Perinatal influences on academic achievement and the developing brain: a scoping systematic review.

Introduction and methods: In this PRISMA-compliant systematic review, we identify and synthesize the findings of research in which neuroimaging and assessments of achievement have been used to examine the relationships among aspects of developmental programming, neurodevelopment, and achievement in reading and mathematics. Results: Forty-seven studies met inclusion criteria. The majority examined the impact of prematurity (n = 32) and prenatal alcohol exposure (n = 13). Several prematurity studies reported a positive correlation between white-matter integrity of callosal fibers and executive functioning and/or achievement, and white matter properties were consistently associated with cognitive and academic performance in preterm and full-term children. Volumetric studies reported positive associations between academic and cognitive abilities and white and gray matter volume in regions such as the insula, putamen, and prefrontal lobes. Functional MRI studies demonstrated increased right-hemispheric language processing among preterm children. Altered activation of the frontoparietal network related to numerical abilities was also reported. Prenatal alcohol exposure studies reported alterations in white matter microstructure linked to deficits in cognitive functioning and academic achievement, including mathematics, reading, and vocabulary skills. Volumetric studies reported reductions in cerebral, cerebellar, and subcortical gray matter volumes associated with decreased scores on measures of executive functioning, attention, working memory, and academic performance. Functional MRI studies demonstrated broad, diffuse activation, reduced activation in canonical regions, and increased activation in non-canonical regions during numeric tasks. Discussion: A preponderance of studies linked prematurity and prenatal alcohol exposure to altered neurodevelopmental processes and suboptimal academic achievement. Limitations and recommendations for future research are discussed. Systematic review registration: Identifier: DOI 10.17605/OSF.IO/ZAN67.

Effectiveness and family experiences of interventions promoting partnerships between families and pediatric and neonatal intensive care units: a mixed methods systematic review.

OBJECTIVE: The objective of this mixed methods review was to examine the effectiveness and family experiences of interventions promoting partnerships between families and the multidisciplinary health care team in pediatric and neonatal intensive care units. INTRODUCTION: Hospitalization of infants and children in neonatal intensive care units and pediatric intensive care units has a significant effect on their families, including increased stress, anxiety, and depression. Available evidence syntheses focused on specific family-centered care, but not on partnership, which is another aspect that may improve the families' outcomes and experiences. INCLUSION CRITERIA: This review focused on effectiveness and experiences of interventions by health professionals in partnership with families of infants or children hospitalized in an intensive care unit. The type of intervention was a partnership between the health care team and the family, and focused on outcomes of stress, anxiety, depression, quality of life, attachment, or satisfaction with family-centered care. METHODS: The JBI methodology for convergent segregated mixed methods systematic reviews was followed using the standardized JBI critical appraisal and data extraction tools. Ten databases were searched from January 2000 to April 2022. Findings of quantitative studies were statistically pooled through meta-analyses and those that could not pooled were reported in a narrative format. Qualitative studies were pooled through meta-synthesis. RESULTS: This review included 6 qualitative and 42 quantitative studies. There was mixed methodological quality and all studies were included regardless of methodological quality. Meta-analyses showed positive improvements in anxiety, satisfaction with family-centered care, and stress, yet no conclusive effects in attachment and depression. These results should be interpreted with caution due to high heterogeneity. Qualitative analysis resulted in 2 synthesized findings: "Interventions that incorporate partnerships between families and the health care team can improve the family's experience and capacity to care for the child" and "Having a child in intensive care can be an experience of significant impact for families" Integration of quantitative and qualitative evidence revealed some congruence between findings; however, the paucity of qualitative evidence minimized the depth of this integration. CONCLUSIONS: Partnership interventions can have a positive impact on parents of children in intensive care units, with improvements seen in stress, anxiety, and satisfaction with family-centered care. REVIEW REGISTRATION: PROSPERO CRD42019137834.

A systematic review of clinical practice guidelines and recommendations for the management of pain, sedation, delirium and iatrogenic withdrawal syndrome in pediatric intensive care.

