Optimising the process for conducting scoping reviews
Evidence-Based Medicine; Humans; information science; Publications; Research Design; Q3 Scoping Review
Knowledge synthesis constitutes a key part of evidence-based medicine and a scoping review is a type of knowledge synthesis that maps the breadth of literature on a topic. Conducting a scoping review is resource intensive and, as a result, it can be challenging to maintain best practices throughout the process. Much of the current guidance describes a scoping review framework or broad ways to conduct a scoping review. However, little detailed guidance exists on how to complete each stage to optimise the process. We present five recommendations based on our experience when conducting a particularly challenging scoping review: (1) engage the expertise of a librarian throughout the process, (2) conduct a truly systematic search, (3) facilitate communication and collaboration, (4) explore new tools or repurpose old ones, and (5) test every stage of the process. These recommendations add to the literature by providing specific and detailed advice on each stage of a scoping review. Our intent is for these recommendations to aid other teams that are undertaking knowledge synthesis projects.
Pawliuk C; Brown HL; Widger K; Dewan T; Hermansen AM; Grégoire MC; Steele R; Siden H
BMJ Evidence-Based Medicine
2021
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1136/bmjebm-2020-111452" target="_blank" rel="noreferrer noopener">10.1136/bmjebm-2020-111452</a>
Rapid response in the COVID-19 pandemic: a Delphi study from the European Pediatric Dialysis Working Group
Adolescent; Child; Chronic/complications/*therapy; Coronavirus Infections/complications/prevention & control/*therapy; COVID-19; Delphi; Delphi Technique; Dialysis; Europe; Evidence-Based Medicine; Humans; Infant; Infection Control; Pandemics; Pandemics/prevention & control; Pneumonia; Preschool; Renal Dialysis; Renal Insufficiency; transplantation; Viral/complications/prevention & control/*therapy
BACKGROUND: COVID-19 was declared a global health emergency. Since children are less than 1% of reported cases, there is limited information to develop evidence-based practice recommendations. The objective of this study was to rapidly gather expert knowledge and experience to guide the care of children with chronic kidney disease during the COVID-19 pandemic. METHODS: A four-round multi-center Delphi exercise was conducted among 13 centers in 11 European countries of the European Pediatric Dialysis Working Group (EPDWG) between March, 16th and 20th 2020. Results were analyzed using a mixed methods qualitative approach and descriptive statistics. RESULTS: Thirteen COVID-19 specific topics of particular need for guidance were identified. Main themes encompassed testing strategies and results (n = 4), changes in use of current therapeutics (n = 3), preventive measurements of transmission and management of COVID-19 (n = 3), and changes in standard clinical care (n = 3). Patterns of center-specific responses varied according to regulations and to availability of guidelines. CONCLUSIONS: As limited quantitative evidence is available in real time during the rapid spread of the COVID-19 pandemic, qualitative expert knowledge and experience represent the best evidence available. This Delphi exercise demonstrates that use of mixed methodologies embedded in an established network of experts allowed prompt analysis of pediatric nephrologists' response to COVID-19 during this fast-emerging public health crisis. Such rapid sharing of knowledge and local practices is essential to timely and optimal guidance for medical management of specific patient groups in multi-country health care systems such as those of Europe and the US.
Eibensteiner F; Ritschl V; Ariceta G; Jankauskiene A; Klaus G; Paglialonga F; Edefonti A; Ranchin B; Schmitt C P; Shroff R; Stefanidis C J; Walle J V; Verrina E; Vondrak K; Zurowska A; Stamm T; Aufricht C
Pediatric Nephrology
2020
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<a href="http://doi.org/10.1007/s00467-020-04584-6" target="_blank" rel="noreferrer noopener">10.1007/s00467-020-04584-6</a>
GRADE guidelines: 15. Going from evidence to recommendation-determinants of a recommendation's direction and strength
Humans; United States; Canada; Practice Guidelines as Topic; Treatment Outcome; Research Design; Risk Assessment; Evidence-Based Medicine; Treatment Failure; Germany; Pulmonary Disease; Health Care; Quality Assurance; Chronic Obstructive
In the GRADE approach, the strength of a recommendation reflects the extent to which we can be confident that the composite desirable effects of a management strategy outweigh the composite undesirable effects. This article addresses GRADE's approach to determining the direction and strength of a recommendation. The GRADE describes the balance of desirable and undesirable outcomes of interest among alternative management strategies depending on four domains, namely estimates of effect for desirable and undesirable outcomes of interest, confidence in the estimates of effect, estimates of values and preferences, and resource use. Ultimately, guideline panels must use judgment in integrating these factors to make a strong or weak recommendation for or against an intervention.
2013-07
Andrews JC; Schunemann HJ; Oxman A; Pottie K; Meerpohl Joerg J; Coello PA; Rind D; Montori VM; Brito JP; Norris S; Elbarbary M; Post P; Nasser M; Shukla V; Jaeschke R; Brozek J; Djulbegovic B; Guyatt G
Journal Of Clinical Epidemiology
2013
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Journal Article
<a href="http://doi.org/10.1016/j.jclinepi.2013.02.003" target="_blank" rel="noreferrer">10.1016/j.jclinepi.2013.02.003</a>
Rayyan-a web and mobile app for systematic reviews
Evidence-Based Medicine; Systematic reviews; Automation
BACKGROUND: Synthesis of multiple randomized controlled trials (RCTs) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions. Filtering of searches is time consuming, and no single method fulfills the principal requirements of speed with accuracy. Automation of systematic reviews is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making. We developed Rayyan ( http://rayyan.qcri.org ), a free web and mobile app, that helps expedite the initial screening of abstracts and titles using a process of semi-automation while incorporating a high level of usability. For the beta testing phase, we used two published Cochrane reviews in which included studies had been selected manually. Their searches, with 1030 records and 273 records, were uploaded to Rayyan. Different features of Rayyan were tested using these two reviews. We also conducted a survey of Rayyan's users and collected feedback through a built-in feature. RESULTS: Pilot testing of Rayyan focused on usability, accuracy against manual methods, and the added value of the prediction feature. The "taster" review (273 records) allowed a quick overview of Rayyan for early comments on usability. The second review (1030 records) required several iterations to identify the previously identified 11 trials. The "suggestions" and "hints," based on the "prediction model," appeared as testing progressed beyond five included studies. Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements. The survey respondents reported 40% average time savings when using Rayyan compared to others tools, with 34% of the respondents reporting more than 50% time savings. In addition, around 75% of the respondents mentioned that screening and labeling studies as well as collaborating on reviews to be the two most important features of Rayyan. As of November 2016, Rayyan users exceed 2000 from over 60 countries conducting hundreds of reviews totaling more than 1.6M citations. Feedback from users, obtained mostly through the app web site and a recent survey, has highlighted the ease in exploration of searches, the time saved, and simplicity in sharing and comparing include-exclude decisions. The strongest features of the app, identified and reported in user feedback, were its ability to help in screening and collaboration as well as the time savings it affords to users. CONCLUSIONS: Rayyan is responsive and intuitive in use with significant potential to lighten the load of reviewers.
