Purpose: The use of simulation has become a routine part of education and training for health professionals in many health education facilities. The increased awareness of patient safety and recent advances in technology are the main incentives to use simulation to teach and evaluate clinical competencies. The primary purpose of this study was to review the best available evidence (level and quality) for the use of simulation training to improve clinical skills, knowledge, and self-confidence among healthcare students. Method: A systematic review of qualitative and quantitative literature published between 2000 and 2016 was undertaken using databases including PubMed, CINAHL®, and PsycINFO® databases as well as three journal collections within ProQuest. In addition to the database search, the literature search for this study included two additional activities: search results were compared against the bibliographies of the reviewed studies, and Google Scholar was used to search the Internet for relevant publications. Data from studies meeting inclusion criteria was extracted and summarized. The level and strength of evidence was rated for each study. Results: Of 1412 studies identified via the search strategy, 30 met the inclusion criteria for this systematic review. A wide variety of study designs, interventions, measurements, and simulation types were represented. Data for study location, health profession, sample size, purpose, simulation type, intervention, and outcome measure are presented via evidence tables by authors. Statistically and/or clinically significant improvements in knowledge, skills, and/or self-confidence following simulation training were reported. Primary and secondary outcomes were identified and summarized. Conclusions: Evidence demonstrates that the use of simulation in student education significantly improves knowledge, skills, and self-confidence. A quality improvement framework of five best practice components for application in simulation research is proposed, generated from the findings of this review. Future research employing high quality research designs focusing on debriefing practices, interprofessional education applications, validation of outcome measures, student satisfaction, and long-term information retention will contribute to the growing body of literature supporting best practices for simulation training in healthcare.
Purpose Tai chi is receiving increasing research attention with its benefit of improving flexibility and balance. The objective of this review was to examine the evidence concerning the impact of tai chi as a practical therapy for vestibular rehabilitation on individuals with balance and vestibular disorders. Method A systematic review using 4 electronic databases was conducted. Randomized clinical trials and quasi-experimental studies were included. Results Four studies met the inclusion criteria and were included for data analysis. Results indicate positive effect of tai chi practice on dynamic postural stability in balance of its practitioners. Conclusion Tai chi may be a useful therapy as for vestibular rehabilitation as it improves dynamic balance control and flexibility of individuals with balance and vestibular disorders.
The ability of certain foods to impair or augment the absorption of various vitamins and minerals has been recognized for many years. However, the contribution of botanical dietary supplements (BDSs) to altered micronutrient disposition has received little attention. Almost half of the US population uses some type of dietary supplement on a regular basis, with vitamin and mineral supplements constituting the majority of these products. BDS usage has also risen considerably over the last 2 decades, and a number of clinically relevant herb-drug interactions have been identified during this time. BDSs are formulated as concentrated plant extracts containing a plethora of unique phytochemicals not commonly found in the normal diet. Many of these uncommon phytochemicals can modulate various xenobiotic enzymes and transporters present in both the intestine and liver. Therefore, it is likely that the mechanisms underlying many herb-drug interactions can also affect micronutrient absorption, distribution, metabolism, and excretion. To date, very few prospective studies have attempted to characterize the prevalence and clinical relevance of herb-micronutrient interactions. Current research indicates that certain BDSs can reduce iron, folate, and ascorbate absorption, and others contribute to heavy metal intoxication. Researchers in the field of nutrition may not appreciate many of the idiosyncrasies of BDSs regarding product quality and dosage form performance. Failure to account for these eccentricities can adversely affect the outcome and interpretation of any prospective herb-micronutrient interaction study. This review highlights several clinically relevant herb-micronutrient interactions and describes several common pitfalls that often beset clinical research with BDSs.
INTRODUCTION: There is limited information on the transparency of gastroenterology clinical trials. METHODS: The ClinicalTrials.gov database was searched for trials focused on most common gastrointestinal diseases up to August 2018. Adherence to reporting of results to the database or in publication form was recorded for each trial along with trial characteristics. RESULTS: Of the 2,429 trials included in the final analysis, 1824 (75%, 95% confidence interval: 73.4%–76.8%) had results on ClinicalTrials.gov or in the form of a publication. However, only 534 (29%) had results posted on ClinicalTrials.gov. DISCUSSION: Improvement of clinical trial transparency is needed in gastroenterology.
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