Introduction: This systematic review aimed to evaluate the quality of clinical practice guidelines (CPGs) and recommendations for managing pain, sedation, delirium, and iatrogenic withdrawal syndrome in pediatric intensive care (PICU). The objectives included evaluating the quality of recommendations, synthesizing recommendations, harmonizing the strength of the recommendation (SoR) and the certainty of evidence (CoE), and assessing the relevance of supporting evidence. Methods: A comprehensive search in four electronic databases (Medline, Embase.com, CINAHL and JBI EBP Database), 9 guideline repositories, and 13 professional societies was conducted to identify CPGs published from January 2010 to the end of May 2023 in any language. The quality of CPGs and recommendations was assessed using the AGREE II and AGREE-REX instruments. Thematic analysis was used to synthesize recommendations, and the GRADE SoR and CoE harmonization method was used to interpret the credibility of summary recommendations. Results: A total of 18 CPGs and 170 recommendations were identified. Most CPGs were of medium-quality, and three were classified as high. A total of 30 summary recommendations were synthesized across each condition, focused on common management approaches. There was inconsistency in the SoRs and CoE for summary recommendations, those for assessment showed the highest consistency, the remaining were conditional, inconsistent, inconclusive, and lacked support from evidence. Conclusion: This systematic review provides an overview of the quality of CPGs for these four conditions in the PICU. While three CPGs achieved high-quality ratings, the overall findings reveal gaps in the evidence base of recommendations, patient and family involvement, and resources for implementation. The findings highlight the need for more rigorous and evidence-based approaches in the development and reporting of CPGs to enhance their trustworthiness. Further research is necessary to enhance the quality of recommendations for this setting. The results of this review can provide a valuable foundation for future CPG development. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=274364, PROSPERO (CRD42021274364).

Effectiveness, quality and implementation of pain, sedation, delirium, and iatrogenic withdrawal syndrome algorithms in pediatric intensive care: a systematic review and meta-analysis.

Background: Pain, sedation, delirium, and iatrogenic withdrawal syndrome are conditions that often coexist, algorithms can be used to assist healthcare professionals in decision making. However, a comprehensive review is lacking. This systematic review aimed to assess the effectiveness, quality, and implementation of algorithms for the management of pain, sedation, delirium, and iatrogenic withdrawal syndrome in all pediatric intensive care settings. Methods: A literature search was conducted on November 29, 2022, in PubMed, Embase, CINAHL and Cochrane Library, ProQuest Dissertations & Theses, and Google Scholar to identify algorithms implemented in pediatric intensive care and published since 2005. Three reviewers independently screened the records for inclusion, verified and extracted data. Included studies were assessed for risk of bias using the JBI checklists, and algorithm quality was assessed using the PROFILE tool (higher % = higher quality). Meta-analyses were performed to compare algorithms to usual care on various outcomes (length of stay, duration and cumulative dose of analgesics and sedatives, length of mechanical ventilation, and incidence of withdrawal). Results: From 6,779 records, 32 studies, including 28 algorithms, were included. The majority of algorithms (68%) focused on sedation in combination with other conditions. Risk of bias was low in 28 studies. The average overall quality score of the algorithm was 54%, with 11 (39%) scoring as high quality. Four algorithms used clinical practice guidelines during development. The use of algorithms was found to be effective in reducing length of stay (intensive care and hospital), length of mechanical ventilation, duration of analgesic and sedative medications, cumulative dose of analgesics and sedatives, and incidence of withdrawal. Implementation strategies included education and distribution of materials (95%). Supportive determinants of algorithm implementation included leadership support and buy-in, staff training, and integration into electronic health records. The fidelity to algorithm varied from 8.2% to 100%. Conclusions: The review suggests that algorithm-based management of pain, sedation and withdrawal is more effective than usual care in pediatric intensive care settings. There is a need for more rigorous use of evidence in the development of algorithms and the provision of details on the implementation process. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021276053, PROSPERO [CRD42021276053].

Quality of clinical practice guidelines and recommendations for the management of pain, sedation, delirium and iatrogenic withdrawal in pediatric intensive care: a systematic review protocol.

