Construct validity and reliability of the BARRIERS scale in the Spanish context.

OBJECTIVE: To establish the construct validity of the Spanish version of the BARRIERS scale. METHOD: Methodological study of validation of a measurement instrument based on data from previously published studies. The study population consisted of nurses from the Basque Health Service and the Canary Health Service. The following variables were extracted and unified: Years of professional experience, possession of a specialist nursing degree, possession of a doctorate, type of activity performed by the professional and field of work. For construct validation, a confirmatory factor analysis (CFA) was performed based on the initial model proposed for the scale and RASCH analysis. A polychoric correlation matrix, factor extraction by unweighted least squares and PROMIN oblique rotation were used. For the RASCH analysis, the Joint Maximun Likelihood estimation (JMLE) method was used; the fit of the items and persons were estimated by means of outfit - Unweighted Mean Square fit statistic (UMS) and infit -Weighted Mean Square Fit Statistic (WMS), as well as the reliability and separation of items and persons. RESULTS: A total of 1200 nurses and midwives made up the final validation sample (n = 1200), with a mean professional experience of 21.22 ± 9.26 years. The CFA presented a good fit to the data (KMO = 0.935 [95%CI:0.921-0.945]), changing the factorial assignment in 6 items, while 5 items received factorial scores in more than one factor. The fit values for the 4-factor solution were RMSEA = 0.026 [95% CI:0.026-0.027] and GFI = 0.991 [95% CI = 0.986-0.991]. In the RASCH analysis most items presented infit-WMS and outfit-UMS values with a good fit. CONCLUSIONS: The Spanish version of the BARRIERS scale has adequate construct validity although there are changes in the assignment of items to the dimensions compared to the original model. The RASCH analysis indicates adequate fit for both persons and items.

Creation and implementation of a REDCap database demonstrates engagement and impact for a hospital-based center for nursing research and evidence-based practice.

Demonstrating impact is essential for hospital-based centers for pediatric nursing research and evidence-based practice. To meet this aim, the Center for Pediatric Nursing Research & Evidence-Based Practice at Children's Hospital of Philadelphia created a Research Electronic Data Capture (REDCap) database as a project engagement tracker to (1) capture all requests for consultation, and (2) summarize the Center's multi-professional consultants' engagement in diverse projects across our large pediatric health system. We implemented our REDCap project engagement tracker six years ago and continue to utilize it as a living database. Customized reports allow us to effectively manage our daily operations and communicate our reach and value to stakeholders internal and external to our organization. With REDCap's flexibility and ease of use, this project engagement tracker can be easily shared with like organizations. And with strong partnerships, we hope to see the development of common metrics to communicate the impact of centers of nursing inquiry on a national scale.

Theory of change for addressing sex and gender bias, invisibility and exclusion in Australian health and medical research, policy and practice.

Sex and gender are inadequately considered in health and medical research, policy and practice, leading to preventable disparities in health and wellbeing. Several global institutions, journals, and funding bodies have developed policies and guidelines to improve the inclusion of diverse participants and consideration of sex and gender in research design and reporting and the delivery of clinical care. However, according to recent evaluations, these policies have had limited impact on the inclusion of diverse research participants, adequate reporting of sex and gender data and reducing preventable inequities in access to, and quality provision of, healthcare. In Australia, the Sex and Gender Policies in Medical Research (SGPMR) project aims to address sex and gender bias in health and medical research by (i) examining how sex and gender are currently considered in Australian research policy and practice; (ii) working with stakeholders to develop policy interventions; and (iii) understanding the wider impacts, including economic, of improved sex and gender consideration in Australian health and medical research. In this paper we describe the development of a theory of change (ToC) for the SGPMR project. The ToC evolved from a two-stage process consisting of key stakeholder interviews and a consultation event. The ToC aims to identify the pathways to impact from improved consideration of sex and gender in health and medical research, policy and practice, and highlight how key activities and policy levers can lead to improvements in clinical practice and health outcomes. In describing the development of the ToC, we present an entirely novel framework for outlining how sex and gender can be appropriately considered within the confines of health and medical research, policy and practice.

