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Biomedical subjects

K Seers

Publications and source records attributed to K Seers.

18 recordsLinked to original sources
PubMed2002

Ingredients for change: revisiting a conceptual framework.

Finding ways to deliver care based on the best possible evidence remains an ongoing challenge. Further theoretical developments of a conceptual framework are presented which influence the uptake of evidence into practice. A concept analysis has been conducted on the key elements of the framework--evidence, context, and facilitation--leading to refinement of the framework. While these three essential elements remain key to the process of implementation, changes have been made to their constituent sub-elements, enabling the detail of the framework to be revised. The concept analysis has shown that the relationship between the elements and sub-elements and their relative importance need to be better understood when implementing evidence based practice. Increased understanding of these relationships would help staff to plan more effective change strategies. Anecdotal reports suggest that the framework has a good level of validity. It is planned to develop it into a practical tool to aid those involved in planning, implementing, and evaluating the impact of changes in health care.

Delivery of Health Care↗
PubMed2001

Systematic review of the use of honey as a wound dressing.

OBJECTIVE: To investigate topical honey in superficial burns and wounds though a systematic review of randomised controlled trials. DATA SOURCES: Cochrane Library, MEDLINE, EMBASE, PubMed, reference lists and databases were used to seek randomised controlled trials. Seven randomised trials involved superficial burns, partial thickness burns, moderate to severe burns that included full thickness injury, and infected postoperative wounds. REVIEW METHODS: Studies were randomised trials using honey, published papers, with a comparator. Main outcomes were relative benefit and number-needed-to-treat to prevent an outcome relating to wound healing time or infection rate. RESULTS: One study in infected postoperative wounds compared honey with antiseptics plus systemic antibiotics. The number needed to treat with honey for good wound healing compared with antiseptic was 2.9 (95% confidence interval 1.7 to 9.7). Five studies in patients with partial thickness or superficial burns involved less than 40% of the body surface. Comparators were polyurethane film, amniotic membrane, potato peel and silver sulphadiazine. The number needed to treat for seven days with honey to produce one patient with a healed burn was 2.6 (2.1 to 3.4) compared with any other treatment and 2.7 (2.0 to 4.1) compared with potato and amniotic membrane. For some or all outcomes honey was superior to all these treatments. Time for healing was significantly shorter for honey than all these treatments. The quality of studies was low. CONCLUSION: Confidence in a conclusion that honey is a useful treatment for superficial wounds or burns is low. There is biological plausibility.

Anti-Bacterial Agents↗
PubMed1998

Relaxation techniques for acute pain management: a systematic review.

This review aims to document the effectiveness of relaxation techniques, when used alone for the management of acute pain, after surgery and during procedures. A systematic review of randomized controlled trials (RCTs) was undertaken. Seven studies involving 362 patients were eligible for this review. One hundred and fifty patients received active relaxation as the sole intervention. Reports were sought by searching MEDLINE, psycLIT, CINAHL, and the Oxford Pain Relief Database. The outcome measures used were pain and psychological factors. A meta-analysis was not possible, due to lack of primary data. Three of the seven studies demonstrated significantly less pain sensation and or pain distress in those who had relaxation. Four studies did not detect any difference. There was some weak evidence to support the use of relaxation in acute pain. However, this was not conclusive and many of both the positive and the negative studies suffered from methodological inadequacies. Well designed and executed randomized controlled trials are needed before the clinical use of relaxation in acute pain management can be firmly underpinned by good quality research evidence. Until this evidence is available we recommend that the clinical use of relaxation in acute pain settings is carefully evaluated and not used as the main treatment for the management of acute pain.

Acute Disease↗
PubMed1998

Relaxation for the relief of chronic pain: a systematic review.

The effectiveness of relaxation techniques in the management of chronic pain was determined in this systematic review of published randomized controlled trials. Reports were sought by searching MEDLINE, psycLIT, CINAHL, EMBASE and the Oxford Pain Relief Database. Studies were included in this review if they were randomized controlled trials of relaxation techniques in chronic pain. Studies which investigated the effects of relaxation in combination with other interventions were not considered. Nine studies involving 414 patients met the predefined inclusion criteria and are critically appraised in this review. Meta-analysis was not possible, due to lack of quantitative data in the primary studies. Studies involved patients with a range of chronic pain conditions. The McGill Pain Questionnaire was the most common pain outcome used. Whilst four studies were able to show a significant difference for the pain outcomes in favour of relaxation for the pre- and post-treatment assessments, few statistically significant differences were reported in favour of relaxation when between treatment comparisons were used. Only three studies reported statistically significant differences in favour of relaxation (judged as a significant difference for at least 1 of the pain outcomes) compared to the other treatment groups. In rheumatoid arthritis the McGill Pain Questionnaire scores were significantly lower for patients receiving relaxation compared to those who were in the routine treatment control group. In ulcerative colitis significant differences were reported for six of seven different pain outcome measures in favour of progressive muscle relaxation compared to patients in the waiting list control group. In one of the two cancer pain studies, relaxation taught by nurses produced significantly lower pain sensation scores compared to the control group. Two studies reported significant differences in favour of the experimental control groups rather than for relaxation. There is insufficient evidence to confirm that relaxation can reduce chronic pain. Many of the studies both positive and negative suffer methodological inadequacies. Recommendations for future research into the effectiveness of relaxation techniques for chronic pain are made.

