Academic literature on the topic '111003 Clinical Nursing: Secondary (Acute Care)'
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Journal articles on the topic "111003 Clinical Nursing: Secondary (Acute Care)"
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Mc Lernon, Siobhan, Philip S. Nash, and David Werring. "Acute spontaneous intracerebral haemorrhage: treatment and management." British Journal of Neuroscience Nursing 18, no. 3 (June 2, 2022): 116–24. http://dx.doi.org/10.12968/bjnn.2022.18.3.116.
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Acute spontaneous intracerebral haemorrhage is a devastating form of stroke, with high rates of mortality and disability in survivors. Despite the burden of intracerebral haemorrhage, there remain few effective treatments that improve the patient outcome when compared to ischaemic stroke. Nonetheless, patients still benefit from specialist stroke unit care, including early interventions to prevent complications. Therapeutic nihilism should be avoided during the acute phase, as well as early care limitations. A proactive multi-targeted approach based on therapeutic strategies to prevent early haematoma expansion and attenuation of secondary brain injury are likely to be important in improving patient outcomes.
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Kalánková, Dominika, Daniela Bartoníčková, Ewelina Kolarczyk, Katarína Žiaková, and Agnieszka Młynarska. "Factors Contributing to Rationed Nursing Care in the Slovak Republic—A Secondary Analysis of Quantitative Data." International Journal of Environmental Research and Public Health 19, no. 2 (January 8, 2022): 702. http://dx.doi.org/10.3390/ijerph19020702.
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Rationed nursing care is a significant problem in healthcare facilities worldwide. Awareness of contributing factors to rationed care might support the development and implementation of strategies for reducing this phenomenon from clinical practice. The study examined the association between selected hospital, unit, and staff variables and the prevalence of rationed nursing care. Secondary analysis of cross-sectional data collected between December 2017 and July 2018 from 895 registered nurses in seven acute care hospitals in the Slovak Republic was performed. Data were collected using the questionnaire Perceived Implicit Rationing of Nursing and analyzed by descriptive and inferential statistics in the statistical program SPSS 25.0. Statistically significant associations were found between rationed nursing care and unit type, education, shift type, nurses’ experience in the current unit, overtime hours, missed shifts, intention to leave the position, perceived staff adequacy, quality of patient care, and job satisfaction. Differences in rating rationed nursing care, quality of patient care, and job satisfaction were identified based on hospital type. Together with top hospital management, nurse managers should develop targeted interventions focusing on mitigating rationed nursing care from the clinical practice with a focus placed on university hospitals. Quality and safe care might be ensured through constant monitoring of the quality of patient care and job satisfaction of nurses as these factors significantly predicted the estimates of rationed nursing care.
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Tan, Maria, Andrea Adjetey, Catalina Wee, Ian Perry, Chris Corbett, Azeez Olajide, Aaron Yamamoto, James Owen, and Saqib Mumtaz. "Decompensated cirrhosis: targeted training of acute medical teams to improve quality of care in first 24 hours." British Journal of Nursing 31, no. 21 (November 24, 2022): 1112–19. http://dx.doi.org/10.12968/bjon.2022.31.21.1112.
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Background: A quality improvement project in a secondary care centre was initiated to investigate and evaluate the impact of staff education and the use of the British Society of Gastroenterology/British Association for the Study of the Liver cirrhosis care bundle in improving care of patients admitted to hospital with decompensated liver cirrhosis. Method: A staff training programme was implemented, involving around 30 health professionals consisting of consultants, junior doctors, physician associates and nurses from the acute medical unit. A review of electronic documentation and analysis of key clinical parameters, pre- and post-intervention, was carried out. Results: The data show that the intervention has led to an improvement in patient management and clinical outcomes. Conclusion: This project illustrates that collaboration between hepatology and medical teams, with emphasis on education and training, benefits patients who present to hospital with decompensated liver cirrhosis.
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Gott, Merryn, Christine Ingleton, Michael I. Bennett, and Clare Gardiner. "Transitions to palliative care in acute hospitals in England: qualitative study." BMJ 342 (2011): d1773. http://dx.doi.org/10.1136/bmj.d1773.
