Background Chemotherapy, whilst treating tumours, can also lead to numerous adverse reactions such as nausea and vomiting, fatigue and kidney toxicity, threatening the physical and mental health of patients. Simultaneously, misuse of chemotherapeutic drugs can seriously endanger patients' lives. Therefore, to maintain the safety of chemotherapy for cancer patients and to reduce the incidence of adverse reactions to chemotherapy, many guidelines state that a comprehensive assessment of the cancer patient should be conducted and documented before chemotherapy. This recommended procedure, however, has yet to be extensively embraced in Chinese hospitals. As such, this study aimed to standardise the content of pre-chemotherapy assessment for cancer patients in hospitals and to improve nurses' adherence to pre-chemotherapy assessment of cancer patients by conducting a national multi-site evidence implementation in China, hence protecting the safety of cancer patients undergoing chemotherapy and reducing the incidence of adverse reactions to chemotherapy in patients.Methods The national multi-site evidence implementation project was launched by a JBI Centre of Excellence in China and conducted using the JBI approach to evidence implementation. A pre- and post-audit approach was used to evaluate the effectiveness of the project. This project had seven phases: training, planning, baseline audit, evidence implementation, two rounds of follow-up audits (3 and 9 months after evidence implementation, respectively) and sustainability assessment. A live online broadcast allowed all participating hospitals to come together to provide a summary and feedback on the implementation of the project.Results Seventy-four hospitals from 32 cities in China participated in the project, four withdrew during the project's implementation, and 70 hospitals completed the project. The pre-and post-audit showed a significant improvement in the compliance rate of nurses performing pre-chemotherapy assessments for cancer patients. Patient satisfaction and chemotherapy safety were also improved through the project's implementation, and the participating nurses' enthusiasm and belief in implementing evidence into practice was increased.Conclusion The study demonstrated the feasibility of academic centres working with hospitals to promote the dissemination of evidence in clinical practice to accelerate knowledge translation. Further research is needed on the effectiveness of cross-regional and cross-organisational collaborations to facilitate evidence dissemination.

This chapter introduces evidence-based library and information practice, focusing on the importance of developing the evidence base for healthcare knowledge and library services. It highlights the importance of librarians conducting research to develop the evidence base for the profession. If the research is to grow the evidence base, the authors argue that part of the research process is the sharing of findings. The chapter covers skills both for conducting research and for librarians supporting research teams.

Patient participation plays a vital role in evidence-based practice (EBP), yet its development in clinical nursing is slow. Current research has focused on identifying barriers to patient participation in everyday care, with less research on barriers to patient participation in EBP. Therefore, a questionnaire containing basic information and open-ended questions was used to explore nursing staff attitudes and barriers to patient participation in EBP. Responses to the open-ended question were analyzed with content analysis. Four roles of patient participation, positive and negative attitudes toward patient participation, and 134 barriers to patient participation in EBP were extracted from 121 nursing staff responses through content analysis. Five categories of barriers were extracted from the 134 barriers to patient participation, including patient, cost-effectiveness of EBP, healthcare staff, organization, and resource. This study found that patients' acceptance and trust in EBP also influenced their participation in the practices. Moreover, nursing staff have little knowledge of engaging patients in EBP. More educational strategies and organizational support should be provided to patients and nurses to promote patient participation.

BACKGROUND:A validated generic impact questionnaire can demonstrate how individual and groups of health libraries contribute to continuing education and patient care outcomes.OBJECTIVES:To validate an existing generic questionnaire for Knowledge for Healthcare, England by examining: (1) internal reliability; (2) content validity; and (3) suggest revisions.METHODS:Methods used included Cronbach's alpha test, simple data mining of patterns among a data set of 187 questionnaire responses and checking respondents' interpretation of questions.RESULTS:Cronbach's alpha was 0.776 (acceptable internal reliability). The patterns of responses indicated that respondents' interpretations of the questions were highly plausible, and consistent. The meaning of 'research' varied among different occupational groups, but overall, respondents could identify relevant personal and service impacts. However, users were confused about the terms that libraries use to describe some services.DISCUSSION:The analysis indicated that the questionnaire worked well for the two types of personal services (literature/evidence searches and training/e-learning) frequently cited on the responses. Further research may be required for library assessment of the impact of other services such as digital resource services.CONCLUSIONS:The generic questionnaire is a reliable way of assessing the impact of health library and knowledge services, both individually and collectively.

