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International Journal of Environmental... Nov 2022Adverse events in hospitals are prevented through risk reduction and reliable processes. Highly reliable hospitals are grounded by a robust patient safety culture with... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Adverse events in hospitals are prevented through risk reduction and reliable processes. Highly reliable hospitals are grounded by a robust patient safety culture with effective communication, leadership, teamwork, error reporting, continuous improvement, and organizational learning. Although hospitals regularly measure their patient safety culture for strengths and weaknesses, there have been no systematic reviews with meta-analyses reported from Latin America.
PURPOSE
Our systematic review aims to produce evidence about the status of patient safety culture in Latin American hospitals from studies using the Hospital Survey on Patient Safety Culture (HSOPSC).
METHODS
This systematic review was guided by the JBI guidelines for evidence synthesis. Four databases were systematically searched for studies from 2011 to 2021 originating in Latin America. Studies identified for inclusion were assessed for methodological quality and risk of bias. Descriptive and inferential statistics, including meta-analysis for professional subgroups and meta-regression for subgroup effect, were calculated.
RESULTS
In total, 30 studies from five countries-Argentina (1), Brazil (22), Colombia (3), Mexico (3), and Peru (1)-were included in the review, with 10,915 participants, consisting primarily of nursing staff (93%). The HSOPSC dimensions most positive for patient safety culture were "organizational learning: continuous improvement" and "teamwork within units", while the least positive were "nonpunitive response to error" and "staffing". Overall, there was a low positive perception (48%) of patient safety culture as a global measure (95% CI, 44.53-51.60), and a significant difference was observed for physicians who had a higher positive perception than nurses (59.84; 95% CI, 56.02-63.66).
CONCLUSIONS
Patient safety culture is a relatively unknown or unmeasured concept in most Latin American countries. Health professional programs need to build patient safety content into curriculums with an emphasis on developing skills in communication, leadership, and teamwork. Despite international accreditation penetration in the region, there were surprisingly few studies from countries with accredited hospitals. Patient safety culture needs to be a priority for hospitals in Latin America through health policies requiring annual assessments to identify weaknesses for quality improvement initiatives.
Topics: Humans; Patient Safety; Latin America; Organizational Culture; Safety Management; Hospitals; Surveys and Questionnaires
PubMed: 36361273
DOI: 10.3390/ijerph192114380 -
Revista Da Escola de Enfermagem Da U S P 2016To analyze the prevalence of falls and frailty syndrome and the association between these two syndromes in the elderly population. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To analyze the prevalence of falls and frailty syndrome and the association between these two syndromes in the elderly population.
METHOD
Systematic review, without restriction of dates, in English, Portuguese and Spanish languages, in the databases PubMed, CINAHL, LILACS and in the SciElo virtual library. The association between both variables was extracted from the studies (Odds Ratio and 95% Confidence Intervals).
RESULTS
The review included 19 studies published between 2001 and 2015. The prevalence of falls in the frail elderly population was between 6.7% and 44%; in the pre-frail, between 10.0% and 52.0%, and in the non-frail, between 7.6% and 90.4%. The association between both variables presented a value of OR 1.80 (95% CI 1.51-2.13).
CONCLUSION
There is evidence that falls are associated to the frailty in the elderly. Other factors may influence this association, such as age, sex, data collection instrument of the studies, place where they live and the process of senescence.
OBJETIVO
Analisar a prevalência de quedas e da síndrome da fragilidade e a associação entre essas duas síndromes na população idosa.
MÉTODO
Revisão sistemática, sem restrição de datas, nos idiomas inglês, português e espanhol, nas bases de dados PubMed, CINAHL, LILACS e na biblioteca virtual SciElo. A associação entre ambas as variáveis foi extraída dos próprios artigos (Odds Ratio e os Intervalos de Confiança de 95%).
RESULTADOS
Foram incluídos na revisão 19 artigos publicados entre 2001 e 2015. A prevalência de queda no idoso frágil esteve entre 6,7% e 44%; nos pré-frágeis, entre 10,0% e 52,0%, e nos não frágeis, entre 7,6% e 90,4%. A associação entre ambas as variáveis apresentou o valor de OR 1,80 (IC 95% 1,51-2,13).
