https://www.um.edu.mt/library/oar/handle/123456789/15054 2026-06-25T03:37:34Z 2026-06-25T03:37:34Z https://www.um.edu.mt/library/oar/handle/123456789/15617 2017-01-19T13:25:46Z 2016-01-01T00:00:00Z

Title: Reducing respiratory complications in ICU : continuous bed rotation vs standard turning practices Abstract: Critically-ill patients are susceptible to respiratory complications. The most common respiratory complication in the intensive care unit (ICU) is nosocomial pneumonia or hospital-acquired pneumonia (HAP) which includes ventilator associated pneumonia (VAP). VAP involves pneumonia developed in a mechanically ventilated (MV) patient. Studies recommend that ICU nurses should practice manual turnings every two hours but due to constraints this is not always possible. Throughout the years, continuous bed rotation specifically Kinetic therapy (KT) and Continuous Lateral Rotation Therapy (CLRT) were developed. These specialised beds are utilised for critically-ill patients who are prone to respiratory complications. Consequently, the following PICO elements and research question were formulated. Patient/Problem: Mechanically ventilated adult critically-ill patients Intervention: Continuous bed rotation (CLRT and KT) Comparison: Standard turning practices Outcome: Reduced respiratory complications Among mechanically ventilated adult critically-ill patients, would continuous bed rotation be more effective than standard turning practices to reduce respiratory complications? This dissertation included English language open full-text articles from the last 15 years only. The articles were limited to MV critically-ill adult patients with respiratory complications. The articles also included patients that underwent continuous bed rotation and standard turning practices. The search strategy involved a combination of 11 keywords and alternate terms inserted in 7 selected databases which generated 34,853 articles from which 95 articles were selected based on their title, presence of abstract and elimination of duplicates. The abstracts of the 95 articles were assessed which resulted in the exclusion of 62 articles. The exclusion of the 62 articles was based on the absence of the scope, purpose, method, results, conclusions and recommendations related to the studies in the abstract. Articles were also excluded if the abstract was not clear and understandable and abstract presented a poor study methodology. The remaining 33 articles were screened through the Critical Appraisal Skill Program (CASP) tool from which 26 articles were excluded. The exclusion of the 26 articles was based on having non-focused measured outcomes as well as systematic reviews that evaluated interventions and in which RCTs were not selected. This led to the selection of seven articles, namely, a prospective randomised multicentre study, a prospective randomised clinical study, a randomised controlled pilot study, a prospective randomised study, a prospective randomised open-label trial, a randomised control trial and a systematic review and meta-analysis. These articles were critically appraised through the CASP tool for Randomised Controlled Trial (RCT) and CASP tool for Systematic Review. The researchers concluded that continuous bed rotation (CLRT and KT) is more effective than standard turning practices in the reduction of respiratory complications. It was highlighted that further research in this field of practice is crucial. Conducting qualitative and quantitative research, promote a learning culture, knowledge sharing and a patient- family-nurse relationship will lead to an effective project implementation. Description: B.SC.(HONS)NURSING

2016-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/15594 2017-06-06T13:09:23Z 2016-01-01T00:00:00Z

Title: Mitomycin versus BCG to reduce recurrence in intermediate to high risk superficial bladder cancer Abstract: The present dissertation will compare the effectiveness of Mitomycin with the standard treatment BCG to evaluate which agent is superior in reducing tumour recurrences. Using the PICO framework, the research question was framed as follows; “Is mitomycin more effective than BCG in reducing tumour recurrence in patients with high risk superficial bladder cancer”. PICO elements: Patients with intermediate to high risk superficial bladder as the population, Mitomycin as a treatment intervention and BCG as the comparison intervention. The expected outcome was reduction in tumour recurrence. The eligible criteria included: English language, peer-reviewed studies published the last eleven years; both genders, all age groups and ethnic groups that had intermediate-high risk, superficial invasion, academic journals related to oncology, urology and pharmacological settings, reviews, RCTs and observational studies. Exclusion criteria were the studies that failed to meet the eligible criteria. The search yielded one systematic review, three meta-analyses, two randomised prospective studies and a retrospective study. The CASP tools were utilised to conduct a critical appraisal. Tumour recurrence was the primary outcome measured, whereas tumour progression, survival and side-effects were secondary outcomes. Results: BCG continued to be preferred over Mitomycin in reducing recurrence in highrisk tumours. However, there was no significance difference with intermediate-high risk tumours. Mitomycin was more effective when BCG maintenance was not administered. These findings imply that the outcome result is based on the tumour characteristics and the maintenance regime. Therefore findings to support EBP, are at this stage, inconclusive. Recommendations: Introduce Mitomycin for intermediate risk and BCG incompatibilities, further studies to identify ideal schedules for both agents, conducting a local study with homogenous population and treatment schedule, healthcare professionals and patient education to enhance the effectiveness of treatment. Description: B.SC.(HONS)NURSING

