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How to be involved in the FOC Node activities

How to be involved in the FOC Node activities. Co-convenors: Alison Kitson & Suzi Robertson-Malt. Professor Alison Kitson Professor of Nursing School of Nursing University of Adelaide AUSTRALIA Dr Suzanne Robertson-Malt Senior Clinical Planning Consultant (Education)

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How to be involved in the FOC Node activities

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  1. How to be involved in the FOC Node activities Co-convenors: Alison Kitson & Suzi Robertson-Malt

  2. Professor Alison Kitson Professor of Nursing School of Nursing University of Adelaide AUSTRALIA Dr Suzanne Robertson-Malt Senior Clinical Planning Consultant (Education) Clinical Planning Department Sidra Medical & Research Center Qatar Foundation Doha QATAR

  3. Stage 1 Where to start: Guiding Questions • What is the evidence base upon which the fundamentals of (nursing) care is delivered? • Where do we currently source the information to establish the evidence base for the work nurses (and other carers) do? • How do we identify the key dimensions/elements for each area? • How do we link these fundamental aspects of care to discrete clinical interventions?

  4. Level of agreement on elements of care International Journal of Nursing Practice: Kitson A, et.al, 2010, 16: 423-34

  5. Results of 2010 meta narrative review Published in International Journal of Nursing Practice: Kitson A, et.al, 2010, 16: 423-34

  6. Focus of work for FOC Node • Primary Aim: Helping to ensure that priorities and perspectives in the area of FOC are reflected in the work of Cochrane review groups. • Primary objective :Where do we currently source the information to establish the evidence base for the work nurses (and other carers) do? • Using a standardised template to guide activities: • Direct the activities of Cochrane Review Groups • Inform the activities of other CNCF Nodes

  7. Steps to Follow • Step 1: Listen to the Podcast: “Critically reviewing the inclusiveness of FOC within existing Cochrane Systematic Reviews” • Step 2: Choose a CSR from the Cochrane Database of systematic reviews • Step 3: Carefully read the review and highlight any references made to FOC concepts – see worked examples 1 & 2 • Step 4: Populate the standardized template with terms/ concepts from the CSR • Step 5: Submit recommendations to FOC Node site on CNCF

  8. Example 1: Maternal Position & First Term Labour • Cochrane Review Group: Cochrane Pregnancy and Childbirth Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD003934. DOI: 10.1002/14651858.CD003934.pub2. • Review Title: Maternal positions and mobility during first stage labour • Primary Objective of the review: To assess the effects of encouraging women to assume different upright positions (including walking, sitting, standing and kneeling) versus recumbent positions (supine, semi-recumbent and lateral) for women in the first stage of labour on length of labour, type of delivery and other important outcomes for mothers and babies.

  9. Outcomes of interest that focused the SR Primary maternal outcomes: • length of first stage of labour; • type of delivery (spontaneous vaginal delivery, operative vaginal or caesarean); • maternal satisfaction with positioning and with the childbirth experience. Primary fetal and neonatal outcomes: • fetal distress requiring immediate delivery; • use of neonatal mechanical ventilation. Secondary maternal outcomes: • pain as experienced by the woman; • use of analgesics (amount and type, e.g. epidural/opioid); • length of second stage of labour; • augmentation of labour using oxytocin; • artificial rupture of membranes; • spontaneous rupture of membranes; • hypotension requiring intervention; • estimated blood loss > 500 ml; • perineal trauma (including episiotomy and third and fourth degree tears) Secondary neonatal outcomes: • Apgar of less than seven at five minutes following delivery; • admission to the neonatal intensive care unit.

  10. Review author(s) conclusion • There is evidence that walking and upright positions in the first stage of labour reduce the length of labour and do not seem to be associated with increased intervention or negative effects on mothers' and babies' wellbeing. Women should be encouraged to take up whatever position they find most comfortable in the first stage of labour.

  11. Sample 1:Maternal Positions, First stage labour

  12. Recommendations to Cochrane Review Group(s) • Recommended title for Cochrane Pregnancy and Childbirth Review Group to consider • Interventions to increase ambulation for women in 1st stage labour that promote maternal satisfaction with positioning and mobility embracing fundamental care elements including: having an increased sense of control; being able to move around freely and spontaneously; having privacy and maintaining sense of dignity.

  13. Example 2:Oxygen therapy for acute myocardial infarction • Cochrane Review Group: Cochrane Heart Group Cochrane Database of Systematic Reviews 2010, Issue 6. Art. No.: CD007160. DOI: 10.1002/14651858.CD007160.pub2. • Review Title: Oxygen therapy for Acute Myocardial Infarction • Primary Objective of the review: To review the evidence from randomised controlled trials to establish whether routine use of inhaled oxygen in acute myocardial infarction (AMI) improves patient-centred outcomes, in particular pain and death.

  14. Outcomes of interest that focused the SR The primary outcome: • Mortality The secondary outcomes: • pain and any other complications (such as heart failure, pericarditis and rhythm disorders)

  15. Review author(s) conclusion • There is no conclusive evidence from randomised controlled trials to support the routine use of inhaled oxygen in patients with acute AMI. A definitive randomised controlled trial is urgently required given the mismatch between trial evidence suggestive of possible harm from routine oxygen use and recommendations for its use in clinical practice guidelines.

  16. Sample 2: Oxygen Therapy & Acute Angina

  17. Recommendations to Cochrane Review Group(s) • Recommended title for Cochrane Heart Review Group to consider : Interventions to increase comfort in patients suffering Acute Angina

  18. How to volunteer • Find colleague to undertake the FOC analysis with you • Timeframe – try not to spend more that 2 weeks working on analysing a CSR using the FOC review template • Once completed send your completed analysis to the following email addresses: • Alison Kitson: alison.kitson@adelaide.edu.au • Suzi Robertson-Malt: smalt@sidra.org

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