CONCLUSÃO
Há evidências de que a queda está associada à fragilidade do idoso. Outros fatores podem influenciar essa associação, como idade, sexo, instrumento de coleta de dados dos estudos, local onde vive e o próprio processo de senescência.
Topics: Accidental Falls; Aged; Frail Elderly; Humans; Prevalence; Syndrome
PubMed: 28198967
DOI: 10.1590/S0080-623420160000700018 -
The International Journal of Behavioral... Nov 2020Exercise prevents falls in older adults. Regular updates of estimated effects of exercise on falls are warranted given the number of new trials, the increasing number of...
BACKGROUND
Exercise prevents falls in older adults. Regular updates of estimated effects of exercise on falls are warranted given the number of new trials, the increasing number of older people globally and the major consequences of falls and fall-related injuries.
METHODS
This update of a 2019 Cochrane Review was undertaken to inform the World Health Organization guidelines on physical activity and sedentary behaviour. Searches were conducted in six databases. We included randomised controlled trials evaluating effects of any form of physical activity as a single intervention on falls in people aged 60+ years living in the community. Analyses explored dose-response relationships. The certainty of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE).
RESULTS
This review included 116 studies, involving 25,160 participants; nine new studies since the 2019 Cochrane Review. Exercise reduces the rate of falls by 23% (pooled rate ratio (RaR) 0.77, 95% confidence interval (CI) 0.71 to 0.83, 64 studies, high certainty evidence). Subgroup analysis showed variation in effects of different types of exercise (p < 0.01). Rate of falls compared with control is reduced by 24% from balance and functional exercises (RaR 0.76, 95% CI 0.70 to 0.82, 39 studies, high certainty evidence), 28% from programs involving multiple types of exercise (commonly balance and functional exercises plus resistance exercises, RaR 0.72, 95% CI 0.56 to 0.93, 15 studies, moderate certainty evidence) and 23% from Tai Chi (RaR 0.77, 95% CI 0.61 to 0.97, 9 studies, moderate certainty evidence). The effects of programs that primarily involve resistance training, dance or walking remain uncertain. Interventions with a total weekly dose of 3+ h that included balance and functional exercises were particularly effective with a 42% reduction in rate of falls compared to control (Incidence Rate Ratio (IRR) 0.58, 95% CI 0.45 to 0.76). Subgroup analyses showed no evidence of a difference in the effect on falls on the basis of participant age over 75 years, risk of falls as a trial inclusion criterion, individual versus group exercise, or whether a health professional delivered the intervention.
CONCLUSIONS
Given the strength of this evidence, effective exercise programs should now be implemented at scale.
Topics: Accidental Falls; Aged; Exercise; Female; Guidelines as Topic; Humans; Independent Living; Male; Middle Aged; Randomized Controlled Trials as Topic; World Health Organization
PubMed: 33239019
DOI: 10.1186/s12966-020-01041-3 -
Journal of Cachexia, Sarcopenia and... Jun 2019Sarcopenia is a potentially modifiable risk factor for falls and fractures in older adults, but the strength of the association between sarcopenia, falls, and fractures... (Meta-Analysis)
Meta-Analysis
Sarcopenia is a potentially modifiable risk factor for falls and fractures in older adults, but the strength of the association between sarcopenia, falls, and fractures is unclear. This study aims to systematically assess the literature and perform a meta-analysis of the association between sarcopenia with falls and fractures among older adults. A literature search was performed using MEDLINE, EMBASE, Cochrane, and CINAHL from inception to May 2018. Inclusion criteria were the following: published in English, mean/median age ≥ 65 years, sarcopenia diagnosis (based on definitions used by the original studies' authors), falls and/or fractures outcomes, and any study population. Pooled analyses were conducted of the associations of sarcopenia with falls and fractures, expressed in odds ratios (OR) and 95% confidence intervals (CIs). Subgroup analyses were performed by study design, population, sex, sarcopenia definition, continent, and study quality. Heterogeneity was assessed using the I statistics. The search identified 2771 studies. Thirty-six studies (52 838 individuals, 48.8% females, and mean age of the study populations ranging from 65.0 to 86.7 years) were included in the systematic review. Four studies reported on both falls and fractures. Ten out of 22 studies reported a significantly higher risk of falls in sarcopenic compared with non-sarcopenic individuals; 11 out of 19 studies showed a significant positive association with fractures. Thirty-three studies (45 926 individuals) were included in the meta-analysis. Sarcopenic individuals had a significant higher risk of falls (cross-sectional studies: OR 1.60; 95% CI 1.37-1.86, P < 0.001, I = 34%; prospective studies: OR 1.89; 95% CI 1.33-2.68, P < 0.001, I = 37%) and fractures (cross-sectional studies: OR 1.84; 95% CI 1.30-2.62, P = 0.001, I = 91%; prospective studies: OR 1.71; 95% CI 1.44-2.03, P = 0.011, I = 0%) compared with non-sarcopenic individuals. This was independent of study design, population, sex, sarcopenia definition, continent, and study quality. The positive association between sarcopenia with falls and fractures in older adults strengthens the need to invest in sarcopenia prevention and interventions to evaluate its effect on falls and fractures.
