Evidence-based Literature Review Research Articles

Current understanding of subjective tinnitus in adults.

An up-to-date overview of epidemiology, etiology and pathophysiological mechanisms, diagnostic and evaluation methods, current treatment status and future directions of subjective tinnitus in adults. Review of current evidence-based literature on subjective tinnitus in adults. The prevalence of subjective tinnitus in the adult population is estimated to be around 14%, and it tends to increase with age. Subjective tinnitus is a complex condition with multiple factors contributing to its origin. However, the exact causes and underlying mechanisms remain unknown. Potential causes may include hearing loss, dysfunction in the somatosensory system, and auditory cortical dysfunction, although severe underlying pathology is rare. Currently, diagnosis primarily relies on patient self-reported medical history and physician-based clinical assessment due to the lack of objective testing. Various treatment and management options have been proposed, but their effectiveness varies, and there is no universally agreed-upon treatment option. Tinnitus is a complex and heterogeneous disease with a high incidence rate and a tendency to increase with age. A holistic perspective is needed to understand the generation, perception, and emotional responses to tinnitus. Diagnosis requires a comprehensive assessment based on medical history and relevant examinations, identification of concurrent psychosomatic comorbidities, and active pursuit of objective diagnostic methods. At the same time, on the basis of existing treatment plans and combining emerging technologies, we will develop new personalized, precise, and combined treatment plans.

Effects of Caffeine on Breastfeeding Mothers and Infants: A Scoping Review

Objectives:Breastfeeding mothers often consume caffeine in varied quantities. The common dietary sources of caffeine include tea, coffee, chocolate, energy drinks, and sodas. Over time, caffeine has become a widely accepted substance to use throughout pregnancy and lactation. As the range of volumes of caffeine is variable in various beverages, it is essential to explore the positive and negative effects of caffeine on breastfeeding mothers and their babies.Methods:A scoping review of evidence-based literature was undertaken to examine the effects of caffeine on breastfeeding mothers and their babies. We searched major databases using the key terms “caffeine,” “breast milk,” “newborns,” “infants,” “mothers,” and “breastfeeding.” Altogether, 21 articles were shortlisted for this review based on their relevance to the topic.Results:Caffeine travels in small amounts from the mother to the infant, and the infant is typically unaffected in amounts less than 300 mg/d. Caffeine is reported to reduce postnatal depression and fatigue among breastfeeding and has been found useful in treating acute morbidities in neonates like apnea of prematurity, patent ductus arteriosus, and bronchopulmonary dysplasia. A high intake of caffeine (450 mg or more of caffeine per day) in a short time is reported to have detrimental biochemical and neurodevelopmental effects in breastfed infants, anemia, and low iron level in breast milk. Controversy exists surrounding the effects of caffeine on breastfeeding duration of mothers. Recommendations include education and counselling for breastfeeding mothers on the dangers of caffeine consumption, avoidance of frequent and high intake of caffeine during lactation, and monitoring caffeine levels in various beverages/products.Conclusion:The use of caffeine has shown both positive and negative effects on breastfeeding mothers and infants. As a high intake of caffeine (450 mg or more of caffeine per day) is reported to have negative effects, breastfeeding mothers and infants must be protected from the detrimental effects of caffeine through increased education, counselling, and psychosocial support. Clinical practice guidelines are needed on the safe consumption of caffeine by breastfeeding mothers. Future research must examine the effects of varied levels of caffeine found in different products on breast milk composition, duration, health status, and breastfeeding outcomes of term and preterm newborns.

Evidence-based literature review, not the meta-analysis: A rejoinder

Evidence-based literature review, not the meta-analysis: A rejoinder

Sprint Team Approach Yields Rapid Improvement in Leapfrog Quality Indicators.

