An Integrative Literature Review And Critical Reflection Of Intersectionality Theory, Ashley Ruiz, Jeneile Luebke, Katie Klein, Kaylen M. Moore, Michael Gonzalez, Anne Dressel, Lucy Mkandawire-Valhmu

College of Nursing Faculty Research and Publications

Intersectionality theory has been used by nursing scholars to offer insight into how multiple systems of oppression mutually interact to impact health and to examine how multiple social modes of existence shape individual and group experiences of health inequality. The application of intersectionality theory, however, requires a reflexive critical lens to more effectively inform nursing science and practice. We draw on a comprehensive integrative literature review to offer a critical reflection by considering the semantic and structural consistency, generalizability, simplicity and complexity, and the utility and value of intersectionality theory to nursing science and practice. If nurses are to effectively …

Telehealth And The Psychiatric Mental Health Nurse Practitioner: Beyond The Covid-19 Pandemic, Jessica L. Zemlak, Patty Wilson, Brigit Vangraafeiland, Tamar Rodney

College of Nursing Faculty Research and Publications

Objective:

Examine the advantages, disadvantages, and challenges of telehealth for the psychiatric mental health nurse practitioner (PMHNP) in practice and student education. Describe areas for future research and policy development regarding telehealth in PMHNP practice and training during and beyond the COVID-19 pandemic.

Methods:

Review current evidence, standards of practice, and education for the PMHNP.

Results:

Recent rapid pandemic-related shifts in utilization of telehealth for clinical practice and student education have highlighted the advantages, disadvantages, and areas in need of additional study.

Conclusions:

Postpandemic telehealth care delivery will likely persist or expand. PMHNPs must advocate for high practice and education …

Examining The Course Of Transitions From Hospital To Home-Based Palliative Care: A Mixed Methods Study, Stephanie Saunders, Marianne E. Weiss, Chris Meaney, Tieghan Killackey, Jaymie Varenbut, Emily Lovrics, Natalie Ernecoff, Amy T. Hsu, Maya Stern, Ramona Mahtani, Kirsten Wentlandt, Sarina R. Isenberg

College of Nursing Faculty Research and Publications

Background:

Hospital-to-home transitions in palliative care are fraught with challenges. To assess transitions researchers have used patient reported outcome measures and qualitative data to give unique insights into a phenomenon. Few measures examine care setting transitions in palliative care, yet domains identified in other populations are likely relevant for patients receiving palliative care.

Aim:

Gain insight into how patients experience three domains, discharge readiness, transition quality, and discharge-coping, during hospital-to-home transitions.

Design:

Longitudinal, convergent parallel mixed methods study design with two data collection visits: in-hospital before and 3–4 weeks after discharge. Participants completed scales assessing discharge readiness, transition quality, and …

Impacts Of Neonatal Hospitalization On Families During The 2019 Coronavirus Pandemic, Ashlee J. Vance, Kathryn J. Malin, Bingxin Chen, Clayton J. Shuman, Tiffany A. Moore

College of Nursing Faculty Research and Publications

Objective Limited data are available regarding family and financial well-being among parents whose infants were hospitalized during the 2019 coronavirus (COVID-19) pandemic. The study objective was to evaluate the family and financial well-being of parents whose infants were hospitalized in the neonatal intensive care unit (NICU) during COVID-19.

Study Design Parents were recruited for this online, cross-sectional survey via support groups on social media. Data collection was completed between May 18, 2020 and July 31, 2020. The final sample consisted of 178 parents, who had an infant hospitalized in an NICU between February 1, 2020 and July 31, 2020. The …

Promoting Patient Engagement: A Scoping Review Of Actions That Align With The Interactive Care Model, Georgia Tobiano, Teresa Jerofke-Owen, Andrea P. Marshall

College of Nursing Faculty Research and Publications

Background

Conceptual clarity for the term patient engagement is growing. However, there is variability in patient engagement in healthcare, which could be due to the absence of models to guide practice or a myriad of organisational, nurse and patient factors. The recently developed ‘Interactive Care Model’ provides guidance on how to genuinely promote individualised patient engagement. An understanding of how to action this model in nursing is required.

