Background Levothyroxine replacement therapy may decrease the risk of adverse pregnancy outcomes among women with subclinical hypothyroidism (SCH). The aim of this study is to conduct a systematic review and meta-analysis to examine the risk of adverse pregnancy, perinatal, and early childhood outcomes among women with SCH treated with levothyroxine. Methods A systematic literature search was conducted using Ovid-Medline, Ovid-EMBASE, Pubmed (non-Medline), Ebsco-CINAHL Plus with full text and Cochrane Library databases. Randomized controlled studies (RCTs) and observational studies examining the association between treatment of SCH during pregnancy and our outcomes of interest were included. Studies that compared levothyroxine treatment versus no treatment were eligible for inclusion. Data from included studies were extracted and quality assessment was performed by two independent reviewers. Results Seven RCTs and six observational studies met our inclusion criteria. A total of 7342 individuals were included in these studies. RCTs demonstrated several sources of bias, with lack of blinding of the participants or research personnel; only one study was fully blinded. In the observational studies, there was moderate to serious risk of bias due to lack of adjustment for certain confounding variables, participant selection, and selective reporting of results. Pooled analyses showed decreased risk of pregnancy loss (RR: 0.79; 95% CI: 0.67 to 0.93) and neonatal death (RR: 0.35; 95% CI: 0.17 to 0.72) associated with levothyroxine treatment during pregnancy among women with SCH. There were no associations between levothyroxine treatment and outcomes during labour and delivery, or cognitive status in children at 3 or 5 years of age. Conclusion Treatment of SCH with levothyroxine during pregnancy is associated with decreased risks of pregnancy loss and neonatal death. Given the paucity of available data and heterogeneity of included studies, additional studies are needed to address the benefits of levothyroxine use among pregnant women with SCH.
Background: Vascular access devices (VAD), centrally (CVAD) or peripherally (PIV) located, are common in the nursing profession. A high proportion of admitted patients require a VAD to enable administration of intravenous treatments or diagnostic modalities. As the primary caregivers for these patients, nurses are responsible for ongoing care and maintenance of these devices. Objective: This scoping review examines the current state of practicing nurses knowledge around routine care and maintenance of adult VADs. Methods: In the fall of 2018, the following databases were searched: Medline-Ovid 1946 to current, Embase-Ovid 1947 to current, Ebsco CINAHL Plus with full text and ProQuest Nursing & Allied Health database, and articles were selected according to the PRISMA-ScR checklist. Inclusion criteria: original research published in peerreviewed journals; in English or French; and focused on practising nurses' knowledge about the routine care and maintenance of adult VADs. Results: Of the 4,099 abstracts identified, 36 full-text articles were included. Study characteristics are reportedin addition to themes found in the literature: the relationship between demographic data and CVAD/PIV knowledge, the state of nurses' CVAD/PIV knowledge and nurses' CVAD/PIV knowledge scores. Overall, significant gaps in nurses' knowledge on the care and maintenance of VADs are noted. Conclusion: The variability in nurses' knowledge around both CVAD and PIV led the authors to conclude that there is room for improvement in the educational preparation of nurses and a need for workplace training. Relevance to Clinical Practice: This scoping review intends to highlight the knowledge gap of nurses with regard to best practices for VAD routine care and maintenance and demonstrate the need for education, both in educational and healthcare institutions, to ensure high-quality care and improved patient outcomes.
Objective The aims of this study were to evaluate the readability, suitability, and quality of publicly available online self‐management (SM) resources for people with cancer. Methods Resources were identified using two strategies: (1) a targeted search of 20 Canadian organizations and (2) a Google search. These were evaluated using the Suitability Assessment of Materials (SAM), the DISCERN tool for quality, and readability indices. The SM skills (e.g., problem‐solving) and symptom management strategies addressed by each resource were also assessed. Descriptive and hierarchical cluster analyses were performed to identify resources of the highest suitability and quality as well as resource characteristics associated with higher quality and suitability. Results A total of 92 resources were evaluated. The mean reading grade level for English resources was 10.29 (SD = 1.64, range of 7.05 to 15.09) and 12.62 for French resources (SD = 2.27, range of 10.12 to 15.65). The mean SAM score across the sample was 50.4% (SD = 10.6%), or ‘adequate’, and the mean DISCERN score was 61.1% (SD = 11.8%), or ‘fair’. The cluster analysis indicated that 10 resources scored highly on both the SAM and the DISCERN. In total, 91 symptom management strategies were identified. On average, resources addressed 2.73 SM skills (SD = 1.58). Conclusions There is a need for plain language resources for people with lower reading ability and resources that incorporate more SM skills. Study findings will help healthcare professionals, patients, and their families identify optimal resources to address cancer‐related symptoms.
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