Building bridges: evaluating policymakers' research capacities, engagement, and utilization in health policymaking within the Kuwaiti context: a cross-sectional study.

BACKGROUND: Health policymaking is a critical aspect of governmental decision-making that shapes the well-being of populations. In the Middle East and North Africa, particularly in Kuwait, limited attention has been given to exploring the research capacities, engagement, and utilization among health policymakers. This study aims to bridge this gap by investigating how Kuwaiti health policymakers incorporate evidence-based research into the formulation of health-related policies. METHODS: This cross-sectional study targeted health policymakers in leadership positions within the Kuwait Ministry of Health (MOH). Using the Seeking, Engaging with and Evaluating Research (SEER) questionnaire, participants' capacities, engagement, and use of research were assessed. The targeted sample was all health policymakers in leadership positions, starting from the head of departments and above. The questionnaire comprises four domains, 14 sections, and 50 questions and utilizes Likert and binary scales, with aggregate scores predicting engagement actions and research use. The data were collected between March and July 2023. All the statistical analyses were performed using SPSS v27, and the numerical and categorical variables were analyzed using appropriate statistical tests, including t-tests, ANOVA, and Pearson's correlation. RESULTS: Out of 205 policymakers, 88 participated (42.9% response rate): predominantly male (51.1%) and married (78.4%). The mean age was 49.84 ± 7.28 years, with a mean MOH tenure of 24.39 ± 6.80 years. Participants demonstrated high value for research (mean score 4.29 ± 0.55) and expressed confidence in the research utilization. Organizational emphasis on research use exhibited nuanced perceptions, identifying areas where MOH support may be lacking. Access to research resources and processes for policy development guidance were highlighted as challenges. CONCLUSIONS: This study provides crucial insights into the research capacities and engagement of Kuwaiti health policymakers. It emphasizes the need for targeted interventions to align individual perceptions with organizational expectations, address confidence disparities, and enhance collaborative efforts. Organizational investments are crucial for fostering a dynamic research ecosystem to improve evidence-based policy development in Kuwait's healthcare landscape.

Establishing evidence criteria for implementation strategies in the US: a Delphi study for HIV services.

BACKGROUND: There are no criteria specifically for evaluating the quality of implementation research and recommending implementation strategies likely to have impact to practitioners. We describe the development and application of the Best Practices Tool, a set of criteria to evaluate the evidence supporting HIV-specific implementation strategies. METHODS: We developed the Best Practices Tool from 2022-2023 in three phases. (1) We developed a draft tool and criteria based on a literature review and key informant interviews. We purposively selected and recruited by email interview participants representing a mix of expertise in HIV service delivery, quality improvement, and implementation science. (2) The tool was then informed and revised through two e-Delphi rounds using a survey delivered online through Qualtrics. The first and second round Delphi surveys consisted of 71 and 52 open and close-ended questions, respectively, asking participants to evaluate, confirm, and make suggestions on different aspects of the rubric. After each survey round, data were analyzed and synthesized as appropriate; and the tool and criteria were revised. (3) We then applied the tool to a set of research studies assessing implementation strategies designed to promote the adoption and uptake of evidence-based HIV interventions to assess reliable application of the tool and criteria. RESULTS: Our initial literature review yielded existing tools for evaluating intervention-level evidence. For a strategy-level tool, additions emerged from interviews, for example, a need to consider the context and specification of strategies. Revisions were made after both Delphi rounds resulting in the confirmation of five evaluation domains - research design, implementation outcomes, limitations and rigor, strategy specification, and equity - and four evidence levels - best, promising, more evidence needed, and harmful. For most domains, criteria were specified at each evidence level. After an initial pilot round to develop an application process and provide training, we achieved 98% reliability when applying the criteria to 18 implementation strategies. CONCLUSIONS: We developed a tool to evaluate the evidence supporting implementation strategies for HIV services. Although specific to HIV in the US, this tool is adaptable for evaluating strategies in other health areas.