Aims

The aim of this scoping review was to examine actions in the published scientific literature that align with the Interactive Care Model, in the context of nursing care of hospitalised patients. …

Mixed Methods Study Of Nurse Assessment Of Patient Preferences For Engagement During Hospitalization, Teresa Jerofke-Owen, Alexandria Zielinski, Roger L. Brown

College of Nursing Faculty Research and Publications

Background

Global healthcare initiatives emphasize the importance of engaging patients in their healthcare to improve patients’ experience and outcomes. Assessing patient preferences for engagement is critical, as there are many ways patients can engage in their care and preferences vary across individuals.

Objective

The primary purpose of this study was to evaluate the effect of implementation of the Patient Preferences for Engagement Tool 13-Item Short Form (PPET13) during hospitalization on patient and nurse experience of engagement. Readmissions and emergency department (ED) usage within 30 days postdischarge were also examined.

Methods

The mixed methods study was conducted within two medical units …

Acute Care Pediatric Nurse Practitioners As Leaders: Perceptions, Self-Identity, And Role Congruity, Katie Mcdermott, Christine A. Schindler, Krisjon R. Olson, Tara L. Petersen

College of Nursing Faculty Research and Publications

Introduction

This study aimed to gain an understanding of practicing acute care pediatric nurse practitioners’ (AC-PNPs’) perceptions of themselves as leaders in both clinical and professional contexts.

Method

This qualitative study was conducted at a midwestern quaternary care children's hospital. Cultural domain analysis, semistructured interviews, and free listing techniques were employed to identify areas of consensus and variation among a convenience sample of AC-PNPs.

Results

Findings demonstrated the AC-PNPs have a limited self-view of leadership.

Discussion

Nurse practitioners need additional leadership capacity and capability building during graduate education, the transition to practice, and throughout their careers.

Medical Device-Related Pressure Injuries Associated With Electroencephalogram Leads In A Tertiary Care Children’S Hospital: A Retrospective Chart Review, Christine A. Schindler, Rebekah Barrette, Aaron Sandock, Evelyn M. Kuhn

College of Nursing Faculty Research and Publications

BACKGROUND: Medical device-related pressure injuries (MDRPIs) present a substantial safety risk for children who are hospitalized. PURPOSE: This study aimed to describe patient and clinical characteristics of children who develop MDRPIs related to electroencephalogram (EEG) leads, determine risk factors associated with their development, and determine if there are common risk factors that can lead to actionable strategies to reduce MDRPIs related to EEG leads. METHODS: A retrospective review was completed of the electronic health records of all 3136 children who had EEG lead placements between January 1, 2014, and April 16, 2018, at a large tertiary care children’s hospital. Data …

Colorectal Cancer In 18- To 49-Year-Olds: Rising Rates, Presentation, And Outcome In A Large Integrated Health System, Nimish Vakil, Kristin Ciezki, Maharaj Singh

College of Nursing Faculty Research and Publications

Background and Aims

Colorectal cancer (CRC) rates are increasing in young people, and new guidelines recommend screening should begin at age 45 years. We aimed to evaluate CRC detection rates in a large integrated healthcare system to assess treatment outcomes in younger CRC patients and to determine factors that could aid in identifying these individuals.

Methods

We analyzed confirmed cases of CRC using a cancer database spanning from 1985 to 2017 from a large integrated healthcare system composed of 15 hospitals, 150 outpatient clinics, and 20 outpatient oncology clinics. Three cohorts were evaluated (18-44 years, 45-49 years, and ≥50 years). …

A Predictive Model, And Predictors Of Under-Five Child Malaria Prevalence In Ghana: How Do Lasso, Ridge And Elastic Net Regression Approaches Compare?, Justice Moses K. Aheto, Henry Ofori Duah, Pascal Agbadi, Emmanuel Kweku Nakua

College of Nursing Faculty Research and Publications

Malaria is among the leading causes of mortality and morbidity among children in Ghana. Therefore, identifying the predictors of malaria prevalence in children under-five is among the priorities of the global health agenda. In Ghana, the paradigm shifts from using traditional statistics to machine learning techniques to identifying predictors of malaria prevalence are scarce. Thus, the present study used machine learning techniques to identify variables to build the best fitting predictive model of malaria prevalence in Ghana. We analysed the data on 2867 under-five children with malaria RDT results from the 2019 Ghana Malaria Indicator Survey. LASSO, Ridge, and Elastic …