Patient safety and quality care are two critical areas that every healthcare organization strives to grow and improve upon. At Scripps Health, specific efforts reviewed for this article were implemented to reduce hospital-acquired conditions and hospital readmissions that are components of Centers for Medicare & Medicaid Services programs and Leapfrog Hospital Survey scores. Sprint teams, a novel approach to rapidly develop a checklist for lower-performing care improvement areas, were implemented after an internal review of existing tools and an evidence-based literature review. These areas included catheter-associated urinary tract infections (CAUTIs), central-line associated bloodstream infections (CLABSIs), Clostridioides difficile (C. diff.) and methicillin-resistant Staphylococcus aureus (MRSA) infections, chronic obstructive pulmonary disease (COPD) and heart failure readmissions, surgical site infections and handwashing, bar coding, and the computerized physician order entry components of Leapfrog scoring. The checklist for each area served as a teaching tool for staff and a guideline for case review to ensure that standard work was routinely performed. The sprint teams showed dramatic results in the initial focus areas. From a baseline standardized infection ratio (SIR) of 1.141 for CLABSIs, the sprint team reduced the SIR to 0.885 in Year 1 of the program and to 0.687 in Year 2. For CAUTIs, the SIR decreased from a baseline of 1.391 in Year 1 to 0.720 in Year 2. C. diff. infections fell from 0.422 to 0.315 in Year 1 and to 0.260 in Year 2. While the MRSA SIR did not improve during the first year, the MRSA reduction sprint team showed success in Year 2 with a decrease in the SIR from 0.537 to 0.245. Readmission reduction sprint teams focused on heart failure, COPD, and total hip and knee complications. The teams also achieved positive results in reducing readmissions by following checklists and reviewing each readmission case for justification. Rapid change can be safely and effectively implemented with multidisciplinary sprint teams. Developed with an evidence-based, case review approach, sprint team checklists can help to standardize processes for the review of any infections or readmissions that occur in the inpatient arena.

The Role of the Gut Microbiome in Orthopedic Surgery-a Narrative Review.

The importance of the gut microbiome has received increasing attention in recent years. New literature has revealed significant associations between gut health and various orthopedic disorders, as well as the potential for interventions targeting the gut microbiome to prevent disease and improve musculoskeletal outcomes. We provide a broad overview of available literature discussing the links between the gut microbiome and pathogenesis and management of orthopedic disorders. Human and animal models have characterized the associations between gut microbiome dysregulation and diseases of the joints, spine, nerves, and muscle, as well as the physiology of bone formation and fracture healing. Interventions such as probiotic supplementation and fecal transplant have shown some promise in ameliorating the symptoms or slowing the progression of these disorders. We aim to aid discussions regarding optimization of patient outcomes in the field of orthopedic surgery by providing a narrative review of the available evidence-based literature involving gut microbiome dysregulation and its effects on orthopedic disease. In general, we believe that the gut microbiome is a viable target for interventions that can augment current management models and lead to significantly improved outcomes for patients under the care of orthopedic surgeons.

Evidence-based literature review: De-duplication a cornerstone for quality.

Evidence-based literature reviews play a vital role in contemporary research, facilitating the synthesis of knowledge from multiple sources to inform decision-making and scientific advancements. Within this framework, de-duplication emerges as a part of the process for ensuring the integrity and reliability of evidence extraction. This opinion review delves into the evolution of de-duplication, highlights its importance in evidence synthesis, explores various de-duplication methods, discusses evolving technologies, and proposes best practices. By addressing ethical considerations this paper emphasizes the significance of de-duplication as a cornerstone for quality in evidence-based literature reviews.

Vestibular migraine and its management in Indian clinical setting: a narrative review

Vestibular migraine (VM) is a disorder connecting two clinical conditions, migraine and vertigo. A high prevalence of VM (~30%) is reported among Indians suffering from dizziness. Yet, there is no gold standard for diagnosis and treatment. Trials specifically for patients with VM are scarce. This review provides an overview on VM and its management in the Indian clinical setting. An evidence-based discussion and review of literature on VM was performed by expert panelists, and opinions were gathered. Experts opined that in vertigo clinics, around 50% of patients are diagnosed with VM, with a higher predominance in females aged 30-50 years, while in children, the age of manifestation is 12-14 years. The most common presenting symptoms of VM among adults are spontaneous vertigo, followed by positional vertigo with headache, nausea, vomiting, photophobia and phonophobia, while intolerance to loud sounds and sudden falls are common symptoms in children with VM. Common comorbidities associated with VM are benign paroxysmal positional vertigo (BPPV) and Meniere’s disease (MD). Experts opined that there are currently no approved standardized treatment protocols for VM. The steps in the management of VM include diet and lifestyle modification, along with medicines for symptomatic relief (abortive) and prophylaxis and vestibular rehabilitation. Globally, prochlorperazine, a vestibular suppressant, is widely used for the management of vertigo and its associated symptoms. According to experts, prochlorperazine 5 mg twice or thrice daily for 5-7 days can play a significant role as an abortive treatment in the management of various patient profiles of VM.