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Objective To explore how transitions to a palliative care approach are perceived to be managed in acute hospital settings in England.Design Qualitative study.Setting Secondary or primary care settings in two contrasting areas of England.Participants 58 health professionals involved in the provision of palliative care in secondary or primary care.Results Participants identified that a structured transition to a palliative care approach of the type advocated in UK policy guidance is seldom evident in acute hospital settings. In particular they reported that prognosis is not routinely discussed with inpatients. Achieving consensus among the clinical team about transition to palliative care was seen as fundamental to the transition being effected; however, this was thought to be insufficiently achieved in practice. Secondary care professionals reported that discussions about adopting a palliative care approach to patient management were not often held with patients; primary care professionals confirmed that patients were often discharged from hospital with “false hope” of cure because this information had not been conveyed. Key barriers to ensuring a smooth transition to palliative care included the difficulty of “standing back” in an acute hospital situation, professional hierarchies that limited the ability of junior medical and nursing staff to input into decisions on care, and poor communication.Conclusion Significant barriers to implementing a policy of structured transitions to palliative care in acute hospitals were identified by health professionals in both primary and secondary care. These need to be addressed if current UK policy on management of palliative care in acute hospitals is to be established.
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Duncan, Pamela W., Cheryl Bushnell, Mysha Sissine, Sylvia Coleman, Barbara J. Lutz, Anna M. Johnson, Meghan Radman, Janet Pvru Bettger, Richard D. Zorowitz, and Joel Stein. "Comprehensive Stroke Care and Outcomes." Stroke 52, no. 1 (January 2021): 385–93. http://dx.doi.org/10.1161/strokeaha.120.029678.
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Worldwide, stroke is prevalent, costly, and disabling in >80 million survivors. The burden of stroke is increasing despite incredible progress and advancements in evidence-based acute care therapies and despite the substantial changes being made in acute care stroke systems, processes, and quality metrics. Although there has been increased global emphasis on the importance of postacute stroke care, stroke system changes have not expanded to include postacute care and outcome follow-up. Our objectives are to describe the gaps and challenges in postacute stroke care and suboptimal stroke outcomes; to report on stroke survivors’ and caregivers’ perceptions of current postacute stroke care and their call for improvements in follow-up services for recovery and secondary prevention; and, ultimately, to make the case that a paradigm shift is needed in the definition of comprehensive stroke care and the designation of Comprehensive Stroke Center. Three recommendations are made for a paradigm shift in comprehensive stroke care: (1) criteria should be established for designation of rehabilitation readiness for Comprehensive Stroke Centers, (2) The American Heart Association/American Stroke Association implement an expanded Get With The Guidelines–Stroke program and criteria for comprehensive stroke centers to be inclusive of rehabilitation readiness and measure outcomes at 90 days, and (3) a public health campaign should be launched to offer hopeful and actionable messaging for secondary prevention and recovery of function and health. Now is the time to honor the patients’ and caregivers’ strongest ask: better access and improved secondary prevention, stroke rehabilitation, and personalized care.
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Bourassa, Stephane, Emmanuelle Paquette-Raynard, Daniel Noebert, Marc Dauphin, Pelumi Samuel Akinola, Jason Marseilles, Philippe Jouvet, and Jacinthe Leclerc. "Gaps in Prehospital Care for Patients Exposed to a Chemical Attack – A Systematic Review." Prehospital and Disaster Medicine 37, no. 2 (March 11, 2022): 230–39. http://dx.doi.org/10.1017/s1049023x22000401.
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AbstractIntroduction:The survivability of mass casualties exposed to a chemical attack is dependent on clinical knowledge, evidence-based practice, as well as protection and decontamination capabilities. The aim of this systematic review was to identify the knowledge gaps that relate to an efficient extraction and care of mass casualties caused by exposure to chemicals.Methods:This systematic review was conducted from November 2018 through September 2020 in compliance with Cochrane guidelines. Five databases were used (MEDLINE, Web of Science Core Collection, Embase, Cochrane, and CINAHL) to retrieve studies describing interventions performed to treat victims of chemical attacks (protection, decontamination, and treatment). The outcomes were patient’s health condition leading to his/her stabilization (primary) and death (secondary) due to interventions applied (medical, protection, and decontamination).Results:Of the 2,301 papers found through the search strategy, only four publications met the eligibility criteria. According to these studies, the confirmed chemical poisoning cases in acute settings resulting from the attacks in Matsumoto (1994), Tokyo (1995), and Damascus (2014) accounted for 1,333 casualties including 11 deaths. No study reported comprehensive prehospital clinical data in acute settings. No mention was made of the integration of specialized capabilities in medical interventions such as personal protective equipment (PPE) and decontamination to prevent a secondary exposure. Unfortunately, it was not possible to perform the planned meta-analysis.Conclusions:This study demonstrated gaps in clinical knowledge application regarding the medical extraction of casualties exposed during a chemical attack. Further research is required to optimize clinical practice integrating mixed capabilities (protection and decontamination) for the patient and medical staff.