Topics: Accidental Falls; Age Factors; Aged; Aged, 80 and over; Fractures, Bone; Humans; Odds Ratio; Risk Factors; Sarcopenia
PubMed: 30993881
DOI: 10.1002/jcsm.12411 -
The Cochrane Database of Systematic... Jul 2018Falls and fall-related injuries are common, particularly in those aged over 65, with around one-third of older people living in the community falling at least once a... (Review)
Review
BACKGROUND
Falls and fall-related injuries are common, particularly in those aged over 65, with around one-third of older people living in the community falling at least once a year. Falls prevention interventions may comprise single component interventions (e.g. exercise), or involve combinations of two or more different types of intervention (e.g. exercise and medication review). Their delivery can broadly be divided into two main groups: 1) multifactorial interventions where component interventions differ based on individual assessment of risk; or 2) multiple component interventions where the same component interventions are provided to all people.
OBJECTIVES
To assess the effects (benefits and harms) of multifactorial interventions and multiple component interventions for preventing falls in older people living in the community.
SEARCH METHODS
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature, trial registers and reference lists. Date of search: 12 June 2017.
SELECTION CRITERIA
Randomised controlled trials, individual or cluster, that evaluated the effects of multifactorial and multiple component interventions on falls in older people living in the community, compared with control (i.e. usual care (no change in usual activities) or attention control (social visits)) or exercise as a single intervention.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected studies, assessed risks of bias and extracted data. We calculated the rate ratio (RaR) with 95% confidence intervals (CIs) for rate of falls. For dichotomous outcomes we used risk ratios (RRs) and 95% CIs. For continuous outcomes, we used the standardised mean difference (SMD) with 95% CIs. We pooled data using the random-effects model. We used the GRADE approach to assess the quality of the evidence.