Triage Accuracy of Emergency Nurses: An Evidence-Based Review

IntroductionAccurate triage assessment by emergency nurses is essential for prioritizing patient care and providing appropriate treatment. Undertriage and overtriage remain an ongoing issue in care of patients who present to the emergency department. The purpose of this literature review was to examine factors associated with triage accuracy in the emergency department. MethodsWe conducted an evidence-based literature review using the Cumulative Index to Nursing and Allied Health Literature, PubMed, and Embase. The search focused on peer-reviewed articles in English, available in full text, published between January 2011 and December 2021. ResultsA total of 14 articles met inclusion criteria and revealed the following 3 themes for triage accuracy: triage nurse characteristics, patient characteristics, and work environment. Triage nurses’ accuracy rates ranged from 59.3% to 82%, with experience in triage associated with higher accuracy. Patient characteristics influenced triage accuracy, with nontrauma patients being undertriaged and trauma patients often overtriaged. The work environment played a role, as accuracy rates varied based on shift time and patient volume. Competing systems between prehospital and ED triage posed challenges and affected accuracy during fluctuations in patient volumes. DiscussionThis review underscores the complex nature of ED triage accuracy. It highlights the importance of nurse experience, training programs, patient characteristics, and the work environment in enhancing triage decision making. Enhanced understanding of these factors can inform strategies to optimize triage accuracy and improve patient outcomes.

Pediatric chronic rhinosinusitis.

An up-to-date overview of diagnosis, differential diagnosis, comorbidities, and current medical and surgical management of pediatric chronic rhinosinusitis (PCRS). Review of current evidence-based literature on PCRS. Diagnosis of PCRS seems to be improving based on recent evidence using nasal endoscopy as well as computed tomography scanning. Recent literature supports the fact that chronic adenoiditis can be an independent etiology of symptoms of chronic sinusitis, that are very similar to chronic adenoiditis. Allergic rhinitis and immune deficiency play important roles in the management of PCRS. Surgery for PCRS has evolved significantly in the last 15-20 years to include adenoidectomy as well as endoscopic sinus surgery. PCRS is very common in children causing poor QOL for these children. Medical management remains the main stay of treatment with attention to management of co-morbidities that may contribute to the disease severity. Making the correct diagnosis will help with the choice of surgical intervention if medical management fails.

Update on Identifying and Evaluating Quality Measures for Adult Attention-Deficit/Hyperactivity Disorder

The limited recognition and treatment of attention-deficit/hyperactivity disorder (ADHD) in adults has been studied in the research setting and addressed in the clinical education setting during recent years. Despite these efforts, health care professionals continue to struggle with the management of adult ADHD in everyday practice. To better evaluate and measure meaningful practice metrics, a set of 10 key quality measures (QMs) that can help improve health care outcomes in adult ADHD was identified using a combination of evidence-based literature reviews and expert consensus. Subsequently, these QMs were field-tested in a sample of 71,310 adult ADHD patients in the primary care setting and behavioral health clinics over the course of a decade to assess whether these measures were attained. The results allowed us to understand how the clinician approach to diagnosing and treating ADHD has evolved in the past few years and highlighted the ongoing challenges in practice variation by clinicians caring for patients with adult ADHD. In turn, this information also guides our understanding of the next steps needed to improve the quality of care provided to adults with ADHD in different care settings. Accordingly, the American Professional Society of ADHD and Related Disorders (APSARD) assembled a guidelines committee to create a set of clinical practice guidelines to provide practitioners with a standardized, evidence-based approach to diagnosing and treating ADHD in adults. [ Psychiatr Ann . 2023;53(10):444–448.]

The Impact of Remote Working During Covid: Evidence-Based Literature Review (Arab Gulf)

Purpose: The purpose of this study is to explore the impact of remote working during the Covid-19 pandemic on the mental health and well-being of Gulf employees.
  
 Theoretical reference: The study utilizes a systematic literature review to analyze previous studies that have examined the impact of the pandemic on the mental health and well-being of the Gulf population.
  
 Method: A systematic literature review was conducted to identify relevant articles that met the inclusion criteria. Six articles were selected for analysis, focusing on the Gulf region, published during the pandemic, and peer-reviewed.
  
