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Surgery For Obesity and Related... Mar 2023
Meta-Analysis
Topics: Humans; Gastric Bypass; Patient Discharge; Obesity, Morbid; Gastrectomy; Laparoscopy; Treatment Outcome
PubMed: 36379841
DOI: 10.1016/j.soard.2022.10.011 -
Current Problems in Cardiology Oct 2022With the growing utilization of transcatheter aortic valve replacement (TAVR) as an alternative option to surgical valve replacement (SAVR) in patients considered to be... (Meta-Analysis)
Meta-Analysis Review
With the growing utilization of transcatheter aortic valve replacement (TAVR) as an alternative option to surgical valve replacement (SAVR) in patients considered to be suboptimal for surgery, there is a need to explore the possibility of next day discharge (NDD) and its potential outcomes. The aim of our study is to compare outcomes and complications following NDD vs the standard early discharge (ED) (less than 3 days). A comprehensive literature search was performed in PubMed, Embase, and Cochrane to identify relevant trials. Summary effects were calculated using a DerSimonian and Laird random effects model as odds ratio with 95% confidence intervals for all the clinical endpoints. Studies comparing same-day or next-day discharge vs discharge within the next three days were included in our analysis. 6 studies with 2,672 patients were identified. The risk of bleeding and vascular complications was significantly lower in patients with NDD compared to ED (OR 0.10, P < 0.00001 and OR 0.22, P = 0.002 respectively). The incidence of permanent pacemaker (PPM) implants was significantly lower in patients who had NDD compared to ED (OR 0.21, P = 0.0005). The incidence of 30 day mortality, stroke, AKI and readmission rates was not different between the two groups. NDD after TAVR allows for reduction in hospital stay and can mitigate hospital costs without an increased risk of complications. Our analysis shows that complication rate is comparable to ED, NDD is a reasonable option for certain patients with severe aortic stenosis who undergo TAVR. Further studies are needed to elucidate whether higher risk patients who would benefit from an extended inpatient monitoring post TAVR.
Topics: Aortic Valve; Aortic Valve Stenosis; Heart Valve Prosthesis Implantation; Humans; Patient Discharge; Risk Factors; Time Factors; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 34571105
DOI: 10.1016/j.cpcardiol.2021.100998 -
BMJ Quality & Safety Feb 2021Harm due to medications is common during the transition from hospital to home. Approaches that seek to prevent harm often involve isolated medication-related... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Harm due to medications is common during the transition from hospital to home. Approaches that seek to prevent harm often involve isolated medication-related interventions and show conflicting results. However, until now, no review has focused on the effect of intervention components delivered both in hospital and following discharge from hospital to home.
OBJECTIVE
To examine effects of medication-related interventions on hospital readmissions, medication-related problems (MRPs), medication adherence and mortality.
METHODS
For this systematic review and meta-analysis, we searched the PubMed, Embase, CINAHL and CENTRAL databases without language restrictions. Citations of included articles were checked through Web of Science and Scopus from inception to 20 June 2019. We included prospective studies that examined effects of medication-related interventions delivered both in hospital and following discharge from hospital to home compared with usual care. Three authors independently extracted data and assessed study quality in pairs.
RESULTS
Fourteen original studies were included, comprising 8182 patients. Interventions consisted mainly of patient education and medication reconciliation in the hospital, and patient education following discharge. Nine studies were included in the meta-analysis; compared with usual care (n=3376 patients), medication-related interventions (n=1820 patients) reduced hospital readmissions by 3.8 percentage points within 30 days of discharge (number needed to treat=27, risk ratio (RR) 0.79 (95% CI 0.65 to 0.96)). Meta-regression analysis suggested that readmission rates were reduced by 17% per additional intervention component (RR 0.83 (95% Cl 0.75 to 0.91)). Medication adherence and MRPs may be improved. Effects on mortality were unclear.
CONCLUSIONS
Studied medication-related interventions reduce all-cause hospital readmissions within 30 days. The treatment effect appears to increase with higher intervention intensities. More evidence is needed for recommendations on adherence, mortality and MRPs.