INTRODUCTION: Inadequate management of pain and sedation in critically ill children can cause unnecessary suffering and agitation, but also delirium and iatrogenic withdrawal. It is, therefore, important to address these four interrelated conditions together. Some clinical practice guidelines (CPGs) are available for the management of pain and sedation, and a few for delirium and iatrogenic withdrawal in the paediatric intensive care unit; none address the four conditions altogether. Critical appraisal of the quality of CPGs is necessary for their recommendations to be adopted into clinical practice. The aim of this systematic review is to identify and appraise the quality of CPGs and recommendations for management of either pain, sedation, delirium and iatrogenic withdrawal. METHODS AND ANALYSIS: Researchers will conduct a systematic review in electronic databases (Medline ALL (Ovid), Embase.com, CINAHL with Full Text (EBSCO), JBI EBP Database (Ovid)), guideline repositories and websites of professional societies to identify CPGs published from 2010 to date. They will then combine index and free terms describing CPGs with pain, sedation, delirium and withdrawal. The researchers will include CPGs if they can be applied in the paediatric intensive care population (newborns to 18 years old) and include recommendation(s) for assessment of at least one of the four conditions. Two independent reviewers will screen for eligibility, complete data extraction and quality assessments using the Appraisal of Guidelines for Research and Evaluation (AGREE) II and the AGREE Recommendation Excellence instruments. Researchers will report characteristics, content and recommendations from CPGs in tabulated forms. ETHICS AND DISSEMINATION: Ethical approval is not required for this systematic review. Results will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42021274364.

Instruments for the identification of patients in need of palliative care in the hospital setting: a systematic review of measurement properties.

OBJECTIVE: The objective of this review was to provide a comprehensive overview of the measurement properties of the available instruments used by clinicians for identifying adults in need of general or specialized palliative care in hospital settings. INTRODUCTION: Identification of patients in need of palliative care has been recognized as an area where many health care professionals need guidance. Differentiating between patients who require general palliative care and patients with more complex conditions who need specialized palliative care is particularly challenging. INCLUSION CRITERIA: We included development and validation studies that reported on measurement properties (eg, content validity, reliability, or responsiveness) of instruments used by clinicians for identifying adult patients (>18 years and older) in need of palliative care in hospital settings. METHODS: Studies published until March 2020 were searched in four databases: Embase.com, MEDLINE (Ovid), PubMed, and CINAHL (EBSCO). Unpublished studies were searched in Google Scholar, government websites, hospice websites, the Library Network of Western Switzerland, and WorldCat. The search was not restricted by language; however, only studies published in English or French were eligible for inclusion. The title and abstracts of the studies were screened by two independent reviewers against the inclusion criteria. Full-text studies were reviewed for inclusion by two independent reviewers. The quality of the measurement properties of all included studies were assessed independently by two reviewers according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. RESULTS: Out of the 23 instruments identified, four instruments were included, as reported in six studies: the Center to Advance Palliative Care (CAPC) criteria, the Necesidades Paliativas (NECPAL), the Palliative Care Screening Tool (PCST), and the Supportive and Palliative Care Indicators Tool (SPICT). The overall psychometric quality of all four instruments was insufficient according to the COSMIN criteria, with the main deficit being poor construct description during development. CONCLUSIONS: For the early identification of patients needing palliative care in hospital settings, there is poor quality and incomplete evidence according to the COSMIN criteria for the four available instruments. This review highlights the need for further development of the construct being measured. This may be done by conducting additional studies on these instruments or by developing a new instrument for the identification of patients in need of palliative care that addresses the current gaps in construct and structural validity. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020150074.

Identifying relevant concepts and factors for the sustainability of evidence-based practices within acute care contexts: a systematic review and theory analysis of selected sustainability frameworks.

