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A systematic review and meta-analysis: Assessment of hospital walking programs among older patients.Nursing Open Apr 2023The aim of this study is to assess effect of hospital walking programs on outcomes for older inpatients and to characterize hospital walking dose reported across studies. (Meta-Analysis)
Meta-Analysis Review
AIM
The aim of this study is to assess effect of hospital walking programs on outcomes for older inpatients and to characterize hospital walking dose reported across studies.
DESIGN
A systematic review and meta-analysis examining impact of hospital walking and/or reported walking dose among medical-surgical inpatients. For inclusion, studies were observational or experimental, published in English, enrolled inpatients aged ≥ 65 yrs hospitalized for medical or surgical reasons.
METHODS
Searches of PubMed, CINAHL, Embase, Scopus, NICHSR, OneSearch, ClinicalTrials.gov, and PsycINFO were completed in December 2020. Two reviewers screened sources, extracted data, and performed quality bias appraisal.
RESULTS
Hospital walking dose was reported in 6 studies and commonly as steps/24 hr. Length of stay (LOS) was a common outcome reported. Difference in combined mean LOS between walking and control groups was -5.89 days. Heterogeneity across studies was considerable (I = 96%) suggesting poor precision of estimates. Additional, high-quality trials examining hospital walking and patient outcomes of older patients is needed.
Topics: Humans; Length of Stay; Hospitals; Inpatients
PubMed: 36441641
DOI: 10.1002/nop2.1496 -
The Journal of Knee Surgery Dec 2023Patient treatment decisions for knee osteoarthritis (OA) are driven largely by the patient's physical examination and radiograph findings. Because multiple treatment... (Review)
Review
Patient treatment decisions for knee osteoarthritis (OA) are driven largely by the patient's physical examination and radiograph findings. Because multiple treatment options may be medically appropriate, it is imperative that the patient's voice be considered to better facilitate patient-centered treatment decisions. Concordance between physicians and patients on optimal treatment can vary, with few studies identifying the factors important to patients when making treatment decisions for knee OA. The goal of this analysis is to identify and synthesize subjective factors in the literature found to influence patient decision-making in a presurgical knee OA population, such that physicians and health care teams can become better equipped to help patients realize their specific treatment goals. This review was registered with PROSPERO and conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. A systematic search was completed in four databases for search terms related to knee OA and decision-making. Articles were eligible for inclusion when they discussed (1) patients' thoughts, feelings, goals, and perceptions that factored into treatment deliberation and decision-making; and (2) related to knee OA. Twenty-four articles were identified, 11 qualitative studies and 13 quantitative studies. Synthesis of the included articles revealed three main themes that drive patient treatment decisions: (1) individual catalysts to pursue treatment including pain and mobility limitations, (2) interpersonal factors including social networks and clinician trust, and (3) risks versus benefits assessment including patients' beliefs and expectations. Only a few studies looked at nonoperative treatment decisions, and no studies looked at cohorts considering knee preservation surgeries. This study was completed to synthesize literature related to patient treatment decisions for nonoperative and surgical management of knee OA, finding that patients consider multiple subjective factors when choosing whether to move forward with treatment. Understanding how patients' beliefs determine their preferences for treatment can improve shared decision-making.
Topics: Humans; Osteoarthritis, Knee; Pain; Patients
PubMed: 37072026
DOI: 10.1055/s-0043-56998 -
Systematic Reviews Aug 2022Interprofessional collaboration (IPC) is seen as the "gold standard" of comprehensive care, but credible evidence concerning the effects on patient-reported outcomes...
BACKGROUND
Interprofessional collaboration (IPC) is seen as the "gold standard" of comprehensive care, but credible evidence concerning the effects on patient-reported outcomes (PRO) is lacking. The aim of this systematic review is to study the effect of IPC on PRO in inpatient care.
METHODS
We systematically searched six electronic databases (PubMed, Web of Science/Social Science Citation Index, CENTRAL (Cochrane Library), Current Contents (LIVIVO), CINAHL, and Embase) for studies published between 1997 and 2021. Additional studies were identified through citation tracking, manually searching the Internet and Google Scholar, and consultation of experts. Risk of bias (RoB) was assessed using the RoB 2 tool for randomized controlled trials (RCTs) and ROBINS-I for non-randomized studies (NRS). The included controlled before-and-after study (CBA) was assessed using both the ROBINS-I and the Effective Practice and Organization of Care (EPOC) quality criteria. Results were synthesized through narrative description, grouping, and thematic analysis of extracted data.