Systemic Corticosteroid as an Adjunct for Acute Respiratory Distress Syndrome in Non-Fatal Fresh Water Drowning: An Evidence-based Case Report.

BACKGROUND: Acute lung injury or acute respiratory distress syndrome (ARDS) is one of the most common complications of non-fatal drowning. Although respiratory societies' guidelines endorse the role of systemic corticosteroids in ARDS, the evidence for systemic corticosteroid use in ARDS due to non-fatal drowning is limited. METHODS: A search was conducted on Pubmed, OVID, and EuropePMC, assessing the clinical question using inclusion and exclusion criteria. The selected studies were critically appraised, and the results were summarized. RESULTS: A total of six retrospective studies were selected and assessed, all studies showed poor validity and a high risk of bias. Out of six studies, only four informed us of steroid administration's effect on outcomes. In two studies, mortality associated with corticosteroid administration seemed to be higher. On the contrary, one study found no mortality in the corticosteroid group, but 100% mortality was observed in the control group. In another study, steroid therapy seemed to not affect hospital length of stay or mechanical ventilation rates. CONCLUSION: Corticosteroid administration for non-fatal drowning and its impact on clinical outcomes remains equivocal. Routine administration of corticosteroids is not indicated and should be done on a case-by-case basis.

Systematic reviews and meta-analyses in neurosurgery part I: interpreting and critically appraising as a guide for clinical practice.

Neurosurgeons are inundated with the Herculean task to keep abreast with the rapid pace at which clinical research is proliferating. Systematic reviews and meta-analyses (SRMAs) have consequently surged in popularity because when executed properly, they constitute the highest level of evidence, and may save busy neurosurgeons many hours of combing the literature. Well-executed SRMAs may prove instructive for clinical practice, but poorly conducted reviews sow confusion and may potentially cause harm. Unfortunately, many SRMAs within neurosurgery are relatively lackluster in methodological rigor. When neurosurgeons apply the results of an SRMA to patient care, they should start by evaluating the extent to which the employed methods have likely protected against misleading results. The present article aims to educate the reader about how to interpret an SRMA, to assess the potential relevance of its results in the special context of the neurosurgical patient population.

Barriers and facilitators to evidence-based perioperative hypothermia management for orthopaedic patients: A systematic review.

AIM: To assess barriers and facilitators to the implementation of guidelines for the prevention of inadvertent perioperative hypothermia in orthopaedic patients. DESIGN: Systematic review. DATA SOURCES: Nine databases: PubMed, Embase, CINAHL, Cochrane CENTRAL, PsycINFO, ProQuest Dissertations and Theses, Scopus, Web of Science and Trip Clinical Evidence Database. METHODS: Primary studies published in English between January 2008 to July 2022 were screened. Study selection, quality assessment, and data extraction were completed independently by researchers. Data were extracted using the Consolidated Framework for Implementation Research and mapped to the Expert Recommendations for Implementing Change strategies. RESULTS: Eighty-seven studies were included in the review. The most frequently reported barriers and facilitators related to evidence strength, relative advantage, and cost of implementing perioperative hypothermia prevention guidelines. The top four ERIC strategies were: Identify and prepare champions; Conduct educational meetings; Assess for readiness and identify barriers and facilitators; and Inform local opinion leaders. CONCLUSION: This review provides synthesized evidence regarding barriers and facilitators to perioperative hypothermia guidelines for patients undergoing orthopaedic surgery. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Our work provides theory guided strategies to promote implementation of perioperative hypothermia prevention to assist nurses caring for patients undergoing orthopaedic surgery. IMPACT: Findings provide professionals caring for patients undergoing orthopaedic surgery with theory-informed strategies to improve perioperative hypothermia prevention. Reducing perioperative hypothermia will improve outcomes for patients undergoing orthopaedic surgery. REPORTING METHOD: The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. NO PATIENT OR PUBLIC CONSULTATION: Due to the study design, no patient or public consultation took place.