2016-12
Ouzzani M; Hammady H; Fedorowicz Z; Elmagarmid A
Systematic Reviews
2016
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Journal Article
<a href="http://doi.org/10.1186/s13643-016-0384-4" target="_blank" rel="noreferrer">10.1186/s13643-016-0384-4</a>
Haloperidol as a palliative anti-emetic in a toddler: an evidence base challenge
Humans; infant; Male; Palliative Care; Antiemetics; Nausea; Fatal Outcome; Evidence-Based Medicine; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Haloperidol
2008
Siden H
Journal Of Pain And Symptom Management
2008
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Journal Article
<a href="http://doi.org/10.1016/j.jpainsymman.2007.10.001" target="_blank" rel="noreferrer">10.1016/j.jpainsymman.2007.10.001</a>
Is there any evidence to support the use of anti-depressants in painful rheumatological conditions? Systematic review of pharmacological and clinical studies
Humans; Evidence-Based Medicine; Randomized Controlled Trials as Topic; Chronic disease; Pain/drug therapy/etiology; Fibromyalgia/drug therapy; Antidepressive Agents/therapeutic use; Arthritis/complications/drug therapy; Low Back Pain/drug therapy; Rheumatic Diseases/complications/drug therapy
The aim of this study was to review the evidence supporting the use of anti-depressants in painful rheumatological conditions. A systematic review of papers published between 1966 and 2007, in five European languages, on anti-depressants in rheumatological conditions was performed. Papers were scored using Jadad method and analgesic ES was calculated. We selected 78 clinical studies and 12 meta-analyses, from 140 papers. The strongest evidence of an analgesic effect of anti-depressants has been obtained for fibromyalgia. A weak analgesic effect is observed for chronic low back pain, with an efficacy level close to that of analgesics. In RA and AS, there is no analgesic effect of anti-depressants, but these drugs may help to manage fatigue and sleep disorders. There is no clear evidence of an analgesic effect inOA, but studies have poor methodological quality. Analgesic effects of anti-depressants are independent of their anti-depressant effects. Tricyclic anti-depressants (TCAs), even at low doses, have analgesic effects equivalent to those of serotonin and noradrenalin reuptake inhibitors (SNRIs), but are less well tolerated. Selective serotonin reuptake inhibitors (SSRIs) have modest analgesic effects, but higher doses are required to achieve analgesia. Anti-depressant drugs, particularly TCAs and SNRIs, have analgesic effects in chronic rheumatic painful states in which analgesics and NSAIDs are not very efficient, such as fibromyalgia and chronic low back pain. In inflammatory rheumatic diseases, anti-depressants may be useful for managing fatigue and sleep disorders. Further studies are required to compare anti-depressants with other analgesics in the management of chronic painful rheumatological conditions.
2008
Perrot S; Javier RM; Marty M; Le Jeunne C; Laroche F; CEDR (Cercle d'Etude de la Douleur en Rhumatologie France) Pain Study Section French Rheumatological Society
Rheumatology
2008
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Journal Article
<a href="http://doi.org/10.1093/rheumatology/ken110" target="_blank" rel="noreferrer">10.1093/rheumatology/ken110</a>
What is the evidence that palliative care teams improve outcomes for cancer patients and their families?.
Humans; DNAR; Neoplasms/th [Therapy]; Treatment Outcome; patient care team; Evidence-Based Medicine; Family; Palliative Care/ma [Manpower]
Patients with advanced cancer experience a complex web of problems, all of which interact. Specialist palliative care services have developed to meet these needs, but their effectiveness should be considered. We sought to determine whether specialist palliative care teams achieve their aims and improve outcomes for patients with advanced cancer and their caregivers, in terms of improving symptoms and quality of life and/or reducing the emotional concerns of family caregivers. We conducted a systematic review, searching standard databases augmented by reference lists of earlier reviews. The review focused on specialist (ie, with trained and dedicated professionals) palliative care in the home, hospital, or designated inpatient settings for patients with cancer. Outcomes were pain, symptoms, quality of life, use of hospital services, and anxiety. Studies were excluded if they did not test specialist palliative care services. We identified 8 randomized controlled trials and 32 observational or quasi-experimental studies. Overall, the evidence demonstrated that home, hospital, and inpatient specialist palliative care significantly improved patient outcomes in the domains of pain and symptom control, anxiety, and reduced hospital admissions. The results suggest that specialist palliative care should be part of care for cancer patients. Although the appraisal of evidence found improvements across domains, there is a need to understand better the effects of different models of palliative care and to use standardized outcome measurement.
2010
Higginson IJ; Evans CJ
Cancer Journal (Sudbury, Mass.)
