hygiene (such as mechanical removal of dental biofilm or plaques and/or systematic use of mouth rinse) performed by patients themselves or by healthcare staff (such as nurses).Randomized controlled trials and quasi-experimental studies.Nosocomial infections, specifically respiratory tracts infections, and surgical site infections SEARCH STRATEGY: Multiple databases (PubMed, CINAHL, Embase, Scopus, Swemed+, Health Technology Assessment Database and Turning Research Into Practice [TRIP] database) were searched from 1980 to December 2014. Studies published in English, German, Danish, Swedish and Norwegian were considered for inclusion in this review. METHODOLOGICAL QUALITY: Two independent reviewers used the standard critical appraisal tool from the Joanna Briggs Institute to assess the methodological quality of studies. DATA EXTRACTION: The process of data extraction was undertaken independently by two reviewers using tools from the Joanna Briggs Institute. DATA SYNTHESIS: Quantitative results were synthesized in meta-analysis. RESULTS: This review includes six studies: three randomized controlled trials and three quasi-experimental studies.The absolute magnitude of the summary effect sizes were: for nosocomial infections relative risk (RR) 0.65 (95% confidence interval [CI] 0.55-0.78) for respiratory tract infections RR 0.48 (95%CI: 0.36-0.65) and for deep surgical site infections RR 0.48 (95%CI 0.27-0.84). CONCLUSIONS: Systematic perioperative oral hygiene reduces postoperative nosocomial, lower respiratory tract infections and surgical site infections but not urinary tract infections. The effect is statistically, clinically and practically significant.Perioperative decontamination of the nasopharynx and/or oropharynx is a strategy worth pursuing. The intervention is cheap and can easily be carried out by the patients themselves. (Grade A)Studies testing decontamination of the nasopharynx and/or oropharynx have until now only included patients undergoing thoracic surgical procedures. As the interventions are cheap, easy to carry out and have a great impact on the patients' outcome, it is recommendable to carry out more studies involving other type of patients undergoing major surgery with a high prevalence of nosocomial infections, respiratory tract infections and surgical site infections.

Diagnostic accuracy of methods used to verify nasogastric tube position in mechanically ventilated adult patients: a systematic review.

BACKGROUND: Nasogastric tubes are widely used in hospitals, e.g. for the administration of nutrients. However, nasogastric tubes can be inserted accidently into the airways leading to complications like pneumonia, pneumothorax and even death. Mechanically ventilated patients are at high risk of having a nasogastric tube misplaced, since they often have reduced consciousness and weak cough reflex. A variety of methods have been used for determination of nasogastric tube placement, but with varying success. OBJECTIVES: The present systematic review was carried out to evaluate the diagnostic accuracy of methods used to determine nasogastric tube placement in mechanically ventilated adult patients. INCLUSION CRITERIA: Studies including mechanically ventilated adult patients with a nasogastric tube were considered for inclusion, regardless of the type of nasogastric tube.All methods (index tests) used to verify nasogastric tubes placed in the airways and in the gastrointestinal tract were included. As a reference standard, X-ray was used to verify the accuracy of each index test.The studies that were included in the present systematic review were designed based on diagnostic test accuracy studies.The outcome was the accuracy (sensitivity and specificity) of the methods to discriminate between respiratory and gastrointestinal placement of the nasogastric tube. SEARCH STRATEGY: The search strategy aimed to find both published and unpublished studies before September 2013. Eleven electronic databases were searched including CINAHL, PubMed, Scopus and Embase. METHODOLOGICAL QUALITY: Methodological quality was assessed independently by two reviewers using QUADAS as a critical appraisal tool. DATA EXTRACTION: Data were extracted by two reviewers independently using a modified Joanna Briggs Institute data extraction form including specific details such as: population, setting, index test, sensitivity and specificity. DATA SYNTHESIS: Sensitivity and specificity were extracted from the studies and presented in tables. When these were not written in the studies, calculations were performed based on data presented in the studies. RESULTS: Five relevant papers describing two different methods for determining nasogastric tube position were identified: colorimetric capnography (four studies) and capnography (one study).In all four studies examining colorimetric capnography the sensitivity was 100% when nasogastric tubes were inserted intentionally into the airways through an already existing tracheal tube, thereby imitating misplaced nasogastric tubes. When inserted through the nose, the sensitivity was 88-100% and specificity was 99-100%.Capnography obtained a specificity of 100% but sensitivity for when the nasogastric tube was inserted through the nose could not be calculated based on available data. CONCLUSIONS: We found evidence (Level 2b) for colorimetric capnography to be a valid method for verifying nasogastric tube placement.Capnography also detected nasogastric tube position with very high accuracy. However, since these methods were tested in only a single study with a limited sample size, further research is required before clinical recommendations can be made.Despite the impressive results obtained by using colorimetric capnography, implication for practice is not straightforward. A concern is that the colorimetric capnograph is not produced by the manufacture to fit a NG tube and therefore has to be connected to the NG tube by an adaptor-system. Practical issues therefore have to be resolved if the method is supposed to become a standard procedure in a clinical setting.The execution of the procedure using colorimetric capnography differs between the studies. This systematic review therefore recommends that further research should be done to optimize the execution of the procedure.We also recommend that further research be done to reproduce the results obtained using capnography, since this method was tested only in a single study with a limited sample size.