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Rountree, W. Donald. "The Hemopump Temporary Cardiac Assist System." AACN Advanced Critical Care 2, no. 3 (August 1, 1991): 562–74. http://dx.doi.org/10.4037/15597768-1991-3020.
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The Hemopump temporary cardiac assist system is currently in clinical trials at several centers across the United States and abroad. Patients with postcardiotomy low cardiac output or patients with cardiogenic shock secondary to acute myocardial infarction may greatly benefit from this device. Theory of pump operation, patient selection, and nursing management is discussed. Presentation of a case study demonstrating the effect of Hemopump support will be provided. A detailed nursing care plan as well as application of research findings to clinical practice will be outlined. As cardiovascular technology progresses, the critical care nurse must continue to be involved in all aspects of patient care. The Hemopump may prove to be a highly beneficial mode of ventricular assistance for patients with inadequate cardiac function
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Yang, Meijuan, Lijiao Chen, Min Zhang, Xiaoling Huang, Wenjun Zhao, and Hui Wang. "Evidence-Based Nursing Model in Interventional Thrombolysis for Acute Lower Extremity Arterial Embolism." Contrast Media & Molecular Imaging 2022 (May 25, 2022): 1–9. http://dx.doi.org/10.1155/2022/4488797.
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Acute lower extremity arterial embolism (AE) is a serious clinical emergency, and, if not treated in time, it can easily lead to limb ischemia and necrosis and eventually facing amputation, which seriously damages patients' physical and mental health. In the past, the conventional drug thrombolytic therapy had slow and limited efficacy, and the best time for treatment is easily delayed, while arterial dissection and thrombectomy treatment, although fast, is traumatic and has many complications, which is not easily accepted by patients. The aim of this study was to investigate the value of evidence-based care model in the application of interventional thrombolysis for acute lower limb arterial embolism. Seventy-two patients with acute lower limb arterial embolism who underwent interventional thrombolysis treatment received by the Department of Vascular Surgery of our hospital from July 2016 to December 2021 were randomly divided into a control group (given conventional nursing services) and a quality group (given full quality nursing services) to compare the effect of nursing services in the two groups. The results showed that the postoperative psychological status of patients in the quality group was significantly better than that of patients in the control group ( P < 0.05 ). The total incidence of postoperative adverse events and the total treatment efficiency of the quality group were better than those of the control group ( P < 0.05 ). The efficacy of quality nursing care in patients with acute lower extremity arterial embolism is more desirable than conventional nursing care and is recommended. The site of vascular occlusion after bypass surgery can be clarified when angiography is performed after thrombolytic therapy, which can help secondary surgical intervention to prolong the time to patency. The efficacy of quality nursing care in patients with acute lower extremity arterial embolism is more desirable than that of conventional nursing care and is recommended.
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Quinn, Charlene C., Anthony Roggio, Barr Erik, and Ann Gruber-Baldini. "NURSING HOME TELEED INTERVENTION: ADVANCING NEW CARE MODELS." Innovation in Aging 3, Supplement_1 (November 2019): S337—S338. http://dx.doi.org/10.1093/geroni/igz038.1225.