2010
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Journal Article
<a href="http://doi.org/10.1097/ppo.0b013e3181f684e5" target="_blank" rel="noreferrer">10.1097/ppo.0b013e3181f684e5</a>
A Delphi study of district nursing research priorities in Australia
Humans; Australia; Evidence-Based Medicine; Nursing Research; Delphi Technique; Research; Non-U.S. Gov't; Research Support
This study, using a Delphi approach, sought the opinion of a self-selected panel of 320 district nurses regarding research priorities for district nursing in Australia. Over three rounds of questionnaires, the 419 research clinical problem areas requiring research as suggested by the panel were each rated in importance by the panel and then ranked through analysis from high to low average rating scores, thereby, whittling down the list to the top 15% (68) research questions and to a final list of the top 10 research priorities overall. Research questions focusing on discharge planning are dominant in these top 10 priorities, with documentation issues the second most common focus. Other foci in the top 10 priorities are staffing, aged care, palliative care, and assessment. The organization-specific top 10 research priorities focus on wound care, funding, education, and communication issues. Additionally, the top 68 priorities, which are either finitely practice-based or contextual-issues research questions, were categorized into 20 themes. The results will hopefully lead to scarce human and financial resources being directed to practice-relevant research programs that will facilitate improved health for district nursing (primarily home-nursing) clients in Australia and elsewhere.
2005
Annells M; Deroche M; Koch T; Lewin G; Lucke J
Applied Nursing Research
2005
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Journal Article
<a href="http://doi.org/10.1016/j.apnr.2004.04.004" target="_blank" rel="noreferrer">10.1016/j.apnr.2004.04.004</a>
Development of quality indicators for diagnosis and treatment of patients with non-small cell lung cancer: a first step toward implementing a multidisciplinary, evidence-based guideline
Humans; Netherlands; Evidence-Based Medicine; Neoplasm Staging; Practice Guidelines; Health Care; Carcinoma; Lung Neoplasms/diagnosis/therapy; Non-Small-Cell Lung/diagnosis/therapy; Quality Indicators
BACKGROUND: While developing and distributing clinical practice guidelines are important in optimising clinical healthcare, insight into actual care is necessary to achieve successful implementation. Developing quality indicators may be the first step to becoming aware of actual care. The Dutch national practice guideline Non-small cell lung cancer: staging and treatment is one of the first clinical, multidisciplinary guidelines for oncology in the Netherlands for which quality indicators were developed systematically. We describe indicator development based on this guideline as a practical experience. METHODS: To develop a set of indicators for diagnosis and treatment of patients with non-small cell lung cancer, we systematically achieved consensus on the basis of a national, multidisciplinary, evidence-based guideline and the opinions of professionals and patients. After the researchers extracted the recommendations from the guideline, we carried out a so-called Rand-modified-Delphi procedure. This consisted of three rounds: a national panel of professionals and representatives of the national patient organization scored all recommendations, the professionals had a consensus meeting, and the final set of indicators was e-mailed for a last check. Subsequently, some clinimetric characteristics of this final set were assessed in a practice test. RESULTS: Thirty-two of 83 recommendations were selected in the first round. After the consensus meeting, 8 recommendations met the final criteria and were incorporated into 15 indicators, which were tested in practice. The most successful indicators for quality improvement are indicators that are measurable, have potential for improvement, have a broad range between practices and are applicable to a large part of the population. CONCLUSIONS: For successful implementation of evidence-based guidelines, each new guideline should be developed and tested with a set of indicators based on the guideline. The procedure we describe can serve as an example for other new guidelines.
2006
Hermens RP; Ouwens MM; Vonk-Okhuijsen SY; van der Wel Y; Tjan-Heijnen VC; van den Broek LD; Ho VK; Janssen-Heijnen ML; Groen HJ; Grol RP; Wollersheim HC
Lung Cancer (amsterdam, Netherlands)
2006
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Journal Article
<a href="http://doi.org/10.1016/j.lungcan.2006.07.001" target="_blank" rel="noreferrer">10.1016/j.lungcan.2006.07.001</a>
Evidence for healing interventions with perinatal bereavement
Child; Female; Humans; infant; Male; bereavement; Adult; Parents; Attitude to Death; Professional-Family Relations; Health Services Needs and Demand; social support; Age Factors; Nurse's Role; Child Psychology; Sex Factors; Funeral Rites; Helping Behavior; Spirituality; Evidence-Based Medicine; Nursing Evaluation Research; Self-Help Groups; Adaptation; Psychological; bereavement; Newborn; Parents/education/psychology; social support; Intervention; Interventions; sibling bereavement; Maternal-Child Nursing; Funeral Rites/psychology; Maternal-Child Nursing/organization & administration; Nurse's Role/psychology; Symbolism
The purpose of this article is to explore the concept of perinatal grief and evidence-based healing interventions for it. The loss of a pregnancy or death of an infant causes profound grief, yet society has long minimized or ignored this grief, which is among the most painful of bereavement experiences. Throughout the last century, research on grief and the special needs of bereaved parents has changed the context of professional intervention from protective to supportive. The central focus of bereavement interventions is to assist families in healing by helping them make meaning of their losses. The use of symbols, spirituality, and rituals has been shown to help bring meaning. Research has shown that memories are key to healing, and that gender, age, and relationships bring different grief expressions and experiences. While children's understanding of loss and grief differs with developmental age, they should also be given the opportunity to participate in grief rituals and practices. Professionals who care for bereaved parents have a unique opportunity to offer support by validating their grief, facilitating rituals, providing mementos, and letting the bereaved tell their stories. While no intervention can bring back their beloved children, appropriate intervention can promote healing.
2005-12
Capitulo KL
The American Journal Of Maternal Child Nursing
2005
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Journal Article
<a href="http://doi.org/10.1097/00005721-200511000-00007" target="_blank" rel="noreferrer">10.1097/00005721-200511000-00007</a>
The psychosocial well-being of children with chronic disease, their parents and siblings: an overview of the research evidence base.