BACKGROUND: There is growing recognition among healthcare professionals that the sustainability of evidence-based practices (EBPs) within different settings is variable and suboptimal. Understanding why a particular EBP might be sustained in one setting and not another remains unclear. Recent reviews illustrate the need to identify and analyze existing frameworks/models/theories (F/M/Ts) that focus solely on the sustainability of EBPs in specific healthcare settings, such as acute care, to illuminate key determinants and facilitate appropriate selection to guide practice and research. METHODS: We conducted a systematic review to extract sustainability frameworks. This involved using two available syntheses of the literature and a systematic search of four databases from January 2015 to July 2018: CINHAL, MEDLINE, Embase, and ProQuest. We included studies published in English, and if they included sustainability F/M/Ts recommended for use in acute care or an unspecified healthcare organization/setting. F/M/Ts explicitly recommended for use in public health and or community settings were excluded. We then conducted a comparative analysis of F/M/Ts using a modified theory analysis approach, to understand the theoretical underpinnings of each F/M/T, their determinants and concepts hypothesized to influence the sustained use of EBPs within an acute care context. RESULTS: Of 2967 identified citations from the 2 available syntheses and the systematic review, 8 F/M/Ts met the inclusion criteria. We identified 37 core factors, of which 16 were recorded as common factors (occurring within 4 or more of the 8 included F/M/Ts). All factors grouped into 7 main themes: innovation, adopters, leadership and management, inner context, inner processes, outer context, and outcomes. CONCLUSIONS: This systematic review is the first to include a comprehensive analysis of healthcare sustainability F/M/Ts for the sustained use of EBPs in acute care settings. Findings reveal insights into sustainability as a "process or ongoing stage of use" following initial implementation, suggesting this construct should be added to the definition of sustainability. Results provide a resource of available F/M/Ts and hypothesized factors to consider for acute care team members who are planning or currently implementing EBPs with the goal of improving patient outcomes. It also provides a basis for future research on sustainability in acute care.

A Profile of Regulated Nurses Employed in Canadian Long-Term Care Facilities.

ABSTRACTRegistered nurses (RNs) and licensed practical nurses (LPNs) provide the skilled component of nursing care in Canadian residential long-term care facilities, yet we know little about this important workforce. We surveyed 309 RNs and 448 LPNs from 91 nursing homes across Western Canada and report descriptively on their demographics and work and health-related outcomes. LPNs were significantly younger than RNs, worked more hours, and had less nursing experience. LPNs also experienced significantly more dementia-related responsive behaviours from residents compared to RNs. Younger LPNs and RNs reported significantly worse burnout (emotional exhaustion) and poorer mental health compared to older age groups. Significant differences in demographics and work- and health-related outcomes were also found within the LPN and RN samples by province, region, and owner-operator model. These findings can be used to inform important policy decisions and workplace planning to improve quality of work life for nurses in residential long-term care facilities.

Job satisfaction among critical care nurses: A systematic review.

BACKGROUND: Nursing shortages, particularly in critical care units, are a major concern worldwide. Job satisfaction is a key factor associated with the high turnover of critical care nurses. OBJECTIVES: The purpose of this systematic review was to synthesize the evidence on critical care nurses' job satisfaction. Specific research questions were: 1. How is job satisfaction defined and measured in studies of critical care nurses? 2a. What is the level of job satisfaction among critical care nurses? 2b. How has it changed over time? 2c. Do nurses' levels of job satisfaction differ by type of critical care unit? 3. What factors are associated with critical care nurses' job satisfaction? DESIGN: Systematic review. DATA SOURCES: We searched five electronic databases from January 1980 to May 2015: MEDLINE, CINAHL, PsychINFO, EMBASE, and Proquest Nursing & Allied Health Source. REVIEW METHODS: Two team members independently screened all titles and abstracts and extracted data and assessed methodological quality on all included papers. A narrative synthesis with vote counting was undertaken. RESULTS: A total of 1995 titles were identified, of which 61 satisfied our inclusion criteria. Only 24 (39%) of the included studies reported a conceptual definition of job satisfaction. Forty-two different quantitative measures of job satisfaction were identified, of which only 10 (24%) were used in multiple studies. The weighted mean job satisfaction score for critical care nurses across all studies was 56% satisfied and demonstrated fluctuations over time. Four factors showed significant positive relationships to job satisfaction: 1. shift worked - rotating 8- to 12-h and rotating days, evenings or nights; 2. Autonomy; 3. personnel resources and staffing; and 4. teamwork and cohesion; while two factors showed significant negative relationships to job satisfaction: 1. job stress; and 2. burnout-emotional exhaustion. CONCLUSION: From this review, we did not find any evidence to support relationships between individual (socio-demographic) factors and critical care nurses' job satisfaction. We did however find evidence to support relationships between several employment and organizational factors and job satisfaction. Several of these factors are different from those reported among general hospital nurses and long-term care nursing staff, supporting the need for differential strategies to improve critical care nurses' job satisfaction. While the findings from this review hold promise as potential targets of future job satisfaction interventions, there were several methodological problems inherent in many of the studies.