MAIN RESULTS
We included 62 trials involving 19,935 older people living in the community. The median trial size was 248 participants. Most trials included more women than men. The mean ages in trials ranged from 62 to 85 years (median 77 years). Most trials (43 trials) reported follow-up of 12 months or over. We assessed most trials at unclear or high risk of bias in one or more domains.Forty-four trials assessed multifactorial interventions and 18 assessed multiple component interventions. (I not reported if = 0%).Multifactorial interventions versus usual care or attention controlThis comparison was made in 43 trials. Commonly-applied or recommended interventions after assessment of each participant's risk profile were exercise, environment or assistive technologies, medication review and psychological interventions. Multifactorial interventions may reduce the rate of falls compared with control: rate ratio (RaR) 0.77, 95% CI 0.67 to 0.87; 19 trials; 5853 participants; I = 88%; low-quality evidence. Thus if 1000 people were followed over one year, the number of falls may be 1784 (95% CI 1553 to 2016) after multifactorial intervention versus 2317 after usual care or attention control. There was low-quality evidence of little or no difference in the risks of: falling (i.e. people sustaining one or more fall) (RR 0.96, 95% CI 0.90 to 1.03; 29 trials; 9637 participants; I = 60%); recurrent falls (RR 0.87, 95% CI 0.74 to 1.03; 12 trials; 3368 participants; I = 53%); fall-related hospital admission (RR 1.00, 95% CI 0.92 to 1.07; 15 trials; 5227 participants); requiring medical attention (RR 0.91, 95% CI 0.75 to 1.10; 8 trials; 3078 participants). There is low-quality evidence that multifactorial interventions may reduce the risk of fall-related fractures (RR 0.73, 95% CI 0.53 to 1.01; 9 trials; 2850 participants) and may slightly improve health-related quality of life but not noticeably (SMD 0.19, 95% CI 0.03 to 0.35; 9 trials; 2373 participants; I = 70%). Of three trials reporting on adverse events, one found none, and two reported 12 participants with self-limiting musculoskeletal symptoms in total.Multifactorial interventions versus exerciseVery low-quality evidence from one small trial of 51 recently-discharged orthopaedic patients means that we are uncertain of the effects on rate of falls or risk of falling of multifactorial interventions versus exercise alone. Other fall-related outcomes were not assessed.Multiple component interventions versus usual care or attention controlThe 17 trials that make this comparison usually included exercise and another component, commonly education or home-hazard assessment. There is moderate-quality evidence that multiple interventions probably reduce the rate of falls (RaR 0.74, 95% CI 0.60 to 0.91; 6 trials; 1085 participants; I = 45%) and risk of falls (RR 0.82, 95% CI 0.74 to 0.90; 11 trials; 1980 participants). There is low-quality evidence that multiple interventions may reduce the risk of recurrent falls, although a small increase cannot be ruled out (RR 0.81, 95% CI 0.63 to 1.05; 4 trials; 662 participants). Very low-quality evidence means that we are uncertain of the effects of multiple component interventions on the risk of fall-related fractures (2 trials) or fall-related hospital admission (1 trial). There is low-quality evidence that multiple interventions may have little or no effect on the risk of requiring medical attention (RR 0.95, 95% CI 0.67 to 1.35; 1 trial; 291 participants); conversely they may slightly improve health-related quality of life (SMD 0.77, 95% CI 0.16 to 1.39; 4 trials; 391 participants; I = 88%). Of seven trials reporting on adverse events, five found none, and six minor adverse events were reported in two.Multiple component interventions versus exerciseThis comparison was tested in five trials. There is low-quality evidence of little or no difference between the two interventions in rate of falls (1 trial) and risk of falling (RR 0.93, 95% CI 0.78 to 1.10; 3 trials; 863 participants) and very low-quality evidence, meaning we are uncertain of the effects on hospital admission (1 trial). One trial reported two cases of minor joint pain. Other falls outcomes were not reported.
AUTHORS' CONCLUSIONS
Multifactorial interventions may reduce the rate of falls compared with usual care or attention control. However, there may be little or no effect on other fall-related outcomes. Multiple component interventions, usually including exercise, may reduce the rate of falls and risk of falling compared with usual care or attention control.
Topics: Accidental Falls; Accidents, Home; Aged; Aged, 80 and over; Exercise; Female; Fractures, Bone; Hospitalization; Humans; Independent Living; Male; Middle Aged; Randomized Controlled Trials as Topic; Risk Assessment
PubMed: 30035305
DOI: 10.1002/14651858.CD012221.pub2 -
JAMA Internal Medicine Oct 2018Physician burnout has taken the form of an epidemic that may affect core domains of health care delivery, including patient safety, quality of care, and patient... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Physician burnout has taken the form of an epidemic that may affect core domains of health care delivery, including patient safety, quality of care, and patient satisfaction. However, this evidence has not been systematically quantified.
OBJECTIVE
To examine whether physician burnout is associated with an increased risk of patient safety incidents, suboptimal care outcomes due to low professionalism, and lower patient satisfaction.
DATA SOURCES
MEDLINE, EMBASE, PsycInfo, and CINAHL databases were searched until October 22, 2017, using combinations of the key terms physicians, burnout, and patient care. Detailed standardized searches with no language restriction were undertaken. The reference lists of eligible studies and other relevant systematic reviews were hand-searched.