Child; Humans; Longitudinal Studies; Evidence-Based Medicine; Family Health; Adaptation; Psychological; Parents/psychology; Children W/SNI; Mental Disorders/etiology; Meta-Analysis; Literature review; Chronic Disease/psychology/rehabilitation; Siblings/psychology
BACKGROUND: Chronic disease of childhood may have implications for the psychosocial well-being of children and their families. The purpose of this paper is to provide an overview of the current literature regarding the psychosocial well-being of children with chronic disease, their parents and siblings. METHODS: Electronic searches were conducted using AMED, CINAHL, Cochrane Database, DARE, HTA, MEDLINE, NHS EED, PsycLIT, PsycINFO and PubMED (1990 to week 24, 2004). Inclusion criteria were systematic reviews, meta-analyses and overviews based on traditional reviews of published literature. The titles of papers were reviewed, abstracts were obtained and reviewed, and full copies of selected papers were obtained. RESULTS: Six reviews of the psychosocial well-being of children were identified: three on chronic disease in general, one on asthma, one on juvenile idiopathic arthritis and one on sickle cell disease. Two reviews of psychosocial well-being among parents and two reviews of sibling psychosocial well-being were identified. Evidence from meta-analyses shows that children were at slightly elevated risk of psychosocial distress, although only a minority experience clinical symptomatology. The proportion that experience distress remains to be clarified, as do contributory risk factors. Few conclusions can be drawn from the two reviews of parents. However, a meta-analysis of siblings showed that they are at risk from a number of negative effects. CONCLUSION: This overview has highlighted the need to extend the evidence base for psychosocial well-being of children, parents and siblings.
2006
Barlow JH; Ellard DR
Child: Care, Health And Development
2006
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Journal Article
<a href="http://doi.org/10.1111/j.1365-2214.2006.00591.x" target="_blank" rel="noreferrer">10.1111/j.1365-2214.2006.00591.x</a>
A multidisciplinary review of nutrition considerations in the pediatric oncology population: a perspective from children's oncology group
Child; Humans; Survival Analysis; Evidence-Based Medicine; Nutritional Requirements; Practice Guidelines; Cachexia/etiology/therapy; Nutritional Support/methods; Child Nutrition Physiology; Antineoplastic Combined Chemotherapy Protocols/adverse effects/therapeutic use; Neoplasms/metabolism/physiopathology/therapy
Over the past few decades, great progress has been made in the survival rates of childhood cancer. As survival rates have improved, there has been an increased focus on supportive care. Nutrition is a supportive-care modality that has been associated with improved tolerance to chemotherapy, improved survival, increased quality of life, and decreased risk of infection in children undergoing anticancer therapy. Guidelines and assessment criteria have been proposed for the nutrition management of a child with cancer; however, there is no consistent use of criteria among institutions treating children with cancer. This review will present the current evidence and standards of practice incorporating aspects of nutrition, nursing, pharmacology, and psychosocial challenges to consider in the nutrition management of a child with cancer. Recommendations for clinical practice are presented.
2005
Ladas EJ; Sacks N; Meacham L; Henry D; Enriquez L; Lowry G; Hawkes R; Dadd G; Rogers P
Nutrition In Clinical Practice : Official Publication Of The American Society For Parenteral And Enteral Nutrition
2005
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Journal Article
<a href="http://doi.org/10.1177/0115426505020004377" target="_blank" rel="noreferrer">10.1177/0115426505020004377</a>
Enteral and parenteral nutrition in terminally ill cancer patients: a review of the literature
Humans; Survival Rate; Terminally Ill; Practice Guidelines as Topic; Communication; Treatment Outcome; Decision Support Techniques; Research Design; Risk Factors; Patient Selection; Activities of Daily Living; Evidence-Based Medicine; Patient Education as Topic; quality of life; Nutritional Status; Nutrition Assessment; Enteral Nutrition/adverse effects/methods/utilization; Malnutrition/etiology/therapy; Neoplasms/complications/mortality/psychology; Parenteral Nutrition/adverse effects/methods/utilization; Terminal Care/methods/psychology/utilization
Many terminally ill patients who are able to eat appear to be eating less than they should, losing weight, and becoming malnourished, and many others develop difficulties with eating. These symptoms and signs are usually a marker of advanced cancer, rather than the cause of decreasing functional status, and providing supplemental nutrition rarely changes the course of the disease. This article reviews evidence on issues relevant to enteral and parenteral nutrition in patients with advanced cancer, including benefits, risks, and discomforts; how these types of nutrition are used and perceived, and how decisions are made; and how decision-making might be improved.
2006
Dy SM
The American Journal Of Hospice & Palliative Care
2006
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Journal Article
<a href="http://doi.org/10.1177/1049909106292167" target="_blank" rel="noreferrer">10.1177/1049909106292167</a>
Constipation in paediatric oncology
Child; Humans; Great Britain; Questionnaires; Health Services Needs and Demand; Nurse's Role; Evidence-Based Medicine; Nursing Evaluation Research; Internet; Dietary Fiber; PedPal Lit; Practice Guidelines; Cathartics/therapeutic use; Palliative Care/methods; Causality; Neoplasms/complications; Information Services; Child Nutrition/education; Constipation/diagnosis/etiology/prevention & control; Nursing Assessment/methods/standards; Oncologic Nursing/methods/standards; Pediatric Nursing/methods/standards
Constipation is a common problem encountered by many children during treatment for childhood cancer. It can be distressing and impact on the quality of life for the child. However, the advice and information they and their families receive can vary enormously. The clinical practice group (a subgroup of the paediatric oncology nurses forum (PONF)) decided to examine the management of constipation throughout the paediatric oncology units in the UK. This paper presents the findings and the subsequent action taken and highlights the need for further work.