Approaches, Goals, and Scientific Integrity in Music Therapy Research with Individuals on the Autism Spectrum: An Integrative Review.

Scientific integrity is fundamental to evidence-based practice (EBP) and essential in music therapy (MT) research and clinical practice. Researchers conducted an integrative review of approaches and interventions employed by music therapists (MTs) with individuals on the autism spectrum in the context of how studies are analyzed by the National Autism Center (NAC) and National Clearinghouse on Autism Evidence and Practice (NCAEP). Researchers identified 880 database records meeting initial search criteria (i.e., autism spectrum disorder, autism, PDD-NOS, MT, and music interventions); 36 studies remained after screening for duplication, topic relevance, and adherence to inclusion criteria. Included studies were published between 1964 and 2021, in English language, in free open-access journals, worldwide; peer reviewed; conducted by MTs; empirical quantitative, qualitative, or mixed-methods design; intervention-based; and presented separate data for participants on the autism spectrum. Content and quantitative analyses identified deficits in scientific integrity and the following gaps in studies reviewed: Motor Skills and Placement (NAC-defined intervention targets), Computer-based and Songwriting and Composition (MT techniques), and Wellness and Bonny Method of Guided Imagery in Music (clinical approaches); no patterns were evident among NAC Interventions with MT techniques and approaches. Analysis of 5-point Scientific Merit Ratings yielded a mean 2.78 rating. A comparison of NAC and NCAEP terminology (i.e., how MT researchers report independent variables) indicated eight titles mention specific non-music interventions, 19 mention MT, 14 include music-based technique descriptors, and two mention both non-music interventions and MT. Researchers offer guidelines regarding identity-inclusive language, scientific integrity, and clarity of EBPs within MT intervention research with individuals on the autism spectrum.

Psychodynamic psychotherapy for gender dysphoria is not conversion therapy.

Over the last ten years, there has been a substantial increase in the number of children and adolescents referred to gender clinics for possible gender dysphoria. The gender affirming model of care, a dominant treatment approach in Canada, is based on low quality evidence. Other countries are realizing this and making psychosocial treatments and/or exploratory psychotherapy a first line of treatment for gender related distress in young patients. Psychodynamic (exploratory) psychotherapy has established efficacy for a range of conditions, and has been used in youth and adults with gender dysphoria. In Canada, the adoption of psychodynamic psychotherapy for gender dysphoria is impeded by some academics who argue that it may violate laws against conversion therapy. Psychodynamic psychotherapy is not conversion therapy and should be made available in Canada as a treatment modality for gender dysphoria.

What is needed for nurses to work with evidence-based practice? A qualitative study.

BACKGROUND: Transformation of healthcare is necessary to ensure patients receive high-quality care. Working with the evidence-based practice (EBP) principles enables nurses to make this shift. Although working according to these principles is becoming more common, nurses base their actions too much on traditions and intuition. Therefore, to promote EBP in nursing practice and improve related education, more insight into nurses' needs is necessary to overcome existing EBP barriers. OBJECTIVE: To identify the current needs to work with EBP principles among hospital and community care nurses and student nurses. DESIGN: A qualitative, exploratory approach with focus group discussions. METHODS: Data was collected between February and December 2020 through 5 focus group discussions with 25 nurses and student nurses from a hospital, a community care organisation, and nursing education schools (bachelor and vocational). Data were analysed using reflexive thematic analysis, and the main themes were synchronised to the seven domains from the Tailored Implementation for Chronic Diseases (TICD) checklist. RESULTS: Nurses and student nurses experience EBP as complex and require more EBP knowledge and reliable, ready-to-use evidence. They wanted to be facilitated in access to evidence, the opportunity to share insights with colleagues and more time to work on EBP. The fulfilment of these needs serves to enhance motivation to engage with evidence-based practice (EBP), facilitate personal development, and empower nurses and student nurses to take more leadership in working according to EBP principles and improve healthcare delivery. CONCLUSION: Nurses experience difficulties applying EBP principles and need support with their implementation. Nurses' and student nurses' needs include obtaining more EBP knowledge and access to tailored and ready-to-use information. They also indicated the need for role models, autonomy, incentives, dedicated time, and incorporation of EBP in daily work practice.