Humans↗
PubMed1997

Development of a tool to rate the quality assessment of randomized controlled trials using a Delphi technique.

The aim of this study was to develop a quality of study tool rate the methodological quality of individual primary randomized controlled trials (RCTs) to be included in a meta-analysis. A Delphi-technique using several rounds of questions to seek consensus, among trialists, on criteria important in a RCT was used. Eight trialists formed the Delphi panel. The developed quality of study tool consisted of 53 items in 15 dimensions. The tool was tested for reliability and validity. Unlike many other quality assessment tools, the developed tool may be used to rate numerically each primary study. This is important in reviews or in meta-analyses where one objective may be to ascertain whether those studies of a higher quality exhibit different results to reviewing studies of lower quality. The tool needs further testing.

Clinical Nursing Research↗
PubMed1997

Using research for practice: a UK experience of the BARRIERS Scale.

It is generally recognized that the majority of health care has been largely based upon opinion rather than research evidence of clinical effectiveness. Attempts to rectify this have been initiated by increasing emphasis on the dissemination of findings. For example, in the UK this had been supported via the Cochran Collaboration and the Centre for Dissemination and Reviews. Dissemination does not, however, guarantee implementation. The complex nature of research utilization has been studied and obstacles identified that can influence the uptake of research by practising nurses. Sandra Funk and colleagues developed the BARRIERS Scale using this research and literature on research utilization. The scale may be helpful for identifying and measuring the barriers to research utilization perceived by nurses working within the UK and has formed the basis of the present study. A convenience sample of 316 comprising a broad spectrum of nurses working in the UK provided the data. Comparison is made with North American nurses from the studies used in the scale's development. The results suggest there ware items which are consistently perceived as either strong or negligible barriers by both groups of nurses. Differences, however, did emerge between nurses from the UK and North America on several items. These included the confidence in evaluating research and the perception of the nurse's authority to change patient procedures. Psychometric evaluation was also done. These findings are presented and discussed.

Cross-Cultural Comparison↗
PubMed1996

Clinical guidelines: an introduction to their development and implementation.

There is a great deal of interest in the United Kingdom in clinical guidelines as a means of assisting practitioner and patient decision making about care options and in improving the quality of the care provided. Confusion remains, however, over what is meant by a clinical guideline and how it differs from and relates to protocols and standards. This paper was written under the auspices of the Royal College of Nursing Steering Group for the college's work on clinical guidelines, with the aim of clarifying some of the terminology used in the field and introducing ways in which clinical guidelines might be used by practitioners and patients to readers. At the moment just how effective the use of clinical guidelines can be on care is poorly established. What is known, however, is that crucial to their success are the strategies and methods used for their implementation. Such strategies and methods raise questions about how a sense of ownership can be engendered in those using the clinical guidelines and how they may be best operationalized. These questions are considered in this paper.

Clinical Protocols↗
PubMed1996

From research to practice: one organizational model for promoting research-based practice.

This paper describes a framework used by the National Institute for Nursing in Oxford to integrate research, development and practice. With the increasing attention given to the topic of how research findings are implemented into clinical practice, it was felt important to share the challenges that have arisen in attempting to combine traditional research activities with more practice-based development work. The emerging conceptual framework, structures and functions are described, highlighting the variety of partnerships to be established in order to achieve the goal of integrating research into practice. While the underpinning principles of the framework-generating knowledge, implementing research into practice and evaluating the effectiveness of programmes-are not new, it is the way they have been combined within an organizational structure that could be helpful to others considering such a strategy. Both the strengths and weaknesses of the framework are discussed, a number of conclusions drawn as to its robustness and consideration given to its replication.

Diffusion of Innovation↗
PubMed1996

The patients' experiences of their chronic non-malignant pain.

This paper reports the results of a study which investigated the experiences of 75 people with chronic non-malignant pain. People with chronic non-malignant pain can find that traditional medical techniques do not help their pain, and they have to learn to live with it. However, pain can affect their lives in many ways. Within this study, qualitative data were collected to illustrate what it meant to people to experience this chronic pain. It was found that pain adversely affected many dimensions of sufferers' lives, and the effects extended to family and friends. It seemed that having others believe the pain was crucial to many patients. Health care professionals can offer these patients much in helping them come to terms with the way in which pain has affected both themselves and their lives.

Attitude to Health↗
PubMed1989

Assessing pain.

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Humans↗
PubMedDate not supplied

Implementing evidence-based practice in clinical situations.

Many nurses in a variety of clinical settings are facing the challenges posed by incorporating evidence-based practice in health care. Some of the steps involved in implementing evidence-based care in clinical practice are discussed and a two-step framework to assist practitioners in implementing evidence-based practice is outlined. Factors such as the relevance of specific guidelines or research, generalisability of research findings, the strength of the evidence relative to the risks and benefits of treatment, and patient preferences are discussed in terms of evidence-based decision making.

Benchmarking↗
PubMedDate not supplied

Perceptions of pain.

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Anxiety↗