Efficacy Of Invisalign Attachments: A Retrospective Study, Theresa Karras, Maharaj Singh, Emelia Karkazis, Dawei Liu, Ghada Nimeri, Bhoomika Ahuja

College of Nursing Faculty Research and Publications

Introduction: The purpose of this study was to compare the efficacy of Invisalign's (Align Technology, Santa Clara, Calif) optimized and conventional attachments on rotational and extrusive tooth movements. Methods: Initial, predicted, and achieved digital dental models from 100 orthodontic patients were exported from Invisalign's ClinCheck software as stereolithography files and subsequently imported into the Slicer CMF program (version 4.7.0; http://www.slicer.org) for superimpositions on posterior teeth with no planned movement. Rotational and extrusive measurements for both optimized and conventional attachments were made on 382 teeth from the superimposition of the initial and predicted models (predicted movement) and from the superimposed initial …

Using Debriefing For Meaningful Learning With Screen-Based Simulation, Kristina Dreifuerst, Cynthia S. Bradley, Brandon K. Johnson

College of Nursing Faculty Research and Publications

Background

COVID-19 has led to increased use of screen-based simulation. However, the importance of including a robust debriefing as a component of these simulations is often neglected.

Problem

Failing to include debriefing with screen-based simulation could negatively impact student learning outcomes.

Approach

Debriefing, including recollection, discussion to reveal understanding, feedback and reflection, is a process of helping learners make sense of learned content and knowledge as it is applied to the patient care experience. Debriefing for Meaningful Learning (DML) is an evidence-based method derived from theory, which can be easily incorporated into screen-based simulation to augment the clinical learning experience. …

The Other “Front Line”: Public Health Nursing Clinical Instruction During Covid-19, Lyndsay G. Degroot, Jessica L. Zemlak, Sarah E. Lafave, Lea Marineau, Deborah Wilson, Nicole Warren

College of Nursing Faculty Research and Publications

No abstract provided.

Effectiveness Of Home Health Care In Reducing Return To Hospital: Evidence From A Multi-Hospital Study In The Us, Danielle M. Siclovan, James Bang, Olga Yakusheva, Morris Hamilton, Kathleen L. Bobay, Linda L. Costa, Ronda G. Hughes, Jane M. Miles, Sarah J. Bahr, Marianne E. Weiss

College of Nursing Faculty Research and Publications

Background

Home health care, a commonly used bridge strategy for transitioning from hospital to home-based care, is expected to contribute to readmission avoidance efforts. However, in studies using disease-specific samples, evidence about the effectiveness of home health care in reducing readmissions is mixed.

Objective

To examine the effectiveness of home health care in reducing return to hospital across a diverse sample of patients discharged home following acute care hospitalization.

Research design

Secondary analysis of a multi-site dataset from a study of discharge readiness assessment and post-discharge return to hospital, comparing matched samples of patients referred and not referred for home …

Socio-Economic And Geographical Inequalities In Adolescent Fertility Rate In Ghana, 1993–2014, Bright Opoku Ahinkorah, Eugene Budu, Henry Ofori Duah, Joshua Okyere, Abdul-Aziz Seidu

College of Nursing Faculty Research and Publications

Background

Despite public health interventions to control adolescent fertility, it remains high in sub-Saharan Africa. Ghana is one of the countries in sub-Saharan Africa with the highest adolescent fertility rates. We examined the trends and socio-economic and geographical patterns of disparities in adolescent fertility in Ghana from 1993 to 2014.

Methods

Using the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the 1993–2014 Ghana Demographic and Health surveys were analyzed. First, we disaggregated adolescent fertility rates (AFR) by four equity stratifiers: wealth index, education, residence and region. Second, we measured the inequality through summary measures, namely …

Geographical Variations And Factors Associated With Recent Hiv Testing Prevalence In Ghana: Spatial Mapping And Complex Survey Analyses Of The 2014 Demographic And Health Surveys, Jerry John Nutor, Henry Ofori Duah, Precious Adade Duodu, Pascal Agbadi, Robert Kaba Alhassan, Ernest Darkwah

College of Nursing Faculty Research and Publications

Objective To examine the factors associated with recent HIV testing and to develop an HIV testing prevalence surface map using spatial interpolation techniques to identify geographical areas with low and high HIV testing rates in Ghana.