Topics: Hospitals; Humans; Medication Reconciliation; Patient Discharge; Patient Readmission; Prospective Studies
PubMed: 32434936
DOI: 10.1136/bmjqs-2020-010927 -
Breastfeeding Medicine : the Official... Oct 2022Late preterm infants (LPIs; born at 34 to 36 gestational weeks) and early term infants (ETIs; 37 to 38 gestational weeks) are at higher risk of morbidity and mortality... (Review)
Review
Late preterm infants (LPIs; born at 34 to 36 gestational weeks) and early term infants (ETIs; 37 to 38 gestational weeks) are at higher risk of morbidity and mortality compared with more mature infants. Breastfeeding can reduce these risks, but feeding difficulties are common among these infants and breastfeeding rates are low. We conducted a systematic review to identify the interventions available to improve any breastfeeding, exclusive breastfeeding, or breast milk yield. A literature search was performed up to February 23, 2022, using MEDLINE, CINAHL, Embase, and Google Scholar, and nine articles were included. Only one article was a randomized controlled trial, and only one included ETIs. The remaining articles were quasi-experimental and included only LPIs. Outcomes included breastfeeding duration, breastfeeding exclusivity, and/or breast milk production (volume) before 6 months actual age. Professional support significantly improved exclusive breastfeeding rates. A breastfeeding education program delivered at the hospital with weekly telephone follow-up postdischarge significantly increased breastfeeding rates. Neither cup feeding nor early discharge (with in-home lactation support) improved breastfeeding rates, whereas rooming-in (versus direct admission to the neonatal intensive care unit) worsened exclusive breastfeeding rates. This is the first systematic review to identify interventions available for both LPIs and ETIs. Overall, there are limited studies that investigate interventions promoting breastfeeding in these populations. However, breastfeeding support delivered by health care professionals seems to improve breastfeeding rates. The main limitations are the lack of randomization, blinding, and adjustment for confounding variables. Experimental studies with robust methodological design are needed.
Topics: Infant; Female; Infant, Newborn; Humans; Breast Feeding; Infant, Premature; Aftercare; Patient Discharge; Intensive Care Units, Neonatal; Randomized Controlled Trials as Topic
PubMed: 36282193
DOI: 10.1089/bfm.2022.0118 -
Surgery Sep 2022Enhanced recovery after surgery programs have improved patient outcomes following colorectal surgery. This has provided a platform for the consideration of ambulatory... (Review)
Review
BACKGROUND
Enhanced recovery after surgery programs have improved patient outcomes following colorectal surgery. This has provided a platform for the consideration of ambulatory colectomies where patients are discharged within 24 hours after surgery. Although some studies have demonstrated its feasibility, the safety profile and patient eligibility criteria for discharge within 24 hours after surgery remain relatively ill-defined. This study provided a review of the patient selection criteria and postoperative outcomes shown in patients discharged within 24 hours after surgery.
METHODS
Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines were adhered to. A comprehensive search was performed on 3 electronic databases, and the relevant articles were identified. The primary outcome measures were postoperative morbidity and readmission rates. The different domains relevant to the selection of patients and perioperative care of patients discharged within 24 hours after surgery were also qualitatively assessed.
RESULTS
Eight studies were included, which involved a total of 1,229 patients. The majority of selected patients underwent elective laparoscopic colonic surgeries. The patient characteristics, such as age, comorbidities, obesity, and psychosocial environment, were important considerations. A close follow-up with home-based medical services was ideal in patients discharged within 24 hours after surgery. The readmission rates ranged from 0.0% to 9.0%. Despite morbidity rates of up to 26.7%, the majority of them were minor and classified as Clavien-Dindo Grade I to II.
CONCLUSION
The use of programs related to discharge within 24 hours after surgery in colorectal surgery is safe, feasible, and practical in a select group of patients within a well-designed clinical framework and pathway. Future studies should compare patient outcomes following discharge within 24 hours after surgery with conventional enhanced recovery after surgery protocols. In addition, patient and caregiver perceptions, quality of life, and cost-effectiveness analysis should also be performed.
Topics: Colectomy; Colon; Humans; Laparoscopy; Patient Discharge; Quality of Life
PubMed: 35840425
DOI: 10.1016/j.surg.2022.04.050 -
American Journal of Surgery Aug 2016Despite hospital readmission being a targeted quality metric, few studies have focused on the surgical patient population. We performed a systematic review of... (Review)
Review
BACKGROUND
Despite hospital readmission being a targeted quality metric, few studies have focused on the surgical patient population. We performed a systematic review of transitional care interventions and their effect on hospital readmissions after surgery.