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Abstract New reimbursement and managed care models demonstrate the need to reduce avoidable Emergency Department (ED) use and limit preventable inpatient admissions for older adults in Skilled Nursing Facilities (SNF). The objective was to develop an ED telemedicine consultation intervention for SNF residents with acute medical problems. Secondary objectives including evaluation of health care utilization, provider satisfaction. Demonstration evaluation in three urban SNFs, telemedicine linked to university medical center ED. Mobile telemedicine cart equipment assessed SNF residents for any change in condition. ED physicians used tablets with secure access to conduct the resident assessment. Provider satisfaction measures imbedded in EMRs were completed at consultation visit end. 460 patients had changes in condition, 327 resulted in 911 calls, 85 deemed eligible for telemedicine consult. Conducted 57 telehealth consults. Forty (70%) telemedicine consult residents remained in the SNF. Fourteen residents were transferred to the ED. Average satisfaction scores were 5.8/7 for SNF nurses (n=49) and 5.6 for ED physicians (n=45). Lower-rated items related to technical equipment problems. ED physicians reported residents transferred to ED after telehealth visit had better continuity of care. The intervention was effective in preventing or delaying transfer of acutely ill, medically complex SNF residents. Implementation of the intervention identified need for SNF admission policy and procedure changes; weekly telemedicine training; SNF clinical advocates; on-site tracking and linkage of EMRs across providers; HIPAA shared medical record concerns. Future research plans include analyses of detailed SNF resident characteristics and business case assessment for reduction of transfers, ED and hospital utilization.
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Fuentes, Blanca, María Alonso de Leciñana, Sebastián García-Madrona, Fernando Díaz-Otero, Clara Aguirre, Patricia Calleja, José A. Egido, et al. "Stroke Acute Management and Outcomes During the COVID-19 Outbreak." Stroke 52, no. 2 (February 2021): 552–62. http://dx.doi.org/10.1161/strokeaha.120.031769.
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Background and Purpose: The coronavirus disease 2019 (COVID-19) outbreak has added challenges to providing quality acute stroke care due to the reallocation of stroke resources to COVID-19. Case series suggest that patients with COVID-19 have more severe strokes; however, no large series have compared stroke outcomes with contemporary non–COVID-19 patients. Purpose was to analyze the impact of COVID-19 pandemic in stroke care and to evaluate stroke outcomes according to the diagnosis of COVID-19. Methods: Retrospective multicenter cohort study including consecutive acute stroke patients admitted to 7 stroke centers from February 25 to April 25, 2020 (first 2 months of the COVID-19 outbreak in Madrid). The quality of stroke care was measured by the number of admissions, recanalization treatments, and time metrics. The primary outcome was death or dependence at discharge. Results: A total of 550 acute stroke patients were admitted. A significant reduction in the number of admissions and secondary interhospital transfers was found. COVID-19 was confirmed in 105 (19.1%) patients, and a further 19 patients were managed as suspected COVID-19 (3.5%). No differences were found in the rates of reperfusion therapies in ischemic strokes (45.5% non–COVID-19, 35.7% confirmed COVID-19, and 40% suspected COVID-19; P =0.265). However, the COVID-19 group had longer median door-to-puncture time (110 versus 80 minutes), which was associated with the performance of chest computed tomography. Multivariate analysis confirmed poorer outcomes for confirmed or suspected COVID-19 (adjusted odds ratios, 2.05 [95% CI, 1.12–3.76] and 3.56 [95% CI, 1.15–11.05], respectively). Conclusions: This study confirms that patients with COVID-19 have more severe strokes and poorer outcomes despite similar acute management. A well-established stroke care network helps to diminish the impact of such an outbreak in stroke care, reducing secondary transfers and allowing maintenance of reperfusion therapies, with a minor impact on door-to-puncture times, which were longer in patients who underwent chest computed tomography.
Dissertations / Theses on the topic "111003 Clinical Nursing: Secondary (Acute Care)"
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Gibson, Maria. "Dangerous liaisons : enterprise rationality, nursing practice and the regulation of hospital care to older people." 2010. http://arrow.unisa.edu.au:8081/1959.8/97568.