Design Secondary analysis of Demographic and Health Survey.

Setting Rural and urban Ghana

Participants The study sample comprised 9380 women and 3854 men of 15–49 years.

Results We found that 13% of women and 6% of men of Ghana had tested for HIV in the past 12 months. For women, being within the age groups of 15–39 years, being currently married, attainment of post-secondary …

Actual And Potential Impact Of A Home Nasogastric Tube Feeding Program For Infants Whose Neonatal Intensive Care Unit Discharge Is Affected By Delayed Oral Feedings, Joanne Lagatta, Michael Uhing, Krishna Acharya, Julie Ann Lavoie, Erin Rholl, Kathryn J. Malin, Margaret Malnory, Jonathan Leuthner, David C. Brousseau

College of Nursing Faculty Research and Publications

Objective

To compare healthcare use and parent health-related quality of life (HRQL) in 3 groups of infants whose neonatal intensive care unit (NICU) discharge was delayed by oral feedings.

Study design

This was a prospective, single-center cohort of infants in the NICU from September 2018 to March 2020. After enrollment, weekly chart review determined eligibility for home nasogastric (NG) feeds based on predetermined criteria. Actual discharge feeding decisions were at clinical discretion. At 3 months’ postdischarge, we compared acute healthcare use and parental HRQL, measured by the PedsQL Family Impact Module, among infants who were NG eligible but discharged with …

Providing Palliative And Hospice Care To Children, Adolescents And Young Adults With Cancer, Kimberly A. Pyke-Grimm, Beth Fisher, Amy Haskamp, Cynthia J. Bell, Amy Rose Newman

College of Nursing Faculty Research and Publications

Objectives

To describe palliative, concurrent, and hospice care in pediatric oncology in the United States (US), we present a clinical scenario illustrating palliative and hospice care, including eligibility for concurrent care, insurance coverage and billing, barriers to accessing quality pediatric palliative and hospice care, and implications for oncology nursing practice.

Data Sources

Peer-reviewed articles, clinical practice guidelines, professional organizations, and expert clinical opinion examining pediatric oncology, palliative care, and hospice care.

Conclusion

Understanding the goals of palliative and hospice care and the differences between them is important in providing holistic, goal-directed care.

Implications for Nursing Practice

Oncology nurses play …

Correlates Of Blood Pressure And Blood Glucose Screenings In Cameroon: Insights From The 2018 Demographic And Health Survey, Precious Adade Duodu, Pascal Agbadi, Henry Ofori Duah, Ernest Darkwah, Jerry John Nutor

College of Nursing Faculty Research and Publications

Background

Hypertension and diabetes, two major risk factors for cardiometabolic diseases, are associated with high morbidity and mortality rates. Early detection through screening can initiate early treatment to reduce adverse outcomes. The current study sought to investigate the correlates of blood pressure and blood glucose screenings in Cameroon.

Methods

We used secondary data from the 2018 Cameroon Demographic and Health Survey. Adjusting for a complex sample design, we performed multivariate prevalence ratio estimates of the blood pressure and blood glucose screenings.

Results

Approximately 60% and 30% of Cameroonians had undergone blood pressure and blood glucose screenings, respectively. More females (68%) …

Socioeconomic And Demographic Correlates Of Nonenrolment Onto The National Health Insurance Scheme Among Children In Ghana: Insight From The 2017/18 Multiple Indicator Cluster Survey, Pascal Agbadi, Joshua Okyere, Alberta Lomotey, Henry Ofori Duah, Abdul-Aziz Seidu, Bright Opoku Ahinkorah

College of Nursing Faculty Research and Publications

The goal of Ghana’s health insurance scheme is to achieve universal coverage. Despite NHIS’ benefits to children, not all children in Ghana are covered. This study investigates the sociodemographic covariates of nonenrolment onto the national health insurance scheme among children in Ghana. We used the child dataset of the 2017/18 Ghana Multiple Indicator Cluster Survey (G-MICS). We used STATA version 14 for the data analyses. We described each study variable using frequency and percentages. We used Poisson regression to estimate crude and adjusted prevalence ratios of the relationship between the covariates and the outcome variable. Approxi­ mately 57% of children …

Using A Four-Phased Process When Implementing A Multisite Simulation Study, Aimee A. Woda, Kristina Dreifuerst, Jamie Hansen