 Results and Conclusion: The analysis of the selected articles revealed that there is evidence linking lockdown measures to increased depression and anxiety among Gulf remote workers. Additionally, there is evidence suggesting that remote working during lockdown contributes to an emerging epidemic of unhealthy living, which poses a risk factor for developing chronic diseases and exacerbating mental health challenges.
  
 Implications of research: The findings of this study highlight the need for authorities and healthcare systems in the Gulf region to develop preventive measures to address the rising epidemic of poor mental health and unhealthy living among remote workers. This is crucial to avoid a future burden of mental health challenges among young employees.
  
 Originality/value: This study contributes to the existing literature by specifically focusing on the impact of remote working during the Covid-19 pandemic on the mental health and well-being of Gulf employees. It highlights the need for preventive measures to address the emerging epidemic of poor mental health and unhealthy living in this population.

Development of prone positioning and skin damage prevention digital education: the PRONEtect project.

The incidence of skin/tissue damage, such as pressure ulcers, remains high in mechanically ventilated patients in the prone position. According to guidelines, critically ill patients with acute respiratory distress syndrome (ARDS) should be prone for at least 12-16 hours to improve oxygenation and decrease mortality. Therefore, educating clinicians on how to reposition and manage the patient safely in a prone position plays a vital role in preventing adverse events. This project aimed to develop accessible online educational content to assist clinicians in safely executing the prone manoeuvre and minimise skin/tissue damage. The development of the educational content was based on: a gap analysis and comprehensive review of available educational resources; evidence-based scientific literature; advice from international experts; and a qualitative study exploring the learning needs of 20 clinicians in Belgium and Sweden between February-August 2022. Volunteer clinicians assisted with the creation of eight simulation videos which were professionally filmed and edited. The interactive videos included the supine-to-prone and prone-to-supine manoeuvres, endotracheal and nasogastric tube securement, eye care, stoma care, protecting high-risk areas from pressure damage, and incontinence-associated dermatitis prevention. A prone positioning protocol, a checklist summarising the key aspects of the protocol, and teaching aids (slide deck for didactic lecturing) were developed and validated by a review of the relevant evidence-based literature and the international expert panel. A website was designed to host the content, with free user access, at www.pronetection.com. Education is one strategy towards prevention of complications of prone positioning. Accessible education could assist clinicians unfamiliar with prone positioning or current clinicians requiring refresher training to safely manage patients in this position.

Environmental innovation and corporate sustainability: evidence-based systematic literature review

PurposeSustainability at the corporate level is interpreted as the approach capable of creating prosperity over long-term horizons through targeted strategic integration, sustainable business system and societal transitions, beyond economic growth, along with environmental quality and social equity. In this context, this article aims to explore the interplay of the relationship between environmental innovation and corporate sustainability.Design/methodology/approachA systematic literature review (SLR) was conducted in the Web of Science and Scopus databases for the last six decades to explore the proposed relationship. Data were selected on August 2, 2020, and the analysis period lasted until July 20, 2021. A research protocol consistent with the methodological rigor required in conducting an SLR was prepared for the mapping and analysis of relevant research.FindingsIn the last five years, there has been an evolution in research related to green innovation in supply chain management. Based on this evolution, there is a growing concern with the development of sustainable business models, taking into account the motivation to adopt green innovation practices aimed at corporate image. The purpose lies in verifying the organizational capabilities in achieving corporate sustainability practices and economic performance. The results show a greater concentration of studies exploring (1) sustainable business models, (2) the complexity of the sustainability tripod balance, in addition to (3) organizational strategies based on green and competitive practices.Originality/valueFew works explored the context of small and medium-sized companies, especially those located in emerging and underdeveloped countries. This opens up a promising field of research. The main contributions of this article are related to (1) the presentation of a portfolio of theoretical and methodological approaches on the subject, which allows the exploration of the possibilities of empirical studies; and (2) showing the current status of research on environmental innovation and its impact on corporate sustainability. This article explores the interplay of the relationship between environmental innovation and corporate sustainability and brings state-of-the-art research about the theme.