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Population ageing has been posed as a problem for contemporary governing in relation to the allocation and consumption of finite health care resources, in particular acute hospital care. This thesis explores how nursing practice is a key resource in the management of this ???problem???. Employing Foucault???s concept of governmentality, nursing practice is examined as a form of social government that is central to the regulation of hospital care to older people. A governmentality approach enables consideration of the relationship between the macro political context of governing, as embodied in prevailing political rationalities, and their outworking beyond the arenas of formal government in the micro practices of nurses. Specifically, in this research, it reveals how contemporary entrepreneurial rationalities of governing work at a distance to discursively shape the local practices of nurses in the regulation of hospital care to older people. Discourse analysis of interview texts, literature and documents revealed how enterprise rationality was invested in the discourses circulating in the study site, highlighting the power relationships and subject positions available to registered nurses and outcomes produced in the regulation of hospital care to older people. The analysis details how registered nurses activated a range of technologies and practices as they engaged with enterprise discourses, constituting nursing practice as an activity aimed at making up older people as dischargeable subjects. It shows how enterprise is both a practice and way of thinking that directs us toward a particular truth of hospital, hence nursing, care of older people. The thesis illustrates how changes in the ways of governing hospitals have actively transformed the meaning and practice of nursing in the provision of hospital care to older people. It shows how the values and practices that make entrepreneurial modes of government possible penetrate each layer of an organisation and can create new mentalities or ways of thinking. This was evident in this research whereby an entrepreneurial mode of governance had re-imagined the social practice of nursing as a form of the economic, such that neither recovery, nor health, but discharge assumed pre-eminence as the focus and aim of hospital care for older people and hence the goal of nursing practice. These findings suggest that hospital care of older people has become a political and economic, rather than therapeutic concern. Furthermore, nursing interventions in the hospital care of older people have become administrative rather than therapeutic, with nursing practice focused on individual older people only insofar as they are constituted as part of a population at risk of delayed discharge. The thesis contends that nurses are implicated in the politics of health care in new and different ways amid entrepreneurial rationalities of governing that promote an ethos of risk management, individualism and responsibilisation in relation to health. It argues that the replacement of an ethos of nursing as care based on client need with an ethos of nursing as risk management substitutes the therapeutic intent and practices of nursing with the technical intent of managing risk. In so doing, the thesis illustrates dangers and possibilities arising from the re-framing of health care through entrepreneurial modes of governance. It enables a critically informed consideration of what kind of practice acute care nursing could be into the future and how nurses and others can take action to positively contribute to the futures of older people they provide care to.Thesis (PhD)--University of South Australia, 2010
Books on the topic "111003 Clinical Nursing: Secondary (Acute Care)"
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Barrera, Alvaro, Caroline Attard, and Rob Chaplin, eds. Oxford Textbook of Inpatient Psychiatry. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198794257.001.0001.
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Acute inpatient mental health care remains an irreplaceable part of some people’s mental health recovery pathway, either through the severity of their difficulties or the associated risks. It can often be a traumatic experience associated with distress and vulnerability both for patients and their relatives. Modern acute inpatient psychiatric care must undoubtedly be truly multidisciplinary and part of a wider community-based system. It must emphasize dignity, compassion, and well-being as well as addressing challenges such as involuntary admissions, cultural diversity, physical comorbidities, and the needs of relatives, just to name a few. The present textbook focuses on these and related issues in a way that is relevant to frontline clinicians dealing with them daily, with medical, nursing, and legal aspects going hand in hand with topics such as team leadership or multidisciplinary work. The textbook describes inpatient services as provided in England, so it describes work that takes place within a national health service free at the point of delivery, carried out by universal primary care as well as secondary mental health care services, both operating within clinical governance structures that seek quality improvement and accountability. Crucially, both the Mental Health Act and the Mental Capacity Act provide unique legal frameworks for the care of mental ill health. The editors hope that for readers in the UK and beyond, the textbook will provide a real-life system which can be questioned and problematized and, in that way, may help to orient clinical work.
Book chapters on the topic "111003 Clinical Nursing: Secondary (Acute Care)"
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Ugboma, Debra, and Helen Willis. "Understanding Renal Disorders." In Adult Nursing Practice. Oxford University Press, 2012. http://dx.doi.org/10.1093/oso/9780199697410.003.0021.