College of Nursing Faculty Research and Publications

Multisite simulation studies are critical in nursing research as they allow researchers to obtain larger sample sizes, however, many components need to be addressed to ensure adequate compliance with research protocols. Multisite studies are important in research as they help promote generalizability. Many components go into successfully conducting multisite simulation studies. The purpose of this paper is to describe how the four-phase process of planning, project development, study execution, and dissemination of study findings were contributed to the success of this multisite simulation study. Locating sites that met inclusion criteria, keeping consistent communication with all sites, and ensuring that participants …

Using Electronic Data And A Mixed-Methods Approach To Evaluate Short Peripheral Catheter Outcomes In Acute Care, Aimee A. Woda, Cailin Ford, Kelsey Meise, Maharaj Singh, Mary Hook

College of Nursing Faculty Research and Publications

Short peripheral catheters (SPCs) are commonly used in hospitals, guided by evidence-based standards to optimize dwell time and limit adverse outcomes. Although SPC insertions are common, real-world evaluation is rare. A theory-based framework and mixed-methods design were used to analyze findings from a unit-level survey and electronic data to evaluate SPC care delivered on units at a large quaternary medical center over a 6-month period (quarters 1 and 2, 2017). Dissemination without adoption and maintenance may limit effectiveness. The convergent results confirmed the feasibility of extracting electronic data to be used by leaders to clinically evaluate staff knowledge and use …

Risk Of Atrial Fibrillation And Stroke After Bariatric Surgery In Patients With Morbid Obesity With Or Without Obstructive Sleep Apnea, Ahmed Dalmar, Maharaj Singh, Zoe Heis, Tabitha L. Cumpian, Cheryl Ceretto, M. Eyman Mortada, Atul Bhatia, Imran Niazi, Thomas Y. Chua, Jasbir Sra, Arshad Jahangir

College of Nursing Faculty Research and Publications

Background and Purpose:

Weight loss in morbidly obese patients reduces atrial fibrillation (AF); however, it is unknown whether similar benefits are maintained in patients with obstructive sleep apnea (OSA). We sought to determine whether incident AF and stroke rates are affected by OSA after weight loss and to identify predictors of AF and stroke.

Methods:

Differences in laparoscopic adjustable gastric banding–induced weight loss on incident AF and stroke events in those with and without OSA in the entire and in propensity-matched cohorts were determined longitudinally, and independent predictors of AF and stroke were identified.

Results:

Of 827 morbidly obese patients …

Diverse Students Collaborating To Address Social Determinants Of Health Using Listening Sessions, Juanita T. Garcia, Leona Vandevusse, Gladys Simandl, Amber N. Johnson, Qiyan Mu, Jennifer Jean Dahlman

College of Nursing Faculty Research and Publications

In this article, a Nursing Workforce Diversity grant-funded project examined the social determinants of health (SDH) including diverse high school and baccalaureate nursing students. All involved students were from educationally and/or economically disadvantaged backgrounds and/or underrepresented minority groups. The purpose of this article is to report the project outcome data and analysis gathered from students' experiences of SDH, using the collaborative method, listening sessions. The project staff and student nurses discussed SDH with high school students, who then identified and prioritized key SDH in their neighborhoods during a series of facilitated listening sessions in their schools. Initial analysis included reviewing, …

New-Onset Heart Failure With Atrial Fibrillation: A Distinct Type Of Cardiomyopathy?, Vinay Mehta, Alexander Albers, Maharaj Singh, Ana Cristina Perez Moreno, Timothy E. Paterick

College of Nursing Faculty Research and Publications

Objective

There is limited research comparing demographic and clinical characteristics between patients who present with atrial fibrillation (AF) and new-onset cardiomyopathy (CM) to patients with new-onset CM without dysrhythmia. We aimed to evaluate clinical characteristics and outcomes in patients with new-onset CM with and without AF and to report their real-world treatment.

Methods and Results

The study population was identified using patient records from our healthcare system from January 1, 2012 to September 30, 2016. Patients with a left ventricular ejection fraction ≤40% without a prior history of CM were divided into two groups; those with an antecedent or concomitant …

Patients’ Experiences Of Recovery: Beyond The Intensive Care Unit And Into The Community, Kelly Calkins, Peninnah M. Kako, Jill L. Guttormson

College of Nursing Faculty Research and Publications

Aims

To understand barriers and facilitators of recovery for critical illness survivors’, who are discharged home from the hospital and do not have access to dedicated outpatient care.