Use of digital patient decision-support tools for atrial fibrillation treatments: a systematic review and meta-analysis.

OBJECTIVES: To assess the effects of digital patient decision-support tools for atrial fibrillation (AF) treatment decisions in adults with AF. STUDY DESIGN: Systematic review and meta-analysis. ELIGIBILITY CRITERIA: Eligible randomised controlled trials (RCTs) evaluated digital patient decision-support tools for AF treatment decisions in adults with AF. INFORMATION SOURCES: We searched MEDLINE, EMBASE and Scopus from 2005 to 2023.Risk-of-bias (RoB) assessment: We assessed RoB using the Cochrane Risk of Bias Tool 2 for RCTs and cluster RCT and the ROBINS-I tool for quasi-experimental studies. SYNTHESIS OF RESULTS: We used random effects meta-analysis to synthesise decisional conflict and patient knowledge outcomes reported in RCTs. We performed narrative synthesis for all outcomes. The main outcomes of interest were decisional conflict and patient knowledge. RESULTS: 13 articles, reporting on 11 studies (4 RCTs, 1 cluster RCT and 6 quasi-experimental) met the inclusion criteria. There were 2714 participants across all studies (2372 in RCTs), of which 26% were women and the mean age was 71 years. Socioeconomically disadvantaged groups were poorly represented in the included studies. Seven studies (n=2508) focused on non-valvular AF and the mean CHAD2DS2-VASc across studies was 3.2 and for HAS-BLED 1.9. All tools focused on decisions regarding thromboembolic stroke prevention and most enabled calculation of individualised stroke risk. Tools were heterogeneous in features and functions; four tools were patient decision aids. The readability of content was reported in one study. Meta-analyses showed a reduction in decisional conflict (4 RCTs (n=2167); standardised mean difference -0.19; 95% CI -0.30 to -0.08; p=0.001; I2=26.5%; moderate certainty evidence) corresponding to a decrease in 12.4 units on a scale of 0 to 100 (95% CI -19.5 to -5.2) and improvement in patient knowledge (2 RCTs (n=1057); risk difference 0.72, 95% CI 0.68, 0.76, p<0.001; I2=0%; low certainty evidence) favouring digital patient decision-support tools compared with usual care. Four of the 11 tools were publicly available and 3 had been implemented in healthcare delivery. CONCLUSIONS: In the context of stroke prevention in AF, digital patient decision-support tools likely reduce decisional conflict and may result in little to no change in patient knowledge, compared with usual care. Future studies should leverage digital capabilities for increased personalisation and interactivity of the tools, with better consideration of health literacy and equity aspects. Additional robust trials and implementation studies are warranted. PROSPERO REGISTRATION NUMBER: CRD42020218025.

Knowledge, attitude and utilisation of evidence-based therapeutic exercises in knee osteoarthritis management in Nigeria.

Background: In Nigeria, there is a disparity among physiotherapists regarding therapeutic exercise as a core treatment for patients with knee osteoarthritis (OA). The attitudes and beliefs of physiotherapists could influence this. Objective: To investigate Nigerian physiotherapists' knowledge, attitude, and utilisation of evidence-based therapeutic exercises. Design: A mixed-method of cross-sectional survey and focus group discussion. Setting: Secondary and tertiary health institutions in Nigeria. Participants: Physiotherapists consecutively sampled from the selected institutions. Main outcome measures: Participants' knowledge, attitude and utilisation of evidence-based therapeutic exercises for the management of knee OA. Results: This study revealed that 81% of physiotherapists in Nigeria had a fair knowledge of evidence-based practice and the efficacy of therapeutic exercises in managing knee OA. Despite this fair knowledge, 95.3% had a poor attitude. The important emerging categories/themes are treatment preference, clinical experience, and strength of evidence. Conclusion: Physiotherapists in Nigeria have a fair knowledge of evidence-based therapeutic exercises in managing patients with knee OA, although there is a poor attitude and disparity between the use and current recommendations. Funding: The research received no funding from a commercial or non-profit organisation.

