https://www.um.edu.mt/library/oar/handle/123456789/64365 Thu, 09 Apr 2026 21:33:51 GMT 2026-04-09T21:33:51Z https://www.um.edu.mt/library/oar/handle/123456789/68198 Title: Early mobilisation of mechanically ventilated patients : effect on muscle strength and ventilation duration Abstract: Overview of the topic: Although mechanical ventilation is an effective treatment for patients in the intensive care unit to survive from acute illness, long periods of immobilisation during this time is associated with long-term complications including intensive care unit acquired weakness. This disease can have a negative effect on a number of patient outcomes including muscle strength and ventilation duration. The implementation of early mobilisation during mechanical ventilation would allow for increased physical activity during this time potentially benefiting patient outcomes. In this dissertation, the effect of early mobilisation to maintain muscle strength and reduce ventilation duration will be studied. The research question: Does early mobilisation in mechanically ventilated patients affect muscle strength and ventilation duration? PEO elements: The population (P) studied was mechanically ventilated patients. The exposure (E) observed was early mobilisation. The desired outcomes (O) were maintaining muscle strength and reducing ventilation duration. Method: The elements of the PEO question were used to identify key terms and generate alternative terms. Boolean Operators were used to combine these terms and a systematic search was conducted through various databases including EBSCO, PubMed, and Google Scholar, as well as through manual searching. Inclusion and exclusion criteria were applied to determine the eligible studies. The retrieved studies were then critically appraised by using Critical Appraisal Skills Programme tool. Results: A total of seven studies were identified which included three systematic reviews, two randomised controlled trials and two prospective cohort studies. All studies showed significant results for either maintaining muscle strength or reducing ventilation duration, except for one randomised controlled trial and one prospective cohort study. The randomised controlled trial failed to find statistical differences between the groups whilst the prospective cohort study did not reach statistical significance for ventilation duration. Conclusion: In conclusion, from the evidence gathered there is indication that early mobilisation for mechanically ventilated patients can be beneficial in improving the patient outcomes of muscle strength and ventilation duration. Recommendations: There is a need for further research with more robust methodological base which includes more similar management protocols and guidelines for better evidence. Furthermore, early mobilisation for mechanically ventilated patients should be encouraged more in local practice by providing educational opportunities on the issues and solutions of this practice and through development of a protocol. Description: B.SC.(HONS)NURSING Wed, 01 Jan 2020 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/68198 2020-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/68119 Title: Highly active antiretroviral therapy (HAART) in the prevention and treatment of HIV-associated neurocognitive disorder Abstract: Overview - Despite promising effects of Highly Active Antiretroviral Therapy (HAART) in improving neurocognition in HIV-infected patients, mild forms of HIV-associated neurocognitive disorder (HAND) persist; hence the objective of this dissertation is to explore whether HAART can prevent and treat HAND. Research Question- In adult patients infected with HIV, is Highly Active Antiretroviral Therapy (HAART) effective in the prevention and treatment of HIVassociated neurocognitive disorder (HAND)? PICO elements- Population (P) - adult patients with HIV, Intervention (I) -HAART, Comparison (C) - no treatment, Outcome (O) - prevention and treatment of HAND Inclusion/Exclusion criteria- Included studies - i. focused on HAART ii. lie at the apex of the hierarchy of evidence iii. investigated HAND iv. focused on neurocognitive impairment caused by HIV only Search Outcome- Databases on EBSCOhost and PubMed were searched. Three systematic reviews, four RCTs and three prospective cohort studies were retrieved and reviewed to answer these questions. Critical Appraisal- CASP checklists for systematic reviews/meta-analyses, randomised controlled trials (RCTs) and cohort studies were used for critical appraisal Results- All studies confirmed the beneficial effect of HAART in treating HAND and reducing neurocognitive impairment (NCI). Some questions remain unanswered especially concerning the prevention of HAND. Harezlak et al. (2011) indicated that cerebral inflammatory changes persist despite HAART use. Conclusions- HAART is effective in treating HAND/NCI in adult patients with HIV, though it is unclear whether HAART prevents HAND/NCI. Implications and Recommendations- It is evident that HAART can treat HAND/NCI. Further research is required to determine- whether it can prevent HAND/NCI, optimal treatment for HAND and adjuvant/adjunctive therapies targeting viral replication within the brain. Nurses should screen patients having HIV for NCI/HAND and be aware of predisposing risk factors. They should educate/inform patients regarding HAND/NCI. Health and social care policies should recognise the importance of HAND/NCI in the local context. Description: B.SC.