STUDY SELECTION
Quantitative observational studies.
DATA EXTRACTION AND SYNTHESIS
Two independent reviewers were involved. The main meta-analysis was followed by subgroup and sensitivity analyses. All analyses were performed using random-effects models. Formal tests for heterogeneity (I2) and publication bias were performed.
MAIN OUTCOMES AND MEASURES
The core outcomes were the quantitative associations between burnout and patient safety, professionalism, and patient satisfaction reported as odds ratios (ORs) with their 95% CIs.
RESULTS
Of the 5234 records identified, 47 studies on 42 473 physicians (25 059 [59.0%] men; median age, 38 years [range, 27-53 years]) were included in the meta-analysis. Physician burnout was associated with an increased risk of patient safety incidents (OR, 1.96; 95% CI, 1.59-2.40), poorer quality of care due to low professionalism (OR, 2.31; 95% CI, 1.87-2.85), and reduced patient satisfaction (OR, 2.28; 95% CI, 1.42-3.68). The heterogeneity was high and the study quality was low to moderate. The links between burnout and low professionalism were larger in residents and early-career (≤5 years post residency) physicians compared with middle- and late-career physicians (Cohen Q = 7.27; P = .003). The reporting method of patient safety incidents and professionalism (physician-reported vs system-recorded) significantly influenced the main results (Cohen Q = 8.14; P = .007).
CONCLUSIONS AND RELEVANCE
This meta-analysis provides evidence that physician burnout may jeopardize patient care; reversal of this risk has to be viewed as a fundamental health care policy goal across the globe. Health care organizations are encouraged to invest in efforts to improve physician wellness, particularly for early-career physicians. The methods of recording patient care quality and safety outcomes require improvements to concisely capture the outcome of burnout on the performance of health care organizations.
Topics: Burnout, Psychological; Humans; Patient Safety; Patient Satisfaction; Physicians; Professionalism; Quality of Health Care
PubMed: 30193239
DOI: 10.1001/jamainternmed.2018.3713 -
Stomatologija 2020The aim of this paper was to analyze the literature published in the research related to sodium hypochlorite induced injury. An internet search using search engines...
The aim of this paper was to analyze the literature published in the research related to sodium hypochlorite induced injury. An internet search using search engines (Google, Researchgate and PubMed) was carried out. The keywords used for search were sodium hypochlorite, injury, cellulitis, apical extrusion, ulcer, endodontics. Full text articles of the articles were collected from the year 2007 to 2017. The data available from the clinical trials the journal articles were analyzed and presented in both tabular and descriptive patterns.
Topics: Accidents; Endodontics; Sodium Hypochlorite
PubMed: 32706342
DOI: No ID Found -
Latest Research Trends in Fall Detection and Prevention Using Machine Learning: A Systematic Review.Sensors (Basel, Switzerland) Jul 2021Falls are unusual actions that cause a significant health risk among older people. The growing percentage of people of old age requires urgent development of fall... (Review)
Review
Falls are unusual actions that cause a significant health risk among older people. The growing percentage of people of old age requires urgent development of fall detection and prevention systems. The emerging technology focuses on developing such systems to improve quality of life, especially for the elderly. A fall prevention system tries to predict and reduce the risk of falls. In contrast, a fall detection system observes the fall and generates a help notification to minimize the consequences of falls. A plethora of technical and review papers exist in the literature with a primary focus on fall detection. Similarly, several studies are relatively old, with a focus on wearables only, and use statistical and threshold-based approaches with a high false alarm rate. Therefore, this paper presents the latest research trends in fall detection and prevention systems using Machine Learning (ML) algorithms. It uses recent studies and analyzes datasets, age groups, ML algorithms, sensors, and location. Additionally, it provides a detailed discussion of the current trends of fall detection and prevention systems with possible future directions. This overview can help researchers understand the current systems and propose new methodologies by improving the highlighted issues.