European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma: Part 2. Treatment–Update 2023

In order to update recommendations on treatment, supportive care, education, and follow-up of patients with invasive cutaneous squamous cell carcinoma (cSCC), a multidisciplinary panel of experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF), the European Society for Radiotherapy and Oncology (ESTRO), the European Union of Medical Specialists (UEMS), the European Academy of Dermatology and Venereology (EADV), and the European Organisation of Research and Treatment of Cancer (EORTC) was formed. Recommendations were based on an evidence-based literature review, guidelines, and expert consensus. Treatment recommendations are presented for common primary cSCC (low risk, high risk), locally advanced cSCC, regional metastatic cSCC (operable or inoperable), and distant metastatic cSCC. For common primary cSCC, the first-line treatment is surgical excision with postoperative margin assessment or micrographically controlled surgery. Achieving clear surgical margins is the most important treatment consideration for patients with cSCCs amenable to surgery. Regarding adjuvant radiotherapy for patients with high-risk localised cSCC with clear surgical margins, current evidence has not shown significant benefit for those with at least one high-risk factor. Radiotherapy should be considered as the primary treatment for non-surgical candidates/tumours. For cSCC with cytologically or histologically confirmed regional nodal metastasis, lymph node dissection is recommended. For patients with metastatic or locally advanced cSCC who are not candidates for curative surgery or radiotherapy, anti-PD-1 agents are the first-line systemic treatment, with cemiplimab being the first approved systemic agent for advanced cSCC by the Food and Drugs Administration/European Medicines Agency. Second-line systemic treatments for advanced cSCC, include epidermal growth factor receptor inhibitors (cetuximab) combined with chemotherapy or radiotherapy. Multidisciplinary board decisions are mandatory for all patients with advanced cSCC, considering the risks of toxicity, the age and frailty of patients, and co-morbidities, including immunosuppression. Patients should be engaged in informed, shared decision-making on management and be provided with the best supportive care to improve symptom management and quality of life. The frequency of follow-up visits and investigations for subsequent new cSCC depends on underlying risk characteristics.

The Role of Cervical Disc Arthroplasty in Elite Athletes.

Cervical disc arthroplasty (CDA) for the treatment of symptomatic cervical disc herniations (CDH) is a promising treatment for professional athletes. In recent years, a number of high-profile athletes have returned to professional play within three months after CDA, raising important questions about the potential of this procedure within this patient group. We provide the first comprehensive review of available literature for the safety and efficacy of CDA in professional contact sport athletes. CDA provides theoretical biomechanical advantages over anterior cervical discectomy and fusion (ACDF) and posterior foraminotomy (PF), as CDA is the only operation for treatment of CDH that provides neural decompression, stability and height restoration, with preserved range of motion. While the comparative long-term results from each procedure are unknown, CDA has provided encouraging promise in its use in professional contact athletes. We aim to aid ongoing discussions regarding the controversies in spine surgery for professional athletes by providing a scientific review of the available evidence-based literature involving cervical disc arthroplasty in this population. In general, we believe that CDA is a viable alternative to ACDF and PF for the contact professional athlete who requires full neck range of motion and desires an expedited return to play. For collision athletes, the short- and long-term safety and efficacy profile of this procedure is promising but still unclear.

Polyphenols for preventing dental erosion in pre-clinical studies with in situ designs and simulated acid attack.

Dental erosion is a chemical process characterized by acid dissolution of dental hard tissue, and its etiology is multifactorial. Dietary polyphenols can be a strategy for dental erosion management, collaborating to preserve dental tissues through resistance to biodegradation. This study describes a comprehensive review to interpret the effects of polyphenols on dental erosion of pre-clinical models with in situ designs and simulated acid attacks on enamel and dentin samples. We aim to evaluate evidence about polyphenols' effects in the type of dental substrate, parameters of erosive cycling chosen in the in situ models, and the possible mechanisms involved. An evidence-based literature review was conducted using appropriate search strategies developed for main electronic databases (PubMed, Scopus, Web of Science, LILACS, EMBASE, LIVIVO, CINAHL, and DOSS) and Grey literature (Google Scholar). The Joanna Briggs Institute checklist was used to evaluate the quality of the evidence. From a total of 1900 articles, 8 were selected for evidence synthesis, including 224 specimens treated with polyphenols and 224 control samples. Considering the studies included in this review, it could observe that polyphenols tend to promote a reduction in erosive and abrasive wear compared to control groups. But, as the few studies included have a high risk of bias with different methodologies, and the estimated effect size is low, this conclusion should not be extrapolated to clinical reality.