2006
Selwood K
European Journal Of Oncology Nursing
2006
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Journal Article
Developing the Liverpool Care Pathway for the dying child
Child; Humans; England; Health Services Needs and Demand; Pilot Projects; Nurse's Role; Evidence-Based Medicine; Nursing Assessment; Nursing Evaluation Research; Benchmarking; adolescent; Preschool; PedPal Lit; infant; Practice Guidelines; retrospective studies; Documentation/standards; Patient Care Team/organization & administration; Outcome and Process Assessment (Health Care)/organization & administration; Nursing Audit; Palliative Care/organization & administration; Pediatric Nursing/organization & administration; Critical Pathways/organization & administration; Nursing Records/standards; Total Quality Management/organization & administration
In most western societies the death of a child is a rare occurrence. When it does occur, it typically takes place after a period of intensive and often prolonged treatment. In light of the relative infrequency of these events in clinical practice, ensuring that all dying children and their families receive consistent and appropriate care remains a challenge. A retrospective audit of documentation of care for dying children in two paediatric units in the north-west of England illustrated that the care provided was not always documented consistently. This paper highlights work currently underway to develop an integrated care pathway for the care of the dying child based on the Liverpool Care Pathway (LCP). The aim of this work is to facilitate the delivery and recording of optimum care for all dying children and their families.
2006
Matthews K; Gambles M; Ellershaw JE; Brook L; Williams M; Hodgson A; Barber M
Paediatric Nursing
2006
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Journal Article
End-of-life care in the pediatric intensive care unit: research review and recommendations
Child; Humans; Intensive Care Units; Adult; Attitude of Health Personnel; Attitude to Death; Infant Mortality; Evidence-Based Medicine; Forecasting; Practice; bereavement; Attitudes; decision making; infant; Practice Guidelines; Health Knowledge; ICU Decision Making; Parents/psychology; United States/epidemiology; Quality Assurance; Analgesia/ethics/standards; Conscious Sedation/ethics/standards; Health Care/organization & administration; Intensive Care/ethics/organization & administration/psychology; Pediatric/ethics/organization & administration; Resuscitation/ethics/standards; Terminal Care/ethics/organization & administration/psychology; Withholding Treatment/ethics/standards
Improving the quality of end-of-life care has become a national health care priority. A necessary step in this process in the pediatric intensive care unit (ICU) is examining the knowledge, attitudes,and behaviors of pediatric critical care practitioners in this area. In addition, the perspectives of bereaved parents must be uncovered as well. In this article, the empirical data in the literature on end-of-life care in the pediatric ICU are reviewed, common ethical controversies in this environment are discussed, and promising interventions for the future are presented.
2004
Burns JP; Rushton CH
Critical Care Clinics
2004
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Journal Article
<a href="http://doi.org/10.1016/j.ccc.2004.03.004" target="_blank" rel="noreferrer">10.1016/j.ccc.2004.03.004</a>
Evidence based medicine
Child; Humans; Health Personnel; Evidence-Based Medicine; Adaptation; Psychological; Q3 Literature Search; Cerebral Palsy/therapy; Muscular Dystrophies; Capital Financing/economics; Epilepsy/drug therapy; Gastrostomy/utilization; Home Care Services/organization & administration; Melatonin/physiology
2004
Baxter P
Developmental Medicine And Child Neurology
2004
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Journal Article
<a href="http://doi.org/10.1017/s0012162204001240" target="_blank" rel="noreferrer">10.1017/s0012162204001240</a>
Towards evidence based medicine for paediatricians
Pediatrics; Evidence-Based Medicine; Information Storage and Retrieval; Periodicals
2002
Phillips B
Archives Of Disease In Childhood
2002
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Journal Article
<a href="http://doi.org/10.1136/adc.88.7.638" target="_blank" rel="noreferrer">10.1136/adc.88.7.638</a>
Research methods used in developing and applying quality indicators in primary care
Humans; Consensus; Quality of Health Care; Evidence-Based Medicine; Practice Guidelines; Health Care; Quality Indicators; Health Services Research/methods; Primary Health Care/standards
2003
Campbell SM; Braspenning J; Hutchinson A; Marshall MN
Bmj (clinical Research Ed.)
2003
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Journal Article
<a href="http://doi.org/10.1136/bmj.326.7393.816" target="_blank" rel="noreferrer">10.1136/bmj.326.7393.816</a>
Individualizing treatment decisions. The likelihood of being helped or harmed
Humans; Pilot Projects; Patient Participation; Risk Assessment; Evidence-Based Medicine; decision making; Anticoagulants/therapeutic use; Warfarin/therapeutic use; Stroke/prevention & control
Clinical decision making cannot rely on evidence alone. Although significant advances have occurred in the development of high-quality evidence, similar efforts must be made to develop and evaluate tools that can be used at the bedside to individualize treatment decisions and to facilitate the incorporation of our patients' unique values and circumstances into the decision-making process. These tools should express the helpful and harmful effects of treatment, and it must be possible to modify these statements using patients' values. Finally, this process should be accomplished in real time in a busy clinical practice. In this article, the author outlines some of these decision support tools, describes an attempt to meet some of the challenges inherent in the goal of achieving effective shared decision making, and proposes a patient-centered measure of the likelihood of being helped and harmed by an intervention and discusses its derivation and an evaluation of its usefulness.