RESULTS
The search yielded 10,213 records, from which 22 studies (16 RCTs, five NRS, and one CBA) fulfilled the inclusion criteria. In all but five studies, RoB was assessed as being high (RoB 2) resp. critical or serious (ROBINS-I). Within these 22 studies, nine inductively derived outcomes were assessed: (i) quality of life, (ii) coping, (iii) functional ability and health status, (iv) psychiatric morbidity, (v) pain, (vi) managing one's own health care, (vii) treatment success, (viii) satisfaction, and (ix) therapeutic relationship. While some studies do not report effect estimates, and some of the reported effects appear to be imprecisely estimated, the overall results indicate that IPC may affect PRO positively across all outcomes.
CONCLUSIONS
Due to high clinical heterogeneity and high RoB, the question whether IPC affects PRO cannot be answered conclusively. Methodically rigorous studies are needed in order to answer the question of effectiveness of IPC.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42017073900.
Topics: Bias; Hospitalization; Humans; Inpatients; Patient Reported Outcome Measures; Quality of Health Care
PubMed: 35964148
DOI: 10.1186/s13643-022-02027-x -
JAMA Facial Plastic Surgery Jul 2018Surgical scarring affects patients by distracting the gaze of onlookers, disrupting social interactions, and impairing psychosocial health. Patient and physician...
IMPORTANCE
Surgical scarring affects patients by distracting the gaze of onlookers, disrupting social interactions, and impairing psychosocial health. Patient and physician agreement regarding ideal scar characteristics is important in developing congruent expectations after surgery.
OBJECTIVE
To summarize published studies assessing patient and physician ratings of surgical scars, rates of patient and physician agreement in scar assessment, and elements of cutaneous scar assessment that differ between patients and physicians.
EVIDENCE REVIEW
A literature search of Ovid/Medline, PubMed, and EMBASE was conducted from January 1, 1972, to August 1, 2015. Prospective studies comparing scars from different surgical techniques using at least 1 physician-reported and patient-reported scar measure were included. Strength of studies was graded according to the Oxford Centre for Evidence-Based Medicine guidelines.
FINDINGS
The review identified 29 studies comprising 4485 patients. Of the 29 included studies, 20 (69%) were randomized clinical trials (RCTs), 5 (17%) were prospective, nonrandomized studies, and 4 (14%) were descriptive studies. Disagreement between patients and physician evaluation of scars occurred in 28% (8 of 29) studies, with only patients rating scar difference in 75% (6 of 8) of these cases. Patients were more likely to value scar depth while physicians were more likely to value scar pigmentation and relief.
CONCLUSIONS AND RELEVANCE
Methodologically rigorous studies that include clinician- and patient-reported scar outcomes are uncommon. Studies that incorporate subjective and objective scar grading reveal disagreement between patients and clinicians. Of the incision and wound closure techniques assessed, few affected patient- and clinician-reported outcomes, but the evidence remains weak and future studies are recommended.
Topics: Cicatrix; Esthetics; Humans; Patients; Physicians; Postoperative Complications
PubMed: 29392275
DOI: 10.1001/jamafacial.2017.2314 -
Addiction Science & Clinical Practice Mar 2023Despite the frequent comorbidity of substance use disorders (SUDs) and psychiatric disorders, it remains unclear if screening for substance use in behavioral health... (Review)
Review
OBJECTIVE
Despite the frequent comorbidity of substance use disorders (SUDs) and psychiatric disorders, it remains unclear if screening for substance use in behavioral health clinics is a common practice. The aim of this review is to examine what is known about systematic screening for substance use in outpatient behavioral health clinics.
METHODS
We conducted a PRISMA-based systematic literature search assessing substance use screening in outpatient adult and pediatric behavioral health settings in PubMed, Embase, and PsycINFO. Quantitative studies published in English before May 22, 2020 that reported the percentage of patients who completed screening were included.
RESULTS
Only eight articles met our inclusion and exclusion criteria. Reported prevalence of screening ranged from 48 to 100%, with half of the studies successfully screening more than 75% of their patient population. There were limited data on patient demographics for individuals who were and were not screened (e.g., gender, race) and screening practices (e.g., electronic versus paper/pencil administration).
CONCLUSIONS
The results of this systematic review suggest that successful screening for substance use in behavioral health settings is possible, yet it remains unclear how frequently screening occurs. Given the high rates of comorbid SUD and psychopathology, future research is necessary regarding patient and clinic-level variables that may impact the successful implementation of substance use screening. Trial registry A methodological protocol was registered with the PROSPERO systematic review protocol registry (ID: CRD42020188645).
Topics: Adult; Humans; Child; Outpatients; Substance-Related Disorders; Comorbidity
PubMed: 36967381
DOI: 10.1186/s13722-023-00376-z -
Psychology & Health Apr 2020Inflammatory bowel disease (IBD) is a chronic, gastrointestinal condition that involves a range of debilitating bowel symptoms. Adjustment to living with IBD can be...