The growing older population with advanced chronic kidney disease (ACKD stages 4-5) poses a challenge for healthcare worldwide. The high prevalence of frailty and associated adverse health outcomes highlights concerns for management and interventions specific to this population. The aim was to objectively review the evidence relating to older people (≥65 years) living with frailty and ACKD. More specifically how frailty is identified, what interventions have been studied and what outcomes have been reported including outcomes important to patients, families and carers. A scoping review was undertaken following the PRISMA-Scr guidelines. Nine databases were searched and a review team of five people followed a process using defined inclusion and exclusion criteria. Data were then analysed to answer the specific questions of the review. The World Health Organization's International Classification of Functioning Disability and Health was used to map outcomes across the domains. A total of 90 studies were included. The most reported frailty measure was the frailty phenotype. The most reported outcomes were mortality, hospitalisation and healthcare utilisation. Health-related quality of life was the most common patient-reported outcome measure. There were few intervention studies and limited evidence of patient and carer perspectives. This scoping review highlights important areas for further research in older people living with frailty and ACKD. This includes a 'gold standard' measure for identifying frailty, interventions and improvements in outcome measures that matter to patients (including studies that focus on carers and carer burden) and priority setting for future research.

Background: There is a widespread international agreement that healthcare should be based on high-quality evidence; however, bridging the gap from evidence to practice is still problematic. Although barriers to the implementation of evidence-based nursing practice have been identified, most studies have focused on clinical nurses' perceptions of the barriers to evidence-based nursing practice, with a lack of investigation into barriers from the hospitals' viewpoint. Objectives: To identify existing barriers to implementing evidence-based nursing practice from the hospitals' viewpoint. Design: A descriptive study employing a regional cross-sectional survey. Settings and participants: A convenience sample of 91 hospitals in Guangdong Province, China. Methods: The survey used an online questionnaire containing basic hospital information and an open-ended question. Descriptive statistics were used to analyse basic hospital data. Responses to the open-ended question were analysed with thematic analysis. Results: The sample consisted of 89 valid responses to the open-ended question. Five themes were identified: (1) knowledge (70.8 %); (2) environmental context and resources (42.7 %); (3) social influences (7.9 %); (4) in-tentions (7.9 %); and (5) beliefs about capabilities (1.1 %). Conclusion: Introduced early in 2001, China has embraced evidence-based nursing for more than 20 years. However, lack of knowledge is still the top barrier to implementing evidence-based nursing practice in hospitals in China. The findings indicate a need for more evidence-based nursing practice teaching strategies towards further enhancing clinical nurses' and nursing managers' evidence-based nursing practice beliefs, knowledge, and skills.

OBJECTIVE:To understand the impact of the UK Clinical Librarian (CL) workforce and benchmark the results against a study undertaken in the North West region of the English National Health Service (NHS).METHODS:An online survey was distributed by CLs to their service users regarding literature searches that had been carried out on their behalf in the 6 months from April to October 2017. Interviews were later carried out in person with selected respondents to the questionnaires.RESULTS:CLs across the UK contribute to a wide range of outcomes, with 41% of search requests contributing to the choice of intervention, and 41% also to the advice offered by the clinician requester to a patient or their carer. These results are in line with the previous work undertaken in the North West.DISCUSSION:CLs provide diverse services to clinical teams. They support the continuing professional development and personal research needs of team members, service development needs of organisations, and the information provided contributes to improved quality and safety of patient care.CONCLUSION:The survey confirms the findings of the earlier NW study. It demonstrates the impact of services based around literature searching on patient care.

Introduction Reported outcomes for older people with advanced chronic kidney disease (CKD) often focus on survival and mortality and little attention is paid to symptom burden and health-related quality of life. Recognising frailty and providing interventions that may improve outcomes have been studied in the general population with a growing research interest within CKD. Methods and analysis A scoping review will be undertaken following a recommended process to understand relevant research and priorities for older people living with frailty and advanced CKD. Databases will be searched and following a systematic process by a core team, a final list of included studies will be analysed. Focus groups will then be conducted with older people with advanced CKD to incorporate stakeholder views. Ethics and dissemination Our scoping review will use robust methodology to identify relevant literature focused on outcomes and care priorities for older people with advanced CKD. Ethical approval will be sought to conduct the focus groups. The result of this review will be disseminated through patient networks and national conferences. The interdisciplinary team collaborating plan to continue work in this area to improve the care and management of older people with advanced CKD.