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The aim of this chapter is to provide nurses with the knowledge to be able to assess, manage, and care for people with the renal disorders chronic kidney disease (CKD) and acute kidney injury (AKI) in an evidence-based and person-centred way. In recent years, AKI has replaced the term ‘acute renal failure’. The chapter will provide a comprehensive overview of the causes, risk factors, and impact of CKD and AKI, before exploring best practice to deliver care, as well as to prevent further progression of these conditions. Nursing assessments and priorities are highlighted throughout, and further nursing management of some of the symptoms and common health problems associated with CKD and AKI can be found in Chapters 6, 9, 15, and 19, respectively. Chronic kidney disease (CKD) is the gradual and usually permanent loss of some kidney function over time (Department of Health, 2007). In CKD, the damage and decline in renal function usually occurs over years, and in early stages can go undetected (Department of Health, 2005a). CKD has rapidly moved up the healthcare agenda in recent years, primarily because of the links with cardiovascular risk, and with a shift in focus away from the treatment of established renal failure towards the detection and prevention of CKD in primary care (O’Donohue, 2009). Glomerular filtration rate (GFR) is an indicator of renal function and is the rate at which blood flows through, and is ‘filtered’ by, the kidney; a normal GFR is approximately 125 ml/min. CKD is classified into five stages according to an estimated glomerular filtration rate (eGFR) and, in the milder stages, further evidence of renal damage such as proteinuria and haematuria. This classification holds regardless of the underlying cause of kidney damage. The understanding of GFR is pivotal to caring for patients with renal disorders. Monitoring, management, and referral of the patient in the earlier stages of CKD became much clearer following the publication of the National Clinical Guidelines for the Management of Adults with Chronic Kidney Disease in Primary and Secondary Care (NICE, 2008a). Many people with stage 3 CKD, unless they have proteinuria, diabetes, or other comorbidity such as cardiovascular disease, have a good prognosis and can be managed in primary care (Andrews, 2008).
Conference papers on the topic "111003 Clinical Nursing: Secondary (Acute Care)"
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Ferreira, Hanna dos Santos, Agata Layanne Soares da Silva, and João Lucas de Sousa Peres. "Fibrinolytic therapy in the treatment of pediatric ischemic stroke." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.033.
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Introduction: Pediatric stroke is a disorder that can result in morbidity and mortality. The ischemic type is the most common and has thrombolytics as the preferred therapy. Objective: To evaluate the therapeutic management and efficacy of fibrinolytics in pediatric patients with ischemic stroke. Methodology: The literature review was carried out in PUBMED, MEDLINE, Embase databases, with the descriptors “Fibrinolytic Agents”, “Thrombolytic Therapy”, “Ischemic Stroke”, “Stroke”, “Pediatrics” and “Treatment”. Included were clinical trials, randomized controlled trials, cohort, case- control, and case series in English or Portuguese published in the last 5 years. It gathered 8 articles. Results: Treatment in the acute phase and for secondary prevention in the chronic phase of pediatric stroke are antithrombotic therapies and platelet antiaggregants, commonly aspirin. Comparing the latter and low molecular weight heparin, neither has shown superiority in preventing stroke recurrence. Without good evidence, however, aspirin is indicated for idiopathic stroke and anticoagulants in cardioembolic stroke by some guidelines. In recombinant tissue plasminogen activator therapy in one paper it was suggested there is more risk for conversion to hemorrhagic events compared to untreated, but in another paper hemorrhage was not seen. There was high mortality with this therapy and higher chances of being discharged to short term hospital, skilled nursing facility or intermediate care facility. In endovascular therapy, delay in diagnosis limits its use and stroke complications did not differ between patients who did or did not undergo this therapy. Conclusion: Further studies are needed to evaluate the efficacy of fibrinolytics.
Reports on the topic "111003 Clinical Nursing: Secondary (Acute Care)"
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Villa, Michele, Massimo Le Pera, and Michela Bottega. Quality of Abstracts in Randomized Controlled Trials Published in Leading Critical Care Nursing Journals. INPLASY - International Platform of Registered Systematic Review and Meta-analysis Protocols, June 2022. http://dx.doi.org/10.37766/inplasy2022.6.0039.
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Review question / Objective: This review aims to evaluate the methodological quality of RCT-abstracts in leading critical care nursing journals. A methodological quality review with the Consolidated Standards of Reporting Trials (CONSORT) criteria will be performed in RCT-abstracts published between 2011-2021 in the first Scopus-ranking (2021) nursing journals. Eligibility criteria: Abstracts of scientific articles will be included if they fulfil the following inclusion criteria: 1) they report the results of parallel and/or cross-over group RCTs, 2) they are written in English, 3) they refer to the care of adult patients with acute/critical illness or conducted in adult ICUs.Manuscripts reporting results of pilot or feasibility studies, cluster trials, observational or cohort studies, interim analyses, economic analyses of RCTs, post-trial follow-up studies, subgroup and secondary analyses of previously published RCTs, editorials and RCTs without an abstract such as RCTs published as letters to the editor, single-subject clinical trials will be excluded.