Inflammatory bowel disease (IBD) is a chronic, gastrointestinal condition that involves a range of debilitating bowel symptoms. Adjustment to living with IBD can be negatively impacted by maladaptive cognitive and behavioural factors (e.g. negative illness representations and repressing emotions). Patient samples also report negative reactions from the general public and such perceptions can further negatively impact people living with IBD. Therefore, we aimed to systematically review literature investigating the illness perceptions, perceived stigmatisation, and negative emotional reactions toward IBD within patient and community samples. We also aimed to review how these factors impact those living with IBD (i.e. adjustment, psychological health). A range of databases (e.g. Psych INFO, PubMed) were searched over two years. One reviewer individually screened titles and abstracts using the specified inclusion criteria, and this process was repeated by a second reviewer. Subsequently, the full text articles were screened and data were extracted for the 82 articles that satisfied the inclusion criteria. Following data extraction, a narrative synthesis was conducted. The review of 82 studies suggested that negative illness perceptions are linked to poorer psychosocial outcomes, that patient samples frequently anticipate stigmatisation, fear relating to bowel accidents was the most common emotion reported, and that the general public direct little enacted stigma towards IBD. For people living with IBD: (i) poorer psychological adjustment was reported by those who held more negative perceptions and reactions toward their illness; and (ii) their concerns regarding public perceptions of IBD warrants further empirical attention. Results emphasise the importance of targeting perceptions, and facilitating education and adaptive responding during treatment.
Topics: Attitude to Health; Humans; Inflammatory Bowel Diseases; Patients; Social Stigma
PubMed: 31538517
DOI: 10.1080/08870446.2019.1662014 -
Journal of Minimally Invasive Gynecology Jan 2022The aim was to investigate whether outpatient hysterectomy (OH) has benefits when compared with inpatient hysterectomy (IH) regarding postoperative complications,... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim was to investigate whether outpatient hysterectomy (OH) has benefits when compared with inpatient hysterectomy (IH) regarding postoperative complications, readmissions, operative outcomes, cost, and patient quality of life.
DATA SOURCES
A systematic search for studies comparing OH with IH was conducted through PubMed, SAGE, and Scopus from January 2010 to March 2020, without limitations regarding language and study design.
METHODS OF STUDY SELECTION
Studies reporting on the differences between same-day discharge and overnight stay after hysterectomy were included. The study outcomes were overall complication rate, type of complication, readmission after discharge, surgery duration, estimated blood loss, payer savings, hospital savings, and health-related quality of life (HrQoL). Median and range are used to describe non-normal data, while mean ± SD and confidence interval are used to descibe data with normal distribution. A meta-analysis with sensitivity analysis and subgroup analyses was performed.
TABULATION, INTEGRATION, AND RESULTS
Eight studies published between 2011 and 2019 with 104,466 patients who underwent hysterectomy were included in this systematic review and meta-analysis. All included studies except 1 were found to have a high risk of bias. OH in comparison with IH had a lower overall complication rate (odds ratio [OR] 0.70; 95% confidence interval [CI], 0.60-0.82) and lower rates of wound infection (OR 0.60; 95% CI, 0.43-0.84), urinary tract infection (OR 0.64; 95% CI, 0.52-0.78), need for transfusion (OR 0.36; 95% CI, 0.22-0.59), sepsis (OR 0.33; 95% CI, 0.17-0.64), uncontrolled pain (OR 0.79; 95% CI, 0.66-0.95), and bleeding requiring medical attention (OR 0.82; 95% CI, 0.73-0.94). In addition, patients who underwent OH had a lower readmission rate (OR 0.81; 95% CI, 0.75-0.87), surgery duration (standardized mean difference -0.35; 95% CI, -0.61 to -0.08), and estimated blood loss (standardized mean difference -0.63; 95% CI, -0.93 to -0.33) than those who underwent IH. A qualitative analysis found that OH had a poorer patient HrQoL and a lower cost for the hospital as well as the payer.
CONCLUSION
OHs present fewer complications and have a lower readmission rate and estimated blood loss as well as a shorter surgery duration than IHs. OHs also have a cost benefit in comparison with IHs. But patients seem to have a worse HrQoL in the first postoperative week after OH. The high risk of bias of the included studies indicates that well-designed clinical trials and standardization of surgical complication reporting are essential to better address this issue.
Topics: Female; Humans; Hysterectomy; Inpatients; Outpatients; Postoperative Complications; Quality of Life
PubMed: 34182138
DOI: 10.1016/j.jmig.2021.06.012 -
Journal of Patient-reported Outcomes Oct 2023The aim of this study was to create a model of patient-centered outcomes with respect to self-management tasks and skills of patients with a tracheostomy in their home... (Review)
Review
PURPOSE
The aim of this study was to create a model of patient-centered outcomes with respect to self-management tasks and skills of patients with a tracheostomy in their home setting.