ObjectiveTo systematically identify and describe studies that have evaluated the impact of gardens and gardening on health and well-being. A secondary objective was to use this evidence to build evidence-based logic models to guide health strategy decision making about gardens and gardening as a non-medical, social prescription.DesignScoping review of the impact of gardens and gardening on health and well-being. Gardens include private spaces and those open to the public or part of hospitals, care homes, hospices or third sector organisations.Data sourcesA range of biomedical and health management journals was searched including Medline, CINAHL, Psychinfo, Web of Knowledge, ASSIA, Cochrane, Joanna Briggs, Greenfile, Environment Complete and a number of indicative websites were searched to locate context-specific data and grey literature. We searched from 1990 to November 2019.Eligibility criteriaWe included research studies (including systematic reviews) that assessed the effect, value or impact of any garden that met the gardening definition.Data extraction and synthesisThree reviewers jointly screened 50 records by titles and abstracts to ensure calibration. Each record title was screened independently by 2 out of 3 members of the project team and each abstract was screened by 1 member of a team of 3. Random checks on abstract and full-text screening were conducted by a fourth member of the team and any discrepancies were resolved through double-checking and discussion.ResultsFrom the 8896 papers located, a total of 77* studies was included. Over 35 validated health, well-being and functional biometric outcome measures were reported. Interventions ranged from viewing gardens, taking part in gardening or undertaking therapeutic activities. The findings demonstrated links between gardens and improved mental well-being, increased physical activity and a reduction in social isolation enabling the development of 2 logic models.ConclusionsGardens and gardening can improve the health and well-being for people with a range of health and social needs. The benefits of gardens and gardening could be used as a ‘social prescription’ globally, for people with long-term conditions (LTCs). Our logic models provide an evidence-based illustration that can guide health strategy decision making about the referral of people with LTCs to socially prescribed, non-medical interventions involving gardens and gardening.

Background There are a growing number of studies on ethnic differences in progression and mortality for pre-dialysis chronic kidney disease (CKD), but this literature has yet to be synthesised, particularly for studies on mortality. Methods This scoping review synthesized existing literature on ethnic differences in progression and mortality for adults with pre-dialysis CKD, explored factors contributing to these differences, and identified gaps in the literature. A comprehensive search strategy using search terms for ethnicity and CKD was taken to identify potentially relevant studies. Nine databases were searched from 1992 to June 2017, with an updated search in February 2020. Results 8059 articles were identified and screened. Fifty-five studies (2 systematic review, 7 non-systematic reviews, and 46 individual studies) were included in this review. Most were US studies and compared African-American/Afro-Caribbean and Caucasian populations, and fewer studies assessed outcomes for Hispanics and Asians. Most studies reported higher risk of CKD progression in Afro-Caribbean/African-Americans, Hispanics, and Asians, lower risk of mortality for Asians, and mixed findings on risk of mortality for Afro-Caribbean/African-Americans and Hispanics, compared to Caucasians. Biological factors such as hypertension, diabetes, and cardiovascular disease contributed to increased risk of progression for ethnic minorities but did not increase risk of mortality in these groups. Conclusions Higher rates of renal replacement therapy among ethnic minorities may be partly due to increased risk of progression and reduced mortality in these groups. The review identifies gaps in the literature and highlights a need for a more structured approach by researchers that would allow higher confidence in single studies and better harmonization of data across studies to advance our understanding of CKD progression and mortality.

BACKGROUND:The number of people living with a long-term condition is increasing worldwide. Social media offers opportunities for patients to exchange information and experiences with others with the same condition, potentially leading to better self-management and improved patient outcomes, at minimal costs to health service providers.OBJECTIVE:This paper describes how an online network with a range of social media platforms was created, with the help of a group of patients with chronic kidney disease and specialist professionals. The project considered whether information needs and health-related and social outcomes were met.METHODS:We performed a longitudinal in-depth evaluation of the creation of the moderated network, observation of the use of the platforms, self-efficacy surveys (at baseline and 6 months), and semistructured interviews (at baseline and 6 months).RESULTS:A total of 15 patients and professionals participated in the co-design of the network (hub), which was initially launched with 50 patients. Several platforms were needed to engage patients at different levels and encourage generation of information, with the support of moderators. In addition, 14 separate patients participated in the evaluation. Satisfaction of information needs through social engagement improved self-efficacy (n=13) with better self-care and management of illness. Social outcomes included seeking employment and an increase in social capital.CONCLUSIONS:An online network (hub) with several social media platforms helped patients with chronic kidney disease manage their condition. Careful co-designing with users resulted in a sustainable network with wider applicability across health and social care.