2002
Straus SE
Evaluation And The Health Professions
2002
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Journal Article
<a href="http://doi.org/10.1177/016327870202500206" target="_blank" rel="noreferrer">10.1177/016327870202500206</a>
Practice parameter: pharmacological treatment of migraine headache in children and adolescents: report of the American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society
Child; Female; Humans; Male; Evidence-Based Medicine; Double-Blind Method; Cross-Over Studies; Forecasting; adolescent; Preschool; retrospective studies; Anti-Inflammatory Agents; Randomized Controlled Trials; Anticonvulsants/therapeutic use; Non-Steroidal/therapeutic use; Antidepressive Agents/therapeutic use; Analgesics/classification/therapeutic use; Antihypertensive Agents/therapeutic use; Calcium Channel Blockers/therapeutic use; Migraine Disorders/drug therapy/prevention & control; Serotonin Agonists/therapeutic use
OBJECTIVE: To review evidence on the pharmacologic treatment of the child with migraine headache. METHODS: The authors reviewed, abstracted, and classified relevant literature. Recommendations were based on a four-tiered scheme of evidence classification. Treatment options were separated into medications for acute headache and preventive medications. RESULTS: The authors identified and reviewed 166 articles. For acute treatment, five agents were reviewed. Sumatriptan nasal spray and ibuprofen are effective and are well tolerated vs placebo. Acetaminophen is probably effective and is well tolerated vs placebo. Rizatriptan and zolmitriptan were safe and well tolerated but were not superior to placebo. For preventive therapy, 12 agents were evaluated. Flunarizine is probably effective. The data concerning cyproheptadine, amitriptyline, divalproex sodium, topiramate, and levetiracetam were insufficient. Conflicting data were found concerning propranolol and trazodone. Pizotifen, nimodipine, and clonidine did not show efficacy. CONCLUSIONS: For children (>age 6 years), ibuprofen is effective and acetaminophen is probably effective and either can be considered for the acute treatment of migraine. For adolescents (>12 years of age), sumatriptan nasal spray is effective and should be considered for the acute treatment of migraine. For preventive therapy, flunarizine is probably effective and can be considered, but is not available in the United States. There are conflicting or insufficient data to make any other recommendations for the preventive therapy of migraine in children and adolescents. For a clinical problem so prevalent in children and adolescents, there is a disappointing lack of evidence from controlled, randomized, and masked trials.
2004
Lewis D; Ashwal S; Hershey A; Hirtz D; Yonker M; Silberstein S; American Academy of Neurology Quality Standards Subcommittee; Practice Committee of the Child Neurology Society
Neurology
2004
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1212/01.wnl.0000147332.41993.90" target="_blank" rel="noreferrer">10.1212/01.wnl.0000147332.41993.90</a>
Ketamine in chronic pain management: an evidence-based review
Humans; Methadone; Evidence-Based Medicine; Chronic disease; Pain/drug therapy/etiology; Ketamine/pharmacology/therapeutic use; Excitatory Amino Acid Antagonists/therapeutic use
Ketamine has diverse effects that may be of relevance to chronic pain including: N-methyl-D-aspartic acid, alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid, kainate, gamma-aminobutyric acid(A) receptors; inhibition of voltage gated Na(+) and K(+) channels and serotonin, dopamine re-uptake. Ketamine has been in clinical practice for over 30 yr; however, there has been little formal research on the effectiveness of ketamine for chronic pain management. In this review we evaluate the available clinical data as a basis for defining the potential use of ketamine for chronic pain. Literature referenced in this review was obtained from a computer search of EMBASE and MEDLINE from 1966 through August, 2002. Search terms included ketamine, ketalar, pain, painful, analgesic, and analgesia. Abstracts were screened for relevance and publications relating to chronic pain use were obtained. Levels of evidence were stratified according to accepted guidelines (level I-IV). For central pain, there is level II and level IV evidence of efficacy for parenteral and oral ketamine. For complex regional pain syndromes, there is only level IV evidence of efficacy of epidural ketamine. For fibromyalgia, there is level II evidence of pain relief, reduced tenderness at trigger points, and increased endurance. For ischemic pain, a level II study reported a potent dose-dependent analgesic effect, but with a narrow therapeutic window. For nonspecific neuropathic pain, level II and level IV studies reported divergent results with questionable long-term effects on pain. For phantom limb pain and postherpetic neuralgia, level II and level II studies provided objective evidence of reduced hyperpathia and pain relief was usually substantial either after parenteral or oral ketamine. Acute on chronic episodes of severe neuropathic pain represented the most frequent use of ketamine as a "third line analgesic," often by IV or subcutaneous infusion (level IV). In conclusion, the evidence for efficacy of ketamine for treatment of chronic pain is moderate to weak. However, in situations where standard analgesic options have failed ketamine is a reasonable "third line" option. Further controlled studies are needed.
2003
Hocking G; Cousins MJ
Anesthesia & Analgesia
2003
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Journal Article
<a href="http://doi.org/10.1213/01.ane.0000086618.28845.9b" target="_blank" rel="noreferrer">10.1213/01.ane.0000086618.28845.9b</a>
Evidence-based approach to the medical literature
Humans; United States; Physician-Patient Relations; Computer Communication Networks; Evidence-Based Medicine; MEDLINE; Medical; Education; Medical Informatics Applications; continuing; Medical; Guidelines; Information Services; Information Storage and Retrieval; Information Systems; Journalism; Medical Informatics Computing
1997
Fletcher RH; Fletcher SW
Journal Of General Internal Medicine
1997
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Journal Article
<a href="http://doi.org/10.1046/j.1525-1497.12.s2.1.x" target="_blank" rel="noreferrer">10.1046/j.1525-1497.12.s2.1.x</a>
End-of-life care in the intensive care unit: a research agenda.