(HONS)NURSING Wed, 01 Jan 2020 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/68119 2020-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/68099 Title: The effectiveness of mindfulness practices in reducing burnout in nurses Abstract: Brief overview of the topic: Nurse burnout is a global issue; they regularly experience high stress levels and burnout symptoms due to their demanding nature of their work. Meditative interventions have been found to decrease these psychological distresses and improve the well-being; however, studies are still being carried out about its effectiveness as an intervention. The aim of this dissertation is to understand how effective mindfulness practices are in reducing burnout in nurses. Research question: Using the PEO framework, the research question “Is mindfulness practice effective in reducing burnout in nurses”? was formulated. PEO Elements: Population (P): nurses, Exposure (E): Mindfulness practices, Outcome (O): reduced burnout. Methods: From the established PEO elements, alternative terms were generated. A search strategy was then formulated using Boolean operators and limiters. For a further comprehensive search, different databases were accessed being; Hydi, EBSCO, PubMed and Google Scholar, where a manual search was conducted. The PRISMA 2009 checklist was utilized to distinguish and reject unessential articles. A set of inclusion and exclusion criteria were constituted to additionally appraise the articles’ eligibility. Articles included were in the English language, peer reviewed and maximum 10-year old. Studies that had reduced stress and burnout in nurses and health care professionals (HCPs) were included, whilst others that tackled different populations and outcomes were not. As for the study design, only the best sources of evidence were accepted to answer this PEO question. Seven articles were identified; 3 Meta-analysis, 2 Systematic reviews and 2 Randomised control trials (RCTs). The CASP tool for systematic reviews and RCTs were used to critically appraise the articles. 3 Results: All seven articles have statistically shown significant results in highlighting the fact that mindfulness practices reduce burnout and other domains like stress, exhaustion, anxiety and depression in nurses and HCPs. Conclusions: All key articles concluded that the intervention can be implemented in practice. Implications and recommendations: Local studies with a large sample size is necessary, as non were found, to identify if mindfulness interventions are effective in the Maltese population. Future research should focus to avoid self-selection sampling to eliminate selection bias, and avoid non-compliance by finding a short yet effective mindfulness practice for busy nurses. Description: B.SC.(HONS)NURSING Wed, 01 Jan 2020 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/68099 2020-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/68094 Title: Weight loss using motivational interviewing in children/adolescents Abstract: Background: Overweight/obesity is one of the fastest growing global health risks among all age groups. In particular, childhood overweight/obesity is a serious threat as it precedes adulthood obesity and increases the risk of premature morbidity and mortality making it a health, social and economic burden. This highlights the importance for the need of treatment interventions. The aim of this dissertation was to investigate the effectiveness of Motivational Interviewing in comparison to other methods in bringing about weight lose among overweight/obese children and adolescents. The research question: Among overweight/obese children and adolescents, is motivational interviewing effective in bringing about weight loss? PICO elements: Population (P): Overweigh/obese children and/or adolescents, Intervention (I): Motivational Interviewing (MI), Comparison (C): Alternative methods, Outcome (O): Weight loss. Method: A comprehensive and systematic literature search was carried out using a variety of different synonyms and phrases, a number of electronic databases and different search tools and limiters to filter and narrow down the search. Inclusion criteria applied were; overweight/obese children/adolescents aged from three to nineteen years, MI as the intervention, a non-MI intervention as the comparator, weight loss as an outcome measured as BMI/z-score/percentile. Exclusion criteria applied were; participants having conditions or on medication which affect weight, studies aimed at parents, MI used for prevention rather than treatment, studies having no control group or providing no care to control group. Four randomised controlled trials and one quasi-experimental study were identified. The RCT Critical Appraisal Skills Programme (CASP) tool was used to critically appraise the identified literature. Ethical issues were also considered. Results: The analysed findings demonstrate that MI might be more effective than alternative method in bringing about weight loss in overweight/obese children and adolescents. Conclusion: Study findings should be interpreted with caution and until more evidence becomes available a definitive conclusion on the effectiveness of MI on bringing about weight loss cannot be deduced. Implications and recommendations: Apart from the standard health education already provided in schools, MI can also be incorporated into the curriculum. Furthermore, the healthcare sector can look at setting up paediatric health clinics where behavioural counselling including MI is provided. Management should provide healthcare workers with guidelines and training on how to incorporate MI into their care. Nonetheless, further research to overcome outlined methodological limitations to better determine the effectiveness of MI interventions, is required. Description: B.SC.(HONS)NURSING Wed, 01 Jan 2020 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/68094 2020-01-01T00:00:00Z