BACKGROUND:Widespread use of the internet has fundamentally altered the way people access health information and communicate with health providers. Pregnant women are a group who are particularly highly motivated to seek out information online. However, where mothers actually obtain their information, who they trust to supply it, and whether or not it actually fulfils their needs is often unclear. This paper examines the experiences of women accessing advice and information on pregnancy and childbirth through a dedicated social-media platform, mediated by qualified midwives. The study formed part of a larger research project that focussed on professionally moderated online learning in maternity care, and the role of online communities. This paper reports on aspects of midwife mediated information provision in the context of these online communities. METHODS:Two secret (i.e. private / invitation only) Facebook groups were created. Both groups were moderated by 2 qualified midwives. One group had 17 mothers and the other 14 mothers. Both groups ran for 35 weeks. DATA AND ANALYSIS:The data included the written and spoken words of group participants and midwife-moderators in i) face-to-face (n = 4) and online (n = 4) post-intervention focus groups; ii) one-to-one interviews with group participants and midwife moderators (n = 24); iii) the complete corpus of text-based interaction across both groups; iv) a sub-set of private message sessions (n = 24) between individual participants and midwife-moderators. Thematic analysis was applied to the combined dataset. FINDINGS:Participants found engagement with midwives and other pregnant women via a social media group convenient and accessible. The groups provided a safe space for the sharing and validation of maternity relevant information. Members trusted their midwife-moderators to ensure information was reliable. For many members, the group became the primary source of pregnancy related information. CONCLUSION:Midwife-mediated social media groups offer a highly effective way of providing individualised information provision and social support for pregnant woman. Access to a group can also significantly impact on perceptions of relational continuity.

Evidence-based practice is a concept that has grown across health disciplines over the last 25 years as a way of providing high quality health care. Radiographers are keen to implement evidence-based approaches but barriers remain in practice. This article provides a practical guide to help overcome some of the common issues that impact on the implementation of evidence-based practice in radiography. Tips and resources for each step of the evidence-based cycle, along with a worked example are presented.

Introduction Globally, asthma is one of the major non-communicable diseases, with 235 million people currently suffering from the condition. In Saudi Arabia, there is a 4% prevalence of asthma among the adult population. This study aimed to develop an adult asthma patient self-management education programme that took into account the Saudi context and culture. Systematic review A systematic review was conducted to determine the most effective way of delivering asthma self-management education programmes. It was shown in the review that asthma was more prevalent in individuals with less education, and that nurses had an important role in educating patients with this disease. Following analysis of this evidence alongside the Saudi context, small-group education programmes delivered by nurses were selected as the most appropriate means of delivering education, which considered patient individual needs and cultural values to improve their health outcomes in terms of self-management. Methods An explanatory sequential complementary mixed-methods design was adopted. This design encompassed a quasi-experiment using a pre- and post-test comparative study, followed by a qualitative part using face-to-face interviews with patients. The intervention was an educational programme that included topics selected based on patients’ needs in the review and following the Saudi Initiative for Asthma (SINA) guidance.1 The programme was tested to determine whether it provide patients with the necessary knowledge and skills to self-manage their asthma and consequently reduce their visits to emergency departments. Further, the programme was approved and co-designed with nursing staff who provide care for patients with asthma in the selected hospital and following consultation with patients. The programme was delivered by nurses and other professionals who were trained to ensure the quality of delivery. Data were collected pre-, post- and at 3 and 6 months following the intervention and included topics related to asthma, Asthma Control Test, Asthma Self-Management Questionnaire, the Asthma Knowledge Questionnaire and the Patient Activation Measure (PAM) instrument. Prior to data collection, instruments were all translated to Arabic, the language of participants, and validated to assure the validity of patients’ responses. Patients in the control group were able to receive the intervention after 6 months, the last data collection point in the study. Findings Analysis of the responses between the pre- and post-tests demonstrate that patients with higher levels of knowledge had higher PAM scores. Patients’ scores in all datasets in phase 2 were higher than those in phase 1, which indicated that the education was effective and increased confidence in patients’ self-management of their asthma. Results to date suggest that the bespoke education is relevant and provides the necessary knowledge to increase confidence and patient activation towards disease self-management and reducing complications. Study progress Longer-term follow-up data and qualitative interviews will be completed in late February 2019. It is anticipated that these results will confirm that the educational programme is suited to the Saudi Arabian context, improves knowledge and increases confidence in the self-management of asthma.

