/library/oar/handle/123456789/8439 2026-06-21T05:36:14Z /library/oar/handle/123456789/9135 Title: Management of ADHD symptoms in children : iron supplementation versus conventional therapy Abstract: Attention deficit hyperactivity disorder (ADHD) is a neuropsychiatric condition characterized by hyperactivity, impulsivity and inattentiveness. Current first-line pharmacotherapeutic treatments have undesirable side-effects; to try to avoid these, iron supplementation as an alternative therapy was explored. Thus, this evidence-based dissertation explored the research question: ‘How does iron supplementation compare to conventional therapy in the management of ADHD symptoms in 3-15 year old children with ADHD?’ of which the PICO elements were P–3–15 year old children with ADHD, IIron supplementation, C-Conventional therapy, O-Improved ADHD symptoms. The articles required to be: available in full-text, focusing on a population of children with ADHD aged 3-15 years, published within the past 10 years and studying solely ADHD. Articles in abstract form, conducted on adults or animals, published before 2004 and which included comorbidities were excluded from the study. Academic Search Complete, MEDLINE (ProQuest), CINAHL Plus with Full Text (EBSCO) database, Cochrane Database of Systematic Reviews (EBSCO), Cochrane Central Register of Controlled Trials (EBSCO), PubMed, PsycINFO (EBSCO) and Advanced Google Scholar were searched up to August 30th, 2014, for literature regarding ADHD and its possible treatment, particularly iron supplementation. Using inclusion and exclusion criteria, eight articles were chosen for further analysis. AMSTAR, CASP tools, and the Cochrane Effective Practice and Organisation of Care risk of bias form and a critical appraisal tool prepared by the Centre for Evidence-Based Management were used to appraise the selected articles according to their suitability. The lack of statistically significant evidence in the literature due to set study limitations resulted in an indefinite answer to the PICO question. Scientific evidence supports the use of conventional therapy in the treatment of ADHD, but the results in this dissertation reveal the possibility of iron supplementation being also effective in reducing the symptoms of ADHD. This conclusion is conditional on further high quality research being conducted in order to confirm the results of the eight selected studies, which suffered from a small sample size. Furthermore, more awareness and education is needed with regards to ADHD, the current treatments and the availability of potential alternate therapies. Description: B.SC.(HONS)NURSING 2015-01-01T00:00:00Z /library/oar/handle/123456789/8863 Title: The effectiveness of acupuncture in motor function recovery during cerebrovascular accident rehabilitation Abstract: Overview of the topic: Cerebrovascular accident occurs when a rapid development of clinical signs of focal or global disturbance happens in the cerebral function, which last more than 24 hours or has the potential to death, and must be caused by its vascular origin (Hatano, 1976). As a result, a type of disability can be manifested, such as disabilities associated with motor function control. Conventional stroke rehabilitation therapy plays an important role in motor function recovery, however more than half of the survivors remain with a certain degree of impairment (NINDS, 2011). Thereby, the aim of this dissertation is to search for other modalities of care, such as the use of Acupuncture, in the attempt to further improve the outcomes in stroke survivors. Thereby, the main aim is to identify evidence of whether the additional of needle penetrating acupuncture would add a therapeutic effect in stroke patients with motor impairment undergoing rehabilitation. Research question: In adults undergoing conventional stroke rehabilitation within the first 3 months of stroke onset, does the addition of needle penetration acupuncture during stroke rehabilitation therapy, result in improved motor function? PICO elements: The population (P) under investigation is the post-stroke adult patients undergoing rehabilitation within the first 3 months of stroke onset. The intervention (I) and comparison (C) are the use of Acupuncture using needle penetration at the acupuncture points and conventional stroke rehabilitation versus Conventional stroke rehabilitation. The outcome (O) is to improve motor function recovery. Inclusion/exclusion criteria: Only articles in English language, concerning adults who suffered from stroke, undergoing a type of rehabilitation and without cognitive impairment and genetic factors associated with neural plasticity were included. Search Outcome: 8 studies were found being 1 Meta-analysis and 7 Randomised controlled trials (RCTs), which specifically answered the PICO question. Quality Assessment: The Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) checklist was used to critically appraise the Meta-analysis, while the Critical Appraisal Skills Programme (CASP) tool was used to critically appraise the seven RCTS. Main results: The studies included in this review reported inconsistent results. Conclusion: To date, the additional of acupuncture for motor function recovery in patients during the first 3 months of stroke recovery remains inconclusive and debatable. Recommendations: Further research is required, where more rigorously, designed large multicentre randomized trials are needed. Description: B.SC.