METHODS
A scoping review using four search engines was undertaken (Medline, CINAHL, PsycINFO, Cochrane Library) to identify studies relevant to this issue and published since 2000. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statements for Scoping Reviews (PRISMA-ScR), the Joanna Briggs Institute (JBI) approach of conducting and reporting a scoping review, and the Participants, Concept, Context (PCC) scheme were employed. The following elements of the framework synthesis study data were screened, and presented based on the self-management model of Lorig and Holman.
RESULTS
34 publications from 17 countries met the criteria for study inclusion: 24 quantitative, 8 qualitative and 2 mixed methods designs. Regarding the dimensions of self-management, 28 articles reported on "managing the therapeutic regimen", 27 articles discussed "managing role and behavior changes", and 16 articles explored "managing emotions". A model of self-management of patients with tracheostomy was developed, which placed the patient in the center, since it is this individual who is completing the tasks and carrying out his or her skill sets.
CONCLUSION
This scoping review represents the first comprehensive overview and modeling of the complex self-management tasks and skills required of patients with tracheostomy in their home setting. The theoretical model can serve as a cornerstone for empirical intervention studies to better support this patient-centered outcome for this population in the future.
Topics: Humans; Male; Female; Tracheostomy; Self-Management; Patients; Empirical Research
PubMed: 37823948
DOI: 10.1186/s41687-023-00643-2 -
Journal of Human Nutrition and... Jun 2021Despite recommendations for nutritional risk screening of all inpatients, outpatients and care home residents, as well as work to assess clinician's experiences and the...
BACKGROUND
Despite recommendations for nutritional risk screening of all inpatients, outpatients and care home residents, as well as work to assess clinician's experiences and the validity of tools, little attention has been paid to the experiences of patients undergoing nutritional screening. This review aims to synthesise systematically the current evidence regarding nutritional risk screening with respect to the experiences and views of patients, their families and carers.
METHODS
A systematic search was performed in MEDLINE, Embase, PsychINFO, CINAHL, Web of Science and British Nursing Database (inception - July 2019); with screening terms related to malnutrition, screening tools and experience. Titles, abstracts and full-text papers were independently reviewed by two reviewers and then quality-appraised. Qualitative papers and quantitative surveys were included. A narrative review of surveys and a thematic framework synthesis of interviews were used to identify themes.
RESULTS
Nine studies, including five qualitative interview papers, were included. Qualitative and quantitative study results were combined using a matrix chart to allow comparison. Surveyed participants reported processes of nutritional screening as acceptable. Three key themes emerged from qualitative data: (i) experience of nutritional screening; (ii) misunderstanding of malnutrition: of causes, role of screening and poor self-perception of risk; and (iii) barriers to and opportunities for change.
CONCLUSIONS
Although the screening process is acceptable, patients' misunderstanding and poor knowledge regarding causes and consequences of malnutrition result in reduced risk perception and disbelief or disregard of nutritional screening results. Findings should inform policy and clinical practice, as well as highlight the known paucity of data regarding the effectiveness of screening on clinical outcomes.
Topics: Attitude to Health; Caregivers; Diagnostic Screening Programs; Diet; Family; Female; Humans; Male; Malnutrition; Nutrition Assessment; Nutritional Status; Patients
PubMed: 33316101
DOI: 10.1111/jhn.12849 -
Current Hematologic Malignancy Reports Aug 2017The aims of this study were to identify and systematically evaluate studies published from 2005-2017 that took a dyadic approach to assessing or intervening upon... (Review)
Review
PURPOSE OF REVIEW
The aims of this study were to identify and systematically evaluate studies published from 2005-2017 that took a dyadic approach to assessing or intervening upon hematopoietic cell transplant (HCT) recipients and their informal caregivers.
RECENT FINDINGS
Our search yielded 20 studies. Regarding sample demographic characteristics, most participants were Caucasian and most caregivers were related to the patient by marriage. Regarding design characteristics, 18 studies were quantitative and two were qualitative; five were cross-sectional, ten were longitudinal, one was experimental, and four were interventional. Most outcomes were psychosocial and the interventions were largely psycho-educational in nature. Large variation in quality of the studies emerged (six were rated as low quality, seven as adequate, and seven as high quality). Understudied populations include racial/ethnic minorities and same-sex couples. More work is needed to understand functioning during survivorship and impacts on patient medical outcomes, and to truly leverage the dyad to optimize individual- and relationship-level adjustment.
Topics: Adaptation, Psychological; Adult; Caregivers; Communication; Hematopoietic Stem Cell Transplantation; Humans; Interpersonal Relations; Patients; Spouses
PubMed: 28573496
DOI: 10.1007/s11899-017-0391-0