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Plastic and Reconstructive Surgery Jun 2015Cryolipolysis is a nonsurgical technique for localized fat reduction. With the increased risk of complications from more invasive methods such as liposuction,... (Review)
Review
BACKGROUND
Cryolipolysis is a nonsurgical technique for localized fat reduction. With the increased risk of complications from more invasive methods such as liposuction, cryolipolysis presents a promising method for nonsurgical body contouring. This study presents a systematic review of the available clinical data, with an emphasis on the efficacy, methods, safety, and complications of cryolipolysis.
METHODS
To identify clinical studies that assessed outcomes of cryolipolysis, a systematic review of the MEDLINE and Cochrane databases was performed with the search algorithm cryolipolysis OR cool sculpting OR fat freezing OR lipocryolysis.
RESULTS
The primary literature search returned 319 articles. After inclusion criteria were applied and additional articles were idenfied via manual review of article references, 19 studies were selected for review. Average reduction in caliper measurement ranged from 14.67 percent to 28.5 percent. Average reduction by ultrasound ranged from 10.3 percent to 25.5 percent. No significant impact on lipid levels or liver function tests after cryolipolysis treatments was noted in any study. Only mild, short-term side effects, such as erythema, swelling, and pain, were noted. Paradoxical adipose hyperplasia was described in one patient.
CONCLUSIONS
Cryolipolysis is a promising procedure for nonsurgical fat reduction and body contouring and presents a compelling alternative to liposuction and other, more invasive methods. This procedure appears to be safe in the short term, with a limited side effect profile, and results in significant fat reduction when used for localized adiposities. It remains unclear whether posttreatment manual massage and multiple treatments in the same anatomic area enhance the efficacy of cryolipolysis.
Topics: Body Mass Index; Cosmetic Techniques; Cryotherapy; Databases, Factual; Esthetics; Female; Follow-Up Studies; Humans; Lipectomy; Male; Obesity; Patient Safety; Patient Satisfaction; Risk Assessment; Subcutaneous Fat; Treatment Outcome
PubMed: 26017594
DOI: 10.1097/PRS.0000000000001236 -
Inquiry : a Journal of Medical Care... 2023Healthcare-associated infections pose one of the most severe threats to patients' health and remain a major challenge for healthcare providers globally. Among... (Meta-Analysis)
Meta-Analysis Review
Healthcare-associated infections pose one of the most severe threats to patients' health and remain a major challenge for healthcare providers globally. Among healthcare-associated infections, surgical site infection is one of the most commonly reported infections. It remains a major cause of morbidity and mortality across the world. The aim of this study was to provide a pooled incidence of surgical site infection among patients on a regional and global scale. This study was conducted under the PRISMA guidelines developed for systematic review and meta-analysis. The studies were searched using electronic databases (SCOPUS, PubMed/MEDLINE, Web of Science, Google Scholar, DOAJ, and MedNar) from June 1st, 2022 to August 4th, 2022, using Boolean logic operators (AND, OR, and NOT), Medical Subject Headings (MeSH), and keywords. The quality of the study was assessed using the Joanna Briggs Institute Critical Assessment tool to determine the relevance of each included article to the study. A comprehensive meta-analysis version 3 was used to estimate the pooled prevalence of surgical site infections among the patients. A total of 2124 articles were retrieved from the included electronic databases. Finally, after applying inclusion criteria, 43 articles conducted in 39 countries were included in the current study. The global pooled incidence of SSI was found to be 2.5% (95% CI: 1.6, 3.7). Based on the subgroup analysis by WHO region and survey period, the incidence of SSI was 2.7% (95% CI: 2.2, 3.3%) and 2.5% (95% CI: 1.8, 3.5%), respectively. The highest incidence was reported in the African Region (7.2% [95% CI: 4.3, 11.8%]) and among studies conducted between 1996 and 2001 (2.9% [95% CI: 0.9%, 8.8%]). This study revealed that the overall pooled incidence of SSI was 2.5%. SSI estimates varied among the WHO regions of the world. However, the highest incidence (2.7%) was observed in the African region. This indicates that there is a need to implement safety measures, including interventions for SSI prevention to reduce SSI and improve patient safety.
Topics: Humans; Surgical Wound Infection; Incidence; Cross Infection; Prevalence
PubMed: 36964747
DOI: 10.1177/00469580231162549 -
PloS One 2016To determine whether there is an association between healthcare professionals' wellbeing and burnout, with patient safety. (Review)
Review
OBJECTIVE
To determine whether there is an association between healthcare professionals' wellbeing and burnout, with patient safety.
DESIGN
Systematic research review.
DATA SOURCES
PsychInfo (1806 to July 2015), Medline (1946 to July 2015), Embase (1947 to July 2015) and Scopus (1823 to July 2015) were searched, along with reference lists of eligible articles.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Quantitative, empirical studies that included i) either a measure of wellbeing or burnout, and ii) patient safety, in healthcare staff populations.