Female; Humans; Male; United States; Program Evaluation; Quality of Health Care; Evidence-Based Medicine; Palliative Care/standards; Palliative Care/trends; Attitude to Death; Health Services Research/organization & administration; Intensive Care Units; Intensive Care/standards; Intensive Care/trends; Outcome Assessment (Health Care)
BACKGROUND: The intensive care unit (ICU) represents a unique clinical setting in which mortality is relatively high and the professional culture tends to be one of "rescue therapy" using technological and invasive interventions. For these reasons, the ICU is an important environment for understanding and improving end-of-life care. Although there have been consensus statements and review articles on end-of-life care in the ICU, there is limited evidence on which to base an assessment of best practices for providing high-quality end-of-life care in this setting. OBJECTIVE: To convene a Working Group of experts in critical care, palliative medicine, medical ethics, and medical law to address the question "What research needs to be done to improve end-of-life care to patients in the ICU?" METHODS: Participants were identified for membership in the Working Group by purposive sampling within the fields of critical care medicine and nursing, palliative medicine, and medical ethics; others were chosen to represent social work and hospital chaplains. Through a process of breakout and plenary sessions, the group identified important questions that need to be addressed in the areas of defining the problem, identifying solutions, evaluating solutions, and overcoming barriers. CONCLUSIONS: Outlining unanswered questions on end-of-life care in the ICU is a first step to providing the answers that will allow us to improve care to patients dying in the ICU. These questions also serve to focus clinicians and educators on the important areas for improving quality of care. [References: 25]
2001
Rubenfeld GD; Randall CJ; The End-of-Life Care in the ICU Working Group
Critical Care Medicine
2001
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/00003246-200110000-00025" target="_blank" rel="noreferrer">10.1097/00003246-200110000-00025</a>
Using bisphosphonates to control the pain of bone metastases: evidence-based guidelines for palliative care
Female; Humans; Male; Evidence-Based Medicine; Practice Guidelines; Palliative Care/standards; Clodronate; Diphosphonates/therapeutic use; Pain/prevention & control; Prostatic Neoplasms; Bone Neoplasms/secondary; Breast Neoplasms; Multiple Myeloma
This work was undertaken by the Science Committee of the Association for Palliative Medicine of Great Britain and Ireland (APM) as a demonstration project in developing clinical guidelines relevant to palliative care from a pragmatic approach to literature review and grading of clinical evidence. CANCERLIT and Embase were searched for relevant papers written in English, published since 1980. Each study identified was rated against agreed criteria for levels of evidence. Most studies were not specifically designed to define speed of response, and were not undertaken in palliative care patients. Thus, careful reading and grading of each study was necessary. Sufficient evidence was identified to make recommendations for clinical practice in a palliative care population of patients, and areas for future research have been identified. Bisphosphonates appear to have a role in managing pain from metastases which has been refractory to conventional analgesic management and where oncological or orthopaedic intervention is delayed or inappropriate.
2000
Mannix K; Ahmedzai SH; Anderson H; Bennett M; Lloyd-Williams M; Wilcock A
Palliative Medicine
2000
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Journal Article
<a href="http://doi.org/10.1191/026921600701536372" target="_blank" rel="noreferrer">10.1191/026921600701536372</a>
Paediatric palliative care: a lack of research-based evidence.
Child; Humans; Longitudinal Studies; Evidence-Based Medicine; Palliative Care/standards; Clinical Nursing Research; Pediatric Nursing/standards
Providing the best possible care for the child and family is paramount to health professionals working in paediatric palliative care. However, there is little research which enables practitioners to question their current practice. There are concerns about conducting research on children receiving palliative care at such a sensitive time for the child and his/her family. These concerns must be considered against the growing demand for clear standards and guidelines for practice within health care. According to the Department of Health (DoH) there is no place within the modern healthcare system for the adoption of unproven theories or outdated care (DoH, 1998). While no-one would question the dedication and care being delivered to children and their families by well-trained staff, the lack of research is a cause for concern. A group of students undertaking a degree module in paediatric palliative care identified the lack of literature and research in this area and have undertaken a review of the available literature.
2000
Cooley C; Adeodu S; Aldred H; Beesley S; Leung A; Thacker L
International Journal Of Palliative Nursing
2000
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.12968/ijpn.2000.6.7.9070" target="_blank" rel="noreferrer">10.12968/ijpn.2000.6.7.9070</a>
Weaving for the future: using rulers and roses
Humans; Leadership; Nurse's Role; Organizational Objectives; Evidence-Based Medicine; Forecasting; Models; Administration; Nursing; Nursing Process; Biomedical; Nursing Research/organization &; Oncologic Nursing/education/organization &; Technology Assessment
2001
Davies B
Canadian Oncology Nursing Journal
2001
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Journal Article
<a href="http://doi.org/10.5737/1181912x113118122" target="_blank" rel="noreferrer">10.5737/1181912x113118122</a>
Codeine phosphate in children: time for re-evaluation?
Child; Pain; Analgesics; Evidence-Based Medicine; infant; Human; Opioid/therapeutic use; Postoperative/drug therapy; Codeine/therapeutic use
2001
Cunliffe M
British Journal Of Anaesthesia
2001
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Journal Article
The quality of the evidence base for clinical pathway effectiveness: room for improvement in the design of evaluation trials.
Humans; Length of Stay; Risk Assessment; Clinical Trials as Topic; Reproducibility of Results; Randomized Controlled Trials as Topic; Bias (Epidemiology); Meta-Analysis as Topic; Evidence-Based Medicine; Selection Bias; Critical Pathways/st [Standards]; Guidelines as Topic; Outcome and Process Assessment (Health Care); Research Design/st [Standards]
BACKGROUND: The purpose of this article is to report on the quality of the existing evidence base regarding the effectiveness of clinical pathway (CPW) research in the hospital setting. The analysis is based on a recently published Cochrane review of the effectiveness of CPWs., METHODS: An integral component of the review process was a rigorous appraisal of the methodological quality of published CPW evaluations. This allowed the identification of strengths and limitations of the evidence base for CPW effectiveness. We followed the validated Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria for randomized and non-randomized clinical pathway evaluations. In addition, we tested the hypotheses that simple pre-post studies tend to overestimate CPW effects reported., RESULTS: Out of the 260 primary studies meeting CPW content criteria, only 27 studies met the EPOC study design criteria, with the majority of CPW studies (more than 70%) excluded from the review on the basis that they were simple pre-post evaluations, mostly comparing two or more annual patient cohorts. Methodologically poor study designs are often used to evaluate CPWs and this compromises the quality of the existing evidence base., CONCLUSIONS: Cochrane EPOC methodological criteria, including the selection of rigorous study designs along with detailed descriptions of CPW development and implementation processes, are recommended for quantitative evaluations to improve the evidence base for the use of CPWs in hospitals.