2016-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/15593 2017-01-19T13:10:59Z 2016-01-01T00:00:00Z

Title: Evaluating the risks of thrombolysis during CPR in thromboembolic cardiac arrest Abstract: This study focuses on identifying the adverse effects of thrombolysis when used during CPR in patients with cardiac arrest. Since CPR guidelines have changed in the past 10 years, which they now suggest that tPA can be administrated in patients with suspected cardiac arrest of an embolic nature, various studies have been carried out to identify the effectiveness of this treatment. This study systematically identifies and critically appraises the literature available about this subject. The PICO framework is Population: Adults with cardiac arrest due to or suspected thromboembolism, Intervention: administration of thrombolysis during CPR, Comparison: No comparison, Outcome: Adverse effects. Does the question presented in this study is “In adults undergoing cardiac arrest due to thromboembolism, does the use of thrombolysis during CPR cause adverse effects?” Since CPR guidelines started recommending the use of thrombolysis during CPR since 2005, all studies from that period onwards were included, except for a few that were handpicked from a manual reference search. The use of HyDI Interface and individual access to 25 related databases was carried to conduct the literature search. To ensure that only articles of quality were selected, only peer-reviewed journals were used. The studies found, which included 2 RCT’s and several cohort studies were appraised using the CASP tool, and during the appraisal process, the reliability and validity of the studies was analysed along with the related outcomes. The adverse effects related to the combination of thrombolysis and CPR was the main outcome that this review focused on, however ROSC was also discussed since this factor affects the importance of knowing the potential adverse effects this combination of treatment might cause. All studies identified a small percentage of bleeding events, and while some were of clinical significance, none were of statistical significance. Overall, incongruent results amongst the studies was identified pertaining ROSC, since the small cohort studies suggested that thrombolysis is effective in achieving ROSC while the large RCT’s showed that this treatment has no effect. Thus, recommendations for further research and ensuring good nursing assessment skills in patients with acute deterioration has been provided. Description: B.SC.(HONS)NURSING

2016-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/15592 2018-05-07T09:36:45Z 2016-01-01T00:00:00Z

Title: Consumption of cocoa in adults : and its effects on cardiovascular incidences Abstract: Background: Statistics show that global demand for cocoa has increased. On the other hand cardiovascular disease is globally the leading cause of death. It was therefore seen advantageous to amalgamate the two together which determined the research question based on the PICO framework consisting of; P: adults prone to cardiovascular incidences, I: consumption of cocoa, C: no cocoa consumed, O: reduction of cardiovascular incidences. Therefore the following research question was developed: Does the consumption of cocoa reduce the risk of cardiovascular incidences in adults? Search Design: The author undertook the search from October to December 2015. Several databases where searched on the Hybrid Discovery portal. Google Advanced Scholar was also used for the retrieval of relevant journals. Dr. Mario Caruana, a nutritionist was also contacted through the University of Malta. Inclusion and Exclusion Criteria: Journals with full text available, published in English between the years 2005 and 2015, are peer-reviewed, contain studies performed on human adults ≥18 years, used systematic reviews and meta-analyses, randomised controlled trials, single or double blinding, the population involved individuals prone to a form of cardiovascular illness, and consumed cocoa or any of its derivatives. Any opposing criteria to the inclusion criteria were by default exclusion criteria. Appraisal Tools: Journals were selected for appraisal through the CASP tools for Systematic Reviews and RCTs and then ranked according to the Hierarchy of Evidence by Polit & Beck, (2014). Results: The consumption of cocoa; reduces blood pressure, increases; flow mediated dilation and high density lipoprotein levels. In some studies it even improved blood insulin and glucose levels; ultimately cocoa reduced risks for cardiovascular incidences. Recommendations: The study of cocoa is still relatively new; more advanced research is required, as is suggested in Chapter 5. Consequently, approved conventional forms of therapeutic and pharmaceutical treatment of cardiovascular disease must be adhered. Description: B.SC.(HONS)NURSING

2016-01-01T00:00:00Z