Features and effects of computer-based games on cognitive impairments in children with autism spectrum disorder: an evidence-based systematic literature review

IntroductionChildren with Autism Spectrum Disorder (ASD) have different cognitive and intelligence profiles than typical developing individuals. Some of these children need cognitive rehabilitation. This study's main purpose is to provide a systematic review about applying computerized cognitive games for autistic children and to determine the effectiveness of such interventions.Material and methodsA thorough search of the ISI Web of Science, Medline (through PubMed), Scopus, IEEE Xplore, and APA PsycInfo databases was performed for articles published from inception to May 17, 2022.ResultsOf 1746 papers, 28 studies were found to be eligible in this systematic review. Fifteen studies (53.57%) compared a Control Group (CG) with Experimental Groups (EGs), while 13 papers (46.42%) evaluated only the impact of the applied intervention in an experimental group. Major domains of cognitive functions are divided into five main categories: 1. Executive functions, 2. Social cognition/emotions, 3. Attention/concentration, 4. Learning and memory, and 5. Language. In 42.85% (12 studies) of the screened papers, social cognition and emotions were assessed after cognitive rehabilitation. The highest rate of effects reported by studies were related to social cognition enhancement. Of the total number of included studies, 17 studies reported a positive effect at all scales, of which nine were quasi-experimental, and seven were fully experimental.ConclusionUsing suitable computerized game-based solutions could enhance cognition indexes in autistic children. Hence, further investigation is needed to determine the real effectiveness of these novel technologies.

Child Abuse during the Pandemic and Trauma-Informed Care: A Review of Evidence-Based Literature

Child Abuse during the Pandemic and Trauma-Informed Care: A Review of Evidence-Based Literature

Botulinum toxin for cosmetic treatments in young adults: An evidence-based review and survey on current practice among aesthetic practitioners.

Botulinum toxin A (BoNTA) treatments are popular worldwide. Young adults, less than 41 years of age, are an important cohort of patients seen in practice, and the optimal dosage of BoNTA in this age group remains poorly defined. To determine the optimal dosing of BoNTA across different age-matched cohorts by reviewing the literature and to evaluate current BoNTA practices among aesthetic practitioners when treating younger versus older adults. An evidence-based literature review was performed to evaluate the current evidence on BoNTA injections for cosmetic indications in millennials (born between 1981 and 1996) and young adults. A cross-sectional online survey was distributed to aesthetic practitioners to assess their current practice with BoNTA. There is a paucity of high-quality research on BoNT in millennials. Our literature review suggests different patterns of practice when treating younger adults. Specifically, our survey revealed that: (1) younger adults are receiving, on average, fewer units of BoNTA at the glabella, forehead, and crow's feet, (2) younger toxin-naïve patients are also afraid to look frozen or unnatural, and (3) wrinkles prevention was the most common reason for seeking treatment in younger patients. The literature review supports the efficacy of BoNTA for correcting wrinkles in millennials. Our findings provide further insight into the dosing pattern of cosmetic BoNTA and motivating factors for seeking treatments in young adults. This valuable information will help practitioners with treatment planning when seeing patients from different age cohorts. An individualized approach and a lower dosage of BoNTA in toxin-naïve younger adults are recommended.

Spirituality, Religion and Breastfeeding: A Scoping Review

IntroductionSpirituality and religion are often used as coping mechanisms during times of struggle or change. A clear understanding of the impact of spirituality and religious beliefs on breastfeeding is essential to providing culturally appropriate care to breastfeeding mothers of diverse religious backgrounds.MethodsA scoping review of evidence-based literature was conducted. A total of 45 studies published globally were reviewed and analyzed.ResultsGlobally, religion as a socio-demographic factor has direct and indirect associations with breastfeeding. Spiritual/religious aspects that serve as motivators for breastfeeding include its emphasis in religious texts; spiritual qualities of breastmilk; prayer; and the influence of faith communities. Spiritual/religious barriers to breastfeeding include milk sharing concerns; pre-lacteal feeds and colostrum beliefs, sexual abstinence during breastfeeding; fasting; modesty concerns; and belief in the evil eye.ConclusionConsidering the diversity in maternal spiritual belief systems, providing patient-centred support and counselling to breastfeeding mothers is vital.