Factors influencing the reimbursement of cancer drugs in Europe: A scoping review.

RATIONALE: Reimbursement process of oncology drugs in Europe occurs within a complex decision-making process that varies between Member States. Distinctions between the States trigger societal debates since it is necessary to balance access to medicines and health systems sustainability. AIMS AND OBJECTIVES: We aimed to review the evidence concerning factors associated with the reimbursement decision or Health Technology Agency recommendation of oncology drugs in Europe. METHODS: A systematic literature search was performed in two databases from inception to august 2023. Screening and data extraction were performed by pairs. RESULTS: Thirteen articles were included and encompassed data from 11 nations. Seven articles showed that cost-effective (C-E) drugs and lower Incremental Cost-Effectiveness Ratios (ICERs) had higher likelihood of reimbursement. Disease severity might influence the reimbursement decision with financial agreements. Improvement in clinical outcomes, substantial clinical benefit (p < 0.01) or overall survival gains (p < 0.05) were positively associated. Orphan drug designation impact varies between countries but positive decisions are usually achieved under specific conditions. Clinical and C-E uncertainty frequently led to reimbursement with financial agreements or outcomes-based conditions. Sociodemographic factors as: social health insurance system, higher Gross Domestic Product and larger elderly population were positively associated with reimbursement (p < 0.01). CONCLUSION: There is a need for further research into key determinants of reimbursement decisions in Europe and the development of drug access models that can effectively address and overcome costs and effectiveness uncertainties.

Developing evidence-based medication therapy management tools for psychiatric nurses: An evaluative qualitative case study.

RATIONALE, AIMS AND OBJECTIVES: Clinical use of psychotropic medications involves diverse risks, addressable by nursing interventions. The research had a dual purpose: developing an "Evidence-Based Medication Therapy Management Guideline" and a "Medication Administration-Tracking Chart" and evaluating their use through an evaluative case study. METHODS: Evidence-based guideline and chart development and evaluative case study. Initially, Evidence-Based Medication Therapy Management Guideline and Medication Administration Tracking Chart for managing medication in a psychiatric unit were developed. Subsequently, their efficacy was evaluated in a case study involving 10 participating nurses used in the psychiatric unit with 123-bed of a training and research hospital in Turkey. Data was collected through personal forms, interviews, medication charts, and researcher observations, and the analysis employed Merriam's case study method. RESULTS: Three themes (inception, implementation, termination, and sustainers) and 12 sub-themes emerged. Nurses stated that the research tools filled their information gaps, enhancing the medication therapy management process's effectiveness and safety, improving nursing care quality and continuity, and benefiting patient outcomes. Nurses expressed a desire to consistently use the tools in the unit and provided suggestions. CONCLUSION: Nurses highlighted the tools' potential to enhance medication safety, psychiatric care, and patient outcomes. However, their stance on using evidence-based tools revealed an approach/avoidance conflict, balancing benefits and barriers. Experience emerged as a hindrance in embracing evidence-based clinical tools. This study is among the first to comprehensively develop evidence-based medication management guideline and administration-tracking chart for psychiatric nurses globally and in our country. Routine use of the tools is expected to enhance nurses' expertise in psychotropic medication management, leading to improved patient outcomes in medication-related aspects.

Impact of Evidence-Based Nursing on Self-Efficacy, Quality of Life and Treatment Compliance in Patients Undergoing Urological Surgery: Retrospective Study.

