Purpose: This systematic review aimed to provide a comprehensive overview of the validity and reliability of existing measurement instruments for quantifying head and neck lymphedema. Methods: Four databases were searched on January 31st, 2022. The COnsensus-based Standards for selecting health Measurement INstruments (COSMIN) checklists were used for the risk of bias (ROB) assessment. Results: Out of 3362 unique records, eight studies examined the reliability and validity of five measurement instruments of which one patient reported outcome. The Patterson scale for internal lymphedema and the patient reported head and neck external lymphedema and fibrosis (LIDS-H&N) demonstrated validity and reliability. For external lymphedema, none of the instruments had good reliability for all measuring points. Conclusion: There is a lack of sufficiently reliable and valid measurement instruments for external head and neck lymphedema. The Patterson scale and the patient reported LIDS-H&N seem reliable for clinical practice and research.
When physicians and nurses are looking at the same patient, they may not see the same picture. If assuming that the clinical reasoning of both professions is alike and ignoring possible differences, aspects essential for care can be overlooked. Understanding the multifaceted concept of clinical reasoning of both professions may provide insight into the nature and purpose of their practices and benefit patient care, education and research. We aimed to identify, compare and contrast the documented features of clinical reasoning of physicians and nurses through the lens of layered analysis and to conduct a simultaneous concept analysis. The protocol of this systematic integrative review was published doi: 10.1136/bmjopen-2021-049862. A comprehensive search was performed in four databases (PubMed, CINAHL, Psychinfo, and Web of Science) from 30th March 2020 to 27th May 2020. A total of 69 Empirical and theoretical journal articles about clinical reasoning of practitioners were included: 27 nursing, 37 medical, and five combining both perspectives. Two reviewers screened the identified papers for eligibility and assessed the quality of the methodologically diverse articles. We used an onion model, based on three layers: Philosophy, Principles, and Techniques to extract and organize the data. Commonalities and differences were identified on professional paradigms, theories, intentions, content, antecedents, attributes, outcomes, and contextual factors. The detected philosophical differences were located on a care-cure and subjective-objective continuum. We observed four principle contrasts: a broad or narrow focus, consideration of the patient as such or of the patient and his relatives, hypotheses to explain or to understand, and argumentation based on causality or association. In the technical layer a difference in the professional concepts of diagnosis and the degree of patient involvement in the reasoning process were perceived. Clinical reasoning can be analysed by breaking it down into layers, and the onion model resulted in detailed features. Subsequently insight was obtained in the differences between nursing and medical reasoning. The origin of these differences is in the philosophical layer (professional paradigms, intentions). This review can be used as a first step toward gaining a better understanding and collaboration in patient care, education and research across the nursing and medical professions.
MULTIFILE
Developmental Transformations (DvT), a practice involving interactive, improvisational play in pairs or groups, has gained international appeal as a therapeutic intervention for different populations in a variety of health, care and recreational contexts. However, a rigorous review of the benefits of DvT has not been conducted. The purpose of this study was to review extant literature for the observed benefits of DvT, identify gaps in the literature and make recommendations concerning future research including identifying possible areas for outcome measurement for preliminary studies. The authors, who each completed training in this approach, conducted a scoping review of English-language, published, peer-reviewed and grey DvT literature through 2021. From an initial 745 records retrieved through databases and a manual search, 51 publications met criteria, which, when analysed using in-vivo and pattern coding, resulted in a total of seventeen categories of observed benefits ascribed to DvT. These included six general categories – relational, emotional, social, cognitive, behavioural and physical benefits – and eleven complex categories of benefits to participants across the lifespan. In addition to benefits for participants, benefits of DvT were also observed and reported for facilitators, therapists, teachers and supervisors engaged in this practice. This review revealed inconsistencies regarding the reporting of practitioner training, frequency, format, population, intended goals, assessment measures and outcomes. Future studies with increased experimental rigor, standardized outcome measures and consistent reporting are recommended.