(HONS)HEALTH SCIENCE 2015-01-01T00:00:00Z /library/oar/handle/123456789/8808 Title: Post-stroke patients : stroke unit outcomes compared with general medical wards Abstract: Stroke, also referred to as cerebrovascular accident (CVA), is a condition, affecting approximately 5.5million people worldwide. It leads to the disruption of oxygen and nutrient supply to the brain, hence resulting in the death of brain cells, leading to severe brain damage if not immediately treated. As a result, persons affected by CVA can lose the function of parts of the body, which may lead to disability and even death. PICO question: In patients with cerebrovascular accident, do stroke in-patient units reduce mortality, functional dependency and institutionalisation, when compared to general medical wards? This question identifies patients following a CVA as the population, stroke units as the intervention, and general medical wards as the comparison. It also highlights the outcomes, namely: mortality, institutionalisation, and dependency. The studies chosen had to compare stroke units with general medical wards, and include the outcomes mentioned. The types of studies included were randomised control studies (RCTs), systematic reviews and metaanalyses, and had to be available in full text. The final outcome of the search led to one systematic review and meta-analyses, two systematic reviews, and four RCTs. Assessing the quality of the selected studies was carried out using the appropriate CASP tool, in correspondence with the study type. The CASP tool was also used to critically discuss and obtain optimal results. The findings of this research concluded that stroke units showed no significant difference in mortality, while having a significant difference on institutionalisation and dependency. Malta has a high rate of admissions of patients following a stroke with the second highest rate of mortality in Europe. In response to this, this review recommends that a stroke unit is established locally, or that the adoption of the stroke unit’s approach is applied to stroke patients admitted to general medical or neuromedical wards. Description: B.SC.(HONS)NURSING 2015-01-01T00:00:00Z /library/oar/handle/123456789/8807 Title: A comparison of the use of seclusion and mechanical restraints in psychiatric inpatient settings Abstract: Physical restraints and seclusion are coercive interventions which are used to manage violent behavior of patients who are receiving treatment in psychiatric hospitals (Georgieva, Mulder & Whittington, 2012). The purpose for the use of restraints and seclusion is mainly to protect the patients themselves from any harm and people working around them, however they are highly controversial due to the fact that they restrict the patient’s freedom of movement and are used against the patient’s will (Georgieva et al. 2012). Despite this controversy, these methods continue to be used extensively in many countries (Iversen, 2009). The aim of this critical appraisal was to compare the effectiveness of the two coercive measures when used on psychiatric patients. For this reason, the following question was set: In psychiatric patients, does the use of seclusion, compared to mechanical restraints, result in less subjective distress? Psychiatric patients were the population of interest whilst seclusion was the choice for the main intervention. The comparison intervention was mechanical restraint, while a reduction in subjective distress was the expected outcome. The search for literature was carried out using reputable databases available in the University of Malta library online resources such as CINAHL, Academic Search Complete and PubMed. Google Scholar was also used. Different keywords associated with the PICO framework were used to identify new studies. The studies chosen were assessed against inclusion and exclusion criteria, such as the language and research design. Eleven full-text studies published in English between 1999 and 2012 were identified and appraised using a number of critical appraisal tools, mainly CASP (CASP Team, 1993). The findings clearly indicate that there are great similarities with regards to the effects and the use of physical restraints and seclusion. However, although no direct answer to the PICO question was found, both measures were linked to significant subjective distress. The conclusions of the majority of the authors were similar, in which they stated that it would be more beneficial to use alternative techniques such as de-escalation techniques, close engagement and building of a therapeutic relationship rather than seclusion and restraints. This appraisal indicated several recommendations with regards to research, education, practice, policy changes and management. The education of staff members was highlighted as the most important recommendation. Strategies to implement these recommendations followed. Description: B.SC.(HONS)NURSING 2015-01-01T00:00:00Z