BACKGROUND: Urological surgery presents unique challenges to patients, necessitating specialised aftercare nursing. Evidence-based nursing has emerged as a strategy to improve patient outcomes through tailored education, self-management strategies and psychological support. However, its specific impact on post-operative outcomes in patients undergoing urological surgery has not been extensively explored. METHODS: This study assessed postoperative self-efficacy, quality of life, treatment compliance and nursing satisfaction. Self-compiled percentage of satisfaction scale was used to assess the degree of satisfaction with nursing work in both groups. Patients' self-care ability was evaluated using the Self-Care Ability Scale, and their quality of life scores were assessed with Short Form 36 Health Survey (SF-36). Patients' anxiety and depression levels were examined using the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS). Statistical analysis was conducted using SPSS 29.0 statistical software. RESULTS: This retrospective study analysed 231 patients undergoing urological surgery and categorised them into a usual care group (n = 99) and an evidence-based nursing group (n = 132). Post-operative outcomes in the evidence-based nursing group included significantly higher self-care abilities (p < 0.001), improved quality of life scores (p < 0.001), lower anxiety and depression levels (p < 0.001) and higher treatment compliance rates (p < 0.05) compared with the usual care group. Additionally, nursing satisfaction was higher in the evidence-based nursing group (p = 0.001). CONCLUSIONS: The findings provide compelling evidence regarding the favourable impact of evidence-based nursing on various post-operative outcomes in patients undergoing urological surgery. Evidence-based nursing shows promise in enhancing patients' self-efficacy, well-being, treatment compliance and satisfaction. The results underscore the potential benefits of evidence-based nursing in optimising aftercare nursing and driving positive patient-centred outcomes in urological surgery setting.

Best evidence summary of sleep protection in premature infants in the neonatal intensive care unit: a narrative review.

Background and Objective: Sleep influences the interaction between infants and their environment, as well as the achievement of crucial milestones in motor and language development. This is particularly significant for preterm infants in vulnerable positions. However, prematurely born infants in the neonatal intensive care unit (NICU) are exposed to various stimuli such as noise and light, which disrupt their normal sleep patterns. This study assesses and consolidates the existing evidence on non-pharmacological strategies for protecting and promoting sleep in preterm infants. By providing an evidence-based data repository, it offers a valuable reference for clinical interventions. Methods: We conducted computer-based searches using various databases and resources, including UpToDate, BMJ Best Practice, Guidelines International Network (GIN), National Institute for Health and Clinical Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN), National Guideline Clearinghouse (NGC), Registered Nurses Association of Ontario (RNAO), Joanna Briggs Institute (JBI), World Health Organization (WHO), Cochrane Library, Web of Science, PubMed, China National Knowledge Infrastructure (CNKI), Wanfang Data, and China Biology Medicine disc (CBM). The search period spanned from January 2014 to May 2024. Key Content and Findings: We have included a total of 22 articles in our review, comprising two guidelines, 11 systematic reviews, 1 evidence summary, 1 technical report, 2 practice recommendations, and 5 randomized controlled trials. The evidence was synthesized from eight domains: sleep team construction, risk factor assessment, sleep assessment tools, positional management, noise control, light management, sensory stimulation, and hospital-home transition sleep management, resulting in 27 pieces of evidence. Conclusions: This study summarizes the optimal evidence for the management of sleep in premature infants, providing empirical support for standardizing the management of sleep in premature infants. It is recommended that healthcare professionals judiciously apply the best evidence while considering the clinical context, thus promoting safe sleep for premature infants.

Demarcating scientific medicine.

Scientific medicine and homeopathy are interesting case studies for the ongoing project of demarcating science from pseudoscience. Much of the demarcation literature formulates abstract criteria for demarcating science from pseudoscience generally. In service of a more localist approach to the demarcation problem, I reconstruct a specific demarcating difference, the like comparison criterion, invoked by nineteenth century adherents to an early model of scientific medicine. If it is to remain relevant today, I argue that the like comparison criterion must be updated in our current era of epidemiological, evidence-based medicine to recognize the importance of assessing study bias and mechanistic implausibility in contemporary medical science.