DATA SOURCES
PubMed was searched for studies evaluating transitional care interventions in surgical populations within the years 1995 to 2015. Of 3,527 abstracts identified, 3 randomized controlled trials and 7 observational cohort studies met inclusion criteria.
CONCLUSIONS
Discharge planning programs reduced readmissions by 11.5% (P = .001), 12.5% (P = .04), and 23% (P = .26). Patient education interventions reduced readmissions by 14% (P = .28) and 23.5% (P < .05). Primary care follow-up reduced readmissions by 8.3% for patients after high-risk surgeries (P < .001). Home visits reduced readmissions by 7.69% (P = .023) and 4% (P = .161), respectively. Therefore, improving discharge planning, patient education, and follow-up communication may reduce readmissions.
Topics: Continuity of Patient Care; Home Care Services; Humans; Patient Discharge; Patient Education as Topic; Patient Readmission; Postoperative Care; Surgical Procedures, Operative; Transitional Care
PubMed: 27353404
DOI: 10.1016/j.amjsurg.2016.04.004 -
BJS Open Mar 2021Little is known about the electronic collection and clinical feedback of patient-reported outcomes (ePROs) following surgical discharge. This systematic review...
BACKGROUND
Little is known about the electronic collection and clinical feedback of patient-reported outcomes (ePROs) following surgical discharge. This systematic review summarized the evidence on the collection and uses of electronic systems to collect PROs after discharge from hospital after surgery.
METHOD
Systematic searches of MEDLINE, Embase, PsycINFO, CINAHL and Cochrane Central were undertaken from database inception to July 2019 using terms for 'patient reported outcomes', 'electronic', 'surgery' and 'at home'. Primary research of all study designs was included if they used electronic systems to collect PRO data in adults after hospital discharge following surgery. Data were collected on the settings, patient groups and specialties, ePRO systems (including features and functions), PRO data collected, and integration with health records.
RESULTS
Fourteen studies were included from 9474 records, including two RCTs and six orthopaedic surgery studies. Most studies (9 of 14) used commercial ePRO systems. Six reported types of electronic device were used: tablets or other portable devices (3 studies), smartphones (2), combination of smartphones, tablets, portable devices and computers (1). Systems had limited features and functions such as real-time clinical feedback (6 studies) and messaging service for patients with care teams (3). No study described ePRO system integration with electronic health records to support clinical feedback.
CONCLUSION
There is limited reporting of ePRO systems in the surgical literature, and ePRO systems lack integration with hospital clinical systems. Future research should describe the ePRO system and ePRO questionnaires used, and challenges encountered during the study, to support efficient upscaling of ePRO systems using tried and tested approaches.
Topics: Enhanced Recovery After Surgery; Feedback; Humans; Monitoring, Ambulatory; Patient Discharge; Patient Reported Outcome Measures; Randomized Controlled Trials as Topic; Telemedicine
PubMed: 33782708
DOI: 10.1093/bjsopen/zraa072 -
Pediatric Critical Care Medicine : a... Jan 2023Critically ill patients are increasingly being discharged directly home from PICU as opposed to discharged home, via the ward. The objective was to assess the...
OBJECTIVES
Critically ill patients are increasingly being discharged directly home from PICU as opposed to discharged home, via the ward. The objective was to assess the prevalence, safety, and satisfaction of discharge directly home from PICUs.
DATA SOURCES
We searched PubMed, Medline, EMBASE, PsycINFO, and CINAHL for studies published between January 1991 and June 2021.
STUDY SELECTION
We included observational or randomized studies, of children up to 18 years old, that reported on the prevalence, safety, or satisfaction of discharge directly home from the PICU, compared with the ward. Safety outcomes included readmission, unplanned visits to hospital, and any adverse events. We excluded case series, reviews, and studies discharging patients to other facilities.
DATA EXTRACTION
Two independent reviewers evaluated 88 full-text articles; five studies met eligibility (362,868 patients). Only one study had discharge directly home as a primary outcome.
DATA SYNTHESIS
Prevalence of discharge directly to home from the PICU ranged from less than 1% to 23% (random effects proportion 7.7 [95% CI, 1.3-18.6]). Readmissions to the PICU (only safety outcome) were significantly lower in the discharge directly home group compared with the ward group, in two of three studies (p < 0.0001). No studies reported on patient or family satisfaction.