RESULTS
Forty-six studies were identified. Sixteen out of the 27 studies that measured wellbeing found a significant correlation between poor wellbeing and worse patient safety, with six additional studies finding an association with some but not all scales used, and one study finding a significant association but in the opposite direction to the majority of studies. Twenty-one out of the 30 studies that measured burnout found a significant association between burnout and patient safety, whilst a further four studies found an association between one or more (but not all) subscales of the burnout measures employed, and patient safety.
CONCLUSIONS
Poor wellbeing and moderate to high levels of burnout are associated, in the majority of studies reviewed, with poor patient safety outcomes such as medical errors, however the lack of prospective studies reduces the ability to determine causality. Further prospective studies, research in primary care, conducted within the UK, and a clearer definition of healthcare staff wellbeing are needed.
IMPLICATIONS
This review illustrates the need for healthcare organisations to consider improving employees' mental health as well as creating safer work environments when planning interventions to improve patient safety.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO registration number: CRD42015023340.
Topics: Burnout, Professional; Female; Health Personnel; Humans; Male; Mental Health; Patient Safety; United Kingdom
PubMed: 27391946
DOI: 10.1371/journal.pone.0159015 -
Antimicrobial Resistance and Infection... Feb 2022Healthcare-associated infections (HAI) are one of the gravest threats to patient safety worldwide. The importance of the hospital environment has recently been revalued... (Review)
Review
BACKGROUND
Healthcare-associated infections (HAI) are one of the gravest threats to patient safety worldwide. The importance of the hospital environment has recently been revalued in infection prevention and control. Though the literature is evolving rapidly, many institutions still do not consider healthcare environmental hygiene (HEH) very important for patient safety. The evidence for interventions in the healthcare environment on patient colonization and HAI with multidrug-resistant microorganisms (MDROs) or other epidemiologically relevant pathogens was reviewed.
METHODS
We performed a systematic review according to the PRISMA guidelines using the PubMed and Web of Science databases. All original studies were eligible if published before December 31, 2019, and if the effect of an HEH intervention on HAI or patient colonization was measured. Studies were not eligible if they were conducted in vitro, did not include patient colonization or HAI as an outcome, were bundled with hand hygiene interventions, included a complete structural rebuild of the healthcare facility or were implemented during an outbreak. The primary outcome was the comparison of the intervention on patient colonization or HAI compared to baseline or control. Interventions were categorized by mechanical, chemical, human factors, or bundles. Study quality was assessed using a specifically-designed tool that considered study design, sample size, control, confounders, and issues with reporting. The effect of HEH interventions on environmental bioburden was studied as a secondary outcome.
FINDINGS
After deduplication, 952 records were scrutinized, of which 44 were included for full text assessment. A total of 26 articles were included in the review and analyzed. Most studies demonstrated a reduction of patient colonization or HAI, and all that analyzed bioburden demonstrated a reduction following the HEH intervention. Studies tested mechanical interventions (n = 8), chemical interventions (n = 7), human factors interventions (n = 3), and bundled interventions (n = 8). The majority of studies (21/26, 81%) analyzed either S. aureus, C. difficile, and/or vancomycin-resistant enterococci. Most studies (23/26, 88%) reported a decrease of MDRO-colonization or HAI for at least one of the tested organisms, while 58% reported a significant decrease of MDRO-colonization or HAI for all tested microorganisms. Forty-two percent were of good quality according to the scoring system. The majority (21/26, 81%) of study interventions were recommended for application by the authors. Studies were often not powered adequately to measure statistically significant reductions.
INTERPRETATION
Improving HEH helps keep patients safe. Most studies demonstrated that interventions in the hospital environment were related with lower HAI and/or patient colonization. Most of the studies were not of high quality; additional adequately-powered, high-quality studies are needed. Systematic registration number: CRD42020204909.
Topics: Clostridioides difficile; Cross Infection; Delivery of Health Care; Humans; Hygiene; Staphylococcus aureus
PubMed: 35183259
DOI: 10.1186/s13756-022-01075-1 -
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 -
Nursing Open Jan 2022The aim of this review was to synthesize the best available evidence on the impact of nurses' safety attitudes on patient outcomes in acute-care hospitals. (Review)
Review
AIMS
The aim of this review was to synthesize the best available evidence on the impact of nurses' safety attitudes on patient outcomes in acute-care hospitals.
DESIGN
Systematic review with a narrative synthesis of the available data.
DATA SOURCES
Data sources included MEDLINE, Cumulative Index of Nursing and Allied Health Literature, Scopus and Web of Science Core Collection. Studies published up to March 2021 were included.
REVIEW METHODS
This review was conducted using guidance from the Joanna Briggs Institute for Systematic Reviews and reported as per the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines.
RESULTS
A total of 3,452 studies were identified, and nine studies met the inclusion criteria. Nurses with positive safety attitudes reported fewer patient falls, medication errors, pressure injuries, healthcare-associated infections, mortality, physical restraints, vascular access device reactions and higher patient satisfaction. Effective teamwork led to a reduction in adverse patient outcomes. Most included studies (N = 6) used variants of the Hospital Survey on Patient Safety Culture to assess nurses' safety attitudes. Patient outcomes data were collected from four sources: coded medical records data, incident