BackgroundThe international evidence about outcomes of End Stage Kidney Disease (ESKD) for ethnic minorities was reviewed to identify gaps and make recommendations for researchers and policy makers.MethodsNine databases were searched systematically with 112 studies from 14 different countries included and analysed to produce a thematic map of the literature.ResultsReviews (n=26) highlighted different mortality rates and specific causes between ethnic groups and by stage of kidney disease associated with individual, genetic, social and environmental factors. Primary studies focussing on uptake of treatment modalities (n=19) found ethnic differences in access. Research evaluating intermediate outcomes and quality of care in different treatment phases (n=35) e.g. dialysis adequacy, transplant evaluation and immunosuppression showed ethnic minorities were disadvantaged. This is despite a survival paradox for some ethnic minorities on dialysis seen in studies of longer term outcomes (n=29) e.g. in survival time post-transplant and mortality. There were few studies which focussed on end of life care (n=3) and ethnicity.Gaps identified were: limited evidence from all stages of the ESKD pathway, particularly end of life care; a lack of system oriented studies with a reliance on national routine datasets which are limited in scope; a dearth of qualitative studies; and a lack studies from many countries with limited cross country comparison and learning.ConclusionsDifferences between ethnic groups occur at various points and in a variety of outcomes throughout the kidney care system. The combination of individual factors and system related variables affect ethnic groups differently indicating a need for culturally intelligent policy informed by research to prevent disadvantage.

Objectives: To determine whether the shared care model during the follow-up of cancer survivors is effective in terms of patient-reported outcomes, clinical outcomes, and continuity of care. Methods: Using systematic review methods, studies were searched from six electronic databases—MEDLINE (n = 474), British Nursing Index (n = 320), CINAHL (n = 437), Cochrane Library (n = 370), HMIC (n = 77), and Social Care Online (n = 210). The review considered all health-related outcomes that evaluated the effectiveness of shared care for cancer survivors. Results: Eight randomised controlled trials and three descriptive papers were identified. The results showed the likelihood of similar effectiveness between shared care and usual care in terms of quality of life, mental health outcomes, unmet needs, and clinical outcomes in cancer survivorship. The reviewed studies indicated that shared care overall is highly acceptable to cancer survivors and primary care practitioners, and shared care might be cheaper than usual care. Conclusions: The results from this review suggest that the patient satisfaction of shared care is higher than usual care, and the effectiveness of shared care is similar to usual care in cancer survivorship. Interventions that formally involve primary care and improve the communication between primary care and hospital care could support the PCPs in the follow-up.

BACKGROUND:Health libraries contribute to many activities of a health care organisation. Impact assessment needs to capture that range of contributions.OBJECTIVES:To develop and pilot a generic impact questionnaire that: (1) could be used routinely across all English NHS libraries; (2) built on previous impact surveys; and (3) was reliable and robust.METHODS:This collaborative project involved: (1) literature search; (2) analysis of current best practice and baseline survey of use of current tools and requirements; (3) drafting and piloting the questionnaire; and (4) analysis of the results, revision and plans for roll out.FINDINGS:The framework selected was the International Standard Methods And Procedures For Assessing The Impact Of Libraries (ISO 16439). The baseline survey (n = 136 library managers) showed that existing tools were not used, and impact assessment was variable. The generic questionnaire developed used a Critical Incident Technique. Analysis of the findings (n = 214 health staff and students), plus comparisons with previous impact studies indicated that the questionnaire should capture the impact for all types of health libraries.CONCLUSIONS:The collaborative project successfully piloted a generic impact questionnaire that, subject to further validation, should apply to many types of health library and information services.

Information specialists play a key role in undertaking the searching for systematic reviews. This chapter traces the context, background and history of how the role has evolved over the last 20 years, before considering the challenges and debates facing today's expert searchers. Examples from the literature and practice will be used to highlight the debates before a summary of future directions for research and practice for expert searchers concludes the chapter.