CONCLUSIONS
The prevalence of discharge directly home from the PICU ranges from 1% to 23%. PICU readmission rates do not appear to increase after discharge directly home. Caution is needed in the interpretation of the results, given the significant heterogeneity of the included studies. Further high-quality studies are needed to evaluate the safety of discharge directly home from the PICU and support families in this transition.
Topics: Child; Humans; Patient Discharge; Patient Readmission; Prevalence; Hospitals; Intensive Care Units, Pediatric
PubMed: 36594800
DOI: 10.1097/PCC.0000000000003114 -
Critical Care (London, England) Oct 2016There is growing interest in patient outcomes following critical illness, with an increasing number and different types of studies conducted, and a need for synthesis of... (Review)
Review
BACKGROUND
There is growing interest in patient outcomes following critical illness, with an increasing number and different types of studies conducted, and a need for synthesis of existing findings to help inform the field. For this purpose we conducted a systematic review of qualitative studies evaluating patient outcomes after hospital discharge for survivors of critical illness.
METHODS
We searched the PubMed, EMBASE, CINAHL, PsycINFO, and CENTRAL databases from inception to June 2015. Studies were eligible for inclusion if the study population was >50 % adults discharged from the ICU, with qualitative evaluation of patient outcomes. Studies were excluded if they focused on specific ICU patient populations or specialty ICUs. Citations were screened in duplicate, and two reviewers extracted data sequentially for each eligible article. Themes related to patient outcome domains were coded and categorized based on the main domains of the Patient Reported Outcomes Measurement Information System (PROMIS) framework.
RESULTS
A total of 2735 citations were screened, and 22 full-text articles were eligible, with year of publication ranging from 1995 to 2015. All of the qualitative themes were extracted from eligible studies and then categorized using PROMIS descriptors: satisfaction with life (16 studies), including positive outlook, acceptance, gratitude, independence, boredom, loneliness, and wishing they had not lived; mental health (15 articles), including symptoms of post-traumatic stress disorder, anxiety, depression, and irritability/anger; physical health (14 articles), including mobility, activities of daily living, fatigue, appetite, sensory changes, muscle weakness, and sleep disturbances; social health (seven articles), including changes in friends/family relationships; and ability to participate in social roles and activities (six articles), including hobbies and disability.
CONCLUSION
ICU survivors may experience positive emotions and life satisfaction; however, a wide range of mental, physical, social, and functional sequelae occur after hospital discharge. These findings are important for understanding patient-centered outcomes in critical care and providing focus for future interventional studies aimed at improving outcomes of importance to ICU survivors.
Topics: Anxiety; Critical Illness; Depression; Humans; Intensive Care Units; Life Change Events; Patient Discharge; Patient Outcome Assessment; Qualitative Research; Quality of Life; Sleep Wake Disorders; Social Support; Stress Disorders, Post-Traumatic; Survivors
PubMed: 27782830
DOI: 10.1186/s13054-016-1516-x -
Clinical Neurology and Neurosurgery Mar 2016Different factors have been studied and proven to significantly influence discharge destination of acute stroke patients after hospitalization. Few reviews have been... (Review)
Review
Different factors have been studied and proven to significantly influence discharge destination of acute stroke patients after hospitalization. Few reviews have been published combining the results of these studies. Therefore we aim to present an overview of the studies conducted regarding these predicting factors. Through conducting a systematic review we aimed to study the different predictive factors influencing discharge destination of acute stroke patients after hospitalization. Nineteen articles were selected in accordance with the research question and inclusion criteria. The factors found were, according to their significance in the articles, subcategorized in age, gender, functional status, cognitive status, race and ethnicity, co morbidities, education, stroke characteristics, social and living situation. The main factors significantly associated with other than home discharge were functional dependence/comorbidities, neurocognitive dysfunction and previous living circumstances/marital status. A medium or large infarct is associated with institutionalization. The stroke volume is not associated with home discharge. The effect of other factors remain controversial and results differ between studies. These include: age, gender, race, affected hemisphere and availability of a caregiver not living at home. Factors such as education, hospital complications, geographic location and FIM progression during hospitalization have not been studied sufficiently.
Topics: Age Distribution; Caregivers; Cognition; Humans; Patient Discharge; Sex Characteristics; Stroke; Stroke Rehabilitation
PubMed: 26802615
DOI: 10.1016/j.clineuro.2016.01.004