SACM - United Kingdom
Permanent URI for this collectionhttps://drepo.sdl.edu.sa/handle/20.500.14154/9667
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Item Restricted Effectiveness of Strategies, Models, or Training programmes on Reducing Physical Restraints for Managing Challenging Behaviour in Mental Health Nursing Settings: A Systematic Review.(2023-06-08) Alruwaythi, Ohud; Galway, KarenBackground: The use of physical restraints to handle challenging behaviour in mental health nursing settings is a controversial issue that can have unfavourable effects on patients and staff. To decrease the use of physical constraints, it is critical to identify successful strategies, models, or training programmes. Objectives: This systematic review aimed to evaluate the effectiveness of various strategies, models, or training programmes used to reduce physical restraints for managing challenging behaviour in mental health nursing settings. To achieve this aim and guide the review, three objectives were determined. Methods: The review included studies published from 2012 to 2022 and adhered to PRISMA guidelines. A systematic search was undertaken of the following electronic databases: CINAHL (Cumulative Index to Nursing and Allied Health Literature), PubMed, PsycINFO, Scopus, and Medline. The systematic search strategy was created with the help of a professional librarian. In addition, manual article searches were conducted, and the reference lists of relevant papers were examined. The quality of each study was evaluated using a predetermined framework. Results: A total of 14 studies met the inclusion criteria and were included in the review. These assessed a variety of interventions, including the use of alternative interventions such as de-escalation methods, the Six Core Strategies, the Safewards Model, training programmes for healthcare workers, and policy implementations. The findings demonstrated that staff training programmes were successful in lowering the frequency and length of physical restraint usage. Moreover, the introduction of these programmes was associated with a boost in employee attitude and confidence as well as a decline in violence and injuries. Conclusion: This review suggests that strategies, models, and training programmes designed to reduce the use of physical restraints in mental health nursing settings can be effective. However, the heterogeneity of the interventions, duration of the training, and the reported outcomes emphasize the need for additional research to determine the most successful approaches. Nonetheless, this review offers significant insights into possible alternatives to physical restraints that can enhance patient outcomes and uphold human rights principles in mental health care.29 0Item Restricted Effectiveness and safety of apixaban compared to warfarin in atrial fibrillation by BMI: a non-interventional cohort study using the UK’s Clinical Practice Research Datalink (CRPD)(2022-08-30) Bin Hammad, Turki; Wing, KevinBackground: Current guidelines recommend starting anticoagulation therapy for patients with non-valvular atrial fibrillation (NVAF) and an increased risk of stroke. Warfarin was the anticoagulant of choice for a long period before apixaban showed superiority in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) study on the prevention of stroke/systemic embolism and bleeding. However, little is known about their effects on overweight and obese patients compared to normal weight populations, with concerns that obesity might undermine apixaban’s effects because of its fixed dosing across body mass index (BMI) groups. Methods: I emulated a target trial mirroring the ARISTOTLE study using data from the Clinical Practice Research Datalink (CPRD) linked to secondary databases. I estimated the BMI-stratum-specific hazard ratios to investigate the non-inferiority or superiority of apixaban compared to warfarin in NVAF patients in rates of a composite of stroke/systemic embolism (SE) (primary effectiveness outcome) and their individual components or superiority in major bleeding (primary safety outcome) and all-cause mortality. Results: In 51,520 patients, apixaban was non-inferior in all groups of BMI on the composite of stroke/SE with multivariable adjusted hazard ratios (HRs) of 1.11 (95% CI: 0.93, 1.32; p:0.257) in the normal weight, 1.06 (95% CI: 0.90, 1.25; p:0.459) in the overweight and 0.98 (95% CI: 0.83, 1.17; p:0.857) in the obese groups with no evidence of statistical interaction (interaction-p: 0.563). In major bleeding, apixaban was superior in normal weight (HR: 0.79; 95% CI: 0.67, 0.94; p:0.008), overweight (HR: 0.75; 95% CI: 0.64, 0.87; p:<0.001) and obese groups (HR: 0.79; 95% CI: 0.68, 0.91; p:<0.001) with no evidence of interaction (interaction-p: 0.797). Conclusion: In NVAF, BMI was not an effect modifier of the effectiveness and safety of apixaban compared to warfarin. BMI-stratum-specific estimates were consistent in overweight and obese compared to normal weight patients.15 0Item Restricted The Impact of Prone Position on Mechanically Ventilated Patients with Covid19-ARDS, systematic review(Abdulhakeem Alotaibi, 2023-03-22) Alotaibi, Abdulhakeem; Zolfaghari, Parjam; Abu Kursi, AdelBackground Over the last few years coronavirus has spread rampantly, effecting each nation in various ways. This virus causes acute respiratory syndrome (SARS-CoV-2) which must be aided by mechanical respiration. Prone position ventilation is a known technique that enhances oxygenation in COVID-19 patients suffering from serious acute respiratory distress syndrome (ARDS). Methodology This study conducted a systematic analysis of randomised controlled trials (RCTs) that commenced from January 2019 and onwards. The study’s purpose was to measure the effectiveness of prone position applications on individuals with mechanical ventilation who suffered from COVID-19 induced ARDS compared to those administered the supine position treatment. Results Research elected two sufficient randomised controlled trials for this study. Both studies included 452 patients who showed that application of the prone position technique correlates with a substantial enhancement in PaO2/FiO2, considerable rise in static lung compliance and insignificant variations in the extubation rate. This suggests that the prone position approach causes minimal complexities, thus is innocuous for COVID-19 patients. Prone emplacement did not considerably reduce the death rate during the 60 day time period or the length of hospital admission. Moreover, there was no meaningful influence on the 30 day period without invasive or non-invasive mechanical ventilation. No effect was stated during the 60 days without critical care observation or hospitalisation. The majority of trials explained that there was discomfort or musculoskeletal pain from the prone emplacement and desaturation. Conclusion Prone position application for COVI-19 induced ARDS is a safe and effective practice in patients with severe hypoxemic respirational malfunction. Despite prone posture being ineffective in limiting endotracheal intubation requirements compared to typical care that did not implement the prone emplacement, the clinical advantages of prone posture are significant.30 0