Kinsman L; James E; Machotta A; Steyerberg EW
Bmc Medical Research Methodology
2012
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Journal Article
<a href="http://doi.org/10.1186/1471-2288-12-80" target="_blank" rel="noreferrer">10.1186/1471-2288-12-80</a>
Deploying an Interactive Machine Learning System in an Evidence-based Practice Center: Abstrackr
Evidence-Based Medicine; Medical; active learning; applications; machine learning; Scoping Review 2015-2016; text classification
Medical researchers looking for evidence pertinent to a specific clinical question must navigate an increasingly voluminous corpus of published literature. This data deluge has motivated the development of machine learning and data mining technologies to facilitate efficient biomedical research. Despite the obvious labor-saving potential of these technologies and the concomitant academic interest therein, however, adoption of machine learning techniques by medical researchers has been relatively sluggish. One explanation for this is that while many machine learning methods have been proposed and retrospectively evaluated, they are rarely (if ever) actually made accessible to the practitioners whom they would benefit. In this work, we describe the ongoing development of an end-to-end interactive machine learning system at the Tufts Evidence-based Practice Center. More specifically, we have developed abstrackr, an online tool for the task of citation screening for systematic reviews. This tool provides an interface to our machine learning methods. The main aim of this work is to provide a case study in deploying cutting-edge machine learning methods that will actually be used by experts in a clinical research setting.
Wallace BC; Small K; Brodley CE; Lau J; Trikalinos TA
Proceedings of the 2nd ACM SIGHIT International Health Informatics Symposium
2012
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Conference Paper
<a href="http://doi.org/10.1145/2110363.2110464" target="_blank" rel="noreferrer">10.1145/2110363.2110464</a>
End of life in pediatric oncology: how clinical practice leads to research
Biomedical Research; Evidence-based Medicine; Oncology Nursing/td [trends]; Pediatrics/td [trends]; Child; Humans; Research Design
In pediatric oncology nursing, and across practice disciplines in general, clinical research serves as the cornerstone for improving patient care. Historically, advances made in the care and cure of childhood cancer have stemmed directly from clinical research. The developments of new research questions are varied in their origin--some questions are based on previous work that leads logically to the next question, some are based on a clinical problem that requires more immediate attention, and then there are those that arise from an individual clinical experience. This last category provides clinicians with a poignant reason to search for answers on how to provide the most optimal care for all future patients. As the number of advanced practice nurses in pediatric oncology increases, there is the likelihood of an increased pursuit of clinical research. This article describes how one clinician's experience with dying children resulted in the pursuit of answers to clinical research questions. By reflecting on clinical practice and incorporating our practice in the development of research questions, we can improve the quality of care provided to all children with cancer. Copyright 2002 by Association of Pediatric Oncology Nurses
Pritchard M; Davies B
Journal Of Pediatric Oncology Nursing
2002
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<a href="http://doi.org/10.1053/jpon.2002.127226" target="_blank" rel="noreferrer noopener">10.1053/jpon.2002.127226</a>
The United Kingdom Sets Limits on Experimental Treatments: The Case of Charlie Gard
Health Care Rationing/es [ethics]; Mitochondrial Encephalomyopathies/th [therapy]; Patient Transfer/lj [legislation & Jurisprudence]; State Medicine/lj [legislation & Jurisprudence]; Therapies Investigational/ec [economics]; Evidence-based Medicine; Health Care Rationing/ec [economics]; Health Care Rationing/lj [legislation & Jurisprudence]; Humans; Infant; Male; Mitochondrial Encephalomyopathies/ec [economics]; Palliative Care; Patient Transfer/ec [economics]; State Medicine/ec [economics]; State Medicine/es [ethics]; United Kingdom
Truog RD
Jama
2017
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<a href="http://doi.org/10.1001/jama.2017.10410" target="_blank" rel="noreferrer">10.1001/jama.2017.10410</a>
An Evidence-based Infant Safe Sleep Program To Reduce Sudden Unexplained Infant Deaths
Evidence-based Medicine; Humans; Infant Newborn; Intensive Care Units Neonatal; Philadelphia; Sleep; Sudden Infant Death/prevention & Control
Infant Mortality; Neonatal Intensive Care Unit; Safe Sleep; Infant Mortality
Objective: The purpose of this project was to design, implement, and evaluate a safe sleep program for expectant mothers and the families of infants discharged from our hospital's neonatal intensive care unit (NICU). It was prompted by the sleep-related deaths of two infants in the community, both of whom had been discharged from our NICU.
METHODS:
A six-member interdisciplinary team comprising nurses, a physician, an occupational therapist, and a respiratory therapist developed a safe sleep program in an effort to identify and implement evidence-based safe sleep practices for infants in the NICU. The team examined the literature on sleep-related death and safe sleep practices, consulted with colleagues in NICUs at nearby hospitals and clinics, and conducted an audit of practices related to putting infants to sleep in the NICU. The initiative included the use of infant sleep sacks, the development of a clinical practice guideline to promote safe sleep, and the delivery of standardized discharge education for caregivers in the NICU and safe sleep classes for expectant mothers and caregivers in the community. The team educated NICU staff on the new practice guideline in November and December 2014, and implemented the clinical intervention in January 2015.
RESULTS:
Random unit audits showed that prior to implementation of the safe sleep program, NICU nurses had followed safe sleep practices only 20% of the time; after implementation, however, safe sleep practices were followed an average of about 90% of the time. In-hospital and community-oriented evidence-based teaching on safe sleep practices and environments was associated with no sleep-related infant deaths after discharge from our NICU in calendar year 2015.
CONCLUSION:
A multifaceted safe sleep program offers many benefits to both the NICU and its patients. The implementation of a standardized safe sleep program provides an enormous opportunity to improve the health and well-being of the community. All hospitals that care for mothers and infants should adopt a safe sleep program.
Zachritz W; Fulmer M; Chaney N
American Journal Of Nursing
2016
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DOI: 10.1097/01.NAJ.0000505590.78202.a2