Design

Multi-site descriptive study guided by interpretive phenomenology using semi-structured interviews.

Methods

Interviews were conducted between December 2017 -July 2018. Eighteen participants were included. Data were collected from interview recordings, transcripts, field notes, and a retrospective chart review for sample demographics. Analysis was completed using Interpretive Phenomenological Analysis which provided a unique view of recovery through the survivors’ personal experiences and perception of those experiences.

Results

Participants encountered several barriers to their …

Swim Program Pilot For Children With Autism: Impact On Behaviors And Health, Norah L. Johnson, Abir K. Bekhet, Tana Karenke, Mauricio Garnier-Villarreal

College of Nursing Faculty Research and Publications

The purpose of this mixed methods pre-/post-pilot intervention study was to assess parental psychological health and child challenging behaviors before and after a swimming program for children with autism. Participants were 10 parent–child dyads. Child’s challenging behaviors were lower in the post testing (Cohen’s d = 0.07–0.45). Mean scores were improved for parent perception of general health (Cohen’s d = 0.22). Three themes emerged from the post swim program focus group: (a) Parent satisfaction with instructors with sub themes (i) firmness (ii) creativity, and (iii) promotion of social interaction and sharing, (b) improved child sleeping, and (c) family dynamics with …

Implementation And Preliminary Testing Of A Theory-Guided Nursing Discharge Teaching Intervention For Adult Inpatients Aged 50 And Over With Multimorbidity: A Pragmatic Feasibility Study Protocol, Joanie Pellet, Marianne E. Weiss, Franziska Zúñiga, Cédric Mabire

College of Nursing Faculty Research and Publications

Background

Discharge teaching by nurses during hospitalization is essential to provide multimorbid inpatients with the knowledge and skills to self-manage their health conditions. However, available disease-specific teaching guidelines do not address the cumulative complexity of multiple chronic diseases that occur with greater frequency in older adults. Therefore, there is a need for a discharge teaching intervention which uses concepts that specifically address the needs of these patients, such as considering their level of activation (i.e. knowledge, skills and confidence to self-manage their health) and the burden of multimorbid disease. The objectives of this pragmatic study will be to (1) test …

The Effect Of Prolonged Pre-Operative Halo Gravity Traction For Severe Spinal Deformities On The Cervical Spine Radiographs, Kawdwo P. Yankey, Henry Ofori Duah, Cristina Sacramento-Dominguez, Henry O. Tutu, Mabel Adobea Owiredu, Rufai Mahmud, Irene Wulff, Gerhard Ofori-Amankwah, Harry Akoto, Oheneba Boachie-Adjei, Focos Spine Research Group

College of Nursing Faculty Research and Publications

Study Design:

Retrospective review of consecutive series.

Objective:

The study sought to assess the effect of prolonged pre-operative halo gravity traction (HGT) on the c-spine radiographs

Methods:

Data of 37 pediatric and adult patients who underwent ≥ 12wks pre-op HGT prior to definitive spine surgery from 2013-2015 at a single site in West Africa was reviewed. Radiographic assessment of the c-spine including ADI, SVA and C2-C7 Lordosis were done at pre HGT and at 4 weekly intervals. Paired T-Test was performed to evaluate changes in these parameters during HGT.

Results:

37pts, 18/19 (F/M). Average age 18.2yrs. Diagnoses: 22 idiopathic, 6 …

Probiotics For The Management Of Infantile Colic: A Systematic Review, Jennifer Simonson, Kristin Haglund, Emma Weber, Alissa Fial, Lisa Hanson

College of Nursing Faculty Research and Publications

Background:

Colic is defined as periods of inconsolable crying, fussing, or irritability that have no apparent cause and present in healthy infants under 5 months of age. Although colic is a benign and self-limiting condition, it can be distressing to parents and there are few robust treatment interventions. This systematic review explored the evidence for administration of probiotics to prevent or decrease symptoms of colic.

Methods:

Literature searches were conducted in PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library, and Web of Science.

Sample:

Twenty articles were included: 15 randomized controlled trials and 5 meta-analyses.

Results: …