Topics: Accidental Falls; Aged; Algorithms; Humans; Machine Learning; Quality of Life; Seasons
PubMed: 34372371
DOI: 10.3390/s21155134 -
Journal of Sport and Health Science Jan 2021The evidence concerning which physical exercise characteristics are most effective for older adults is fragmented. We aimed to characterize the extent of this diversity...
BACKGROUND
The evidence concerning which physical exercise characteristics are most effective for older adults is fragmented. We aimed to characterize the extent of this diversity and inconsistency and identify future directions for research by undertaking a systematic review of meta-analyses of exercise interventions in older adults.
METHODS
We searched the Cochrane Database of Systematic Reviews, PsycInfo, MEDLINE, Embase, CINAHL, AMED, SPORTDiscus, and Web of Science for articles that met the following criteria: (1) meta-analyses that synthesized measures of improvement (e.g., effect sizes) on any outcome identified in studies of exercise interventions; (2) participants in the studies meta-analyzed were adults aged 65+ or had a mean age of 70+; (3) meta-analyses that included studies of any type of exercise, including its duration, frequency, intensity, and mode of delivery; (4) interventions that included multiple components (e.g., exercise and cognitive stimulation), with effect sizes that were computed separately for the exercise component; and (5) meta-analyses that were published in any year or language. The characteristics of the reviews, of the interventions, and of the parameters improved through exercise were reported through narrative synthesis. Identification of the interventions linked to the largest improvements was carried out by identifying the highest values for improvement recorded across the reviews. The study included 56 meta-analyses that were heterogeneous in relation to population, sample size, settings, outcomes, and intervention characteristics.
RESULTS
The largest effect sizes for improvement were found for resistance training, meditative movement interventions, and exercise-based active videogames.
CONCLUSION
The review identified important gaps in research, including a lack of studies investigating the benefits of group interventions, the characteristics of professionals delivering the interventions associated with better outcomes, and the impact of motivational strategies and of significant others (e.g., carers) on intervention delivery and outcomes.
Topics: Accidental Falls; Activities of Daily Living; Aged; Bone Density; Brain; Cognition Disorders; Exercise; Fear; Health Status; Humans; Meditation; Meta-Analysis as Topic; Muscle, Skeletal; Quality of Life; Resistance Training; Time Factors; Video Games
PubMed: 32525097
DOI: 10.1016/j.jshs.2020.06.003 -
Journal of the American College of... Dec 2021The aim of this study was to identify what parts of the World Health Organization Surgical Safety Checklist (WHO SSC) are working, what can be done to make it more... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The aim of this study was to identify what parts of the World Health Organization Surgical Safety Checklist (WHO SSC) are working, what can be done to make it more effective, and to determine if it achieved its intended effect relative to its design and intended use.
STUDY DESIGN
We conducted a qualitative thematic analysis and meta-meta-analyses of findings in WHO SSC systematic reviews following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
RESULTS
Twenty systematic reviews were included for qualitative thematic analysis. Narrative information was coded in 4 primary areas with a focus on impact of the WHO SSC. Four themes-Clinical Outcomes, Process Measures, Team Dynamics and Communication, and Safety Culture-pertained directly to the aims or purposes behind the development of the SSC. The other 2 themes-Efficiency and Workload involved in using the checklist and Checklist Impact on Institutional Practices-are associated with SSC use, but were not focal areas considered during its development. Included in the 20 systematic reviews were 24 unique observational cohort studies that reported pre-post data on a total of 18 clinical outcomes. Mortality, morbidity, surgical site infection, pneumonia, unplanned return to the operating room, urinary tract infection, blood loss requiring transfusion, unplanned intubation, and sepsis favored the use of the WHO SSC. Deep vein thrombosis was the only postoperative outcome assessed that did not favor use of the WHO SSC.
CONCLUSIONS
The WHO SSC positively impacts the things it was explicitly designed to address and does not positively impact things it was not explicitly designed for.
Topics: Checklist; Humans; Operating Rooms; Patient Safety; Postoperative Complications; Process Assessment, Health Care; Qualitative Research; Safety Management; Surgical Procedures, Operative; World Health Organization
PubMed: 34592406
DOI: 10.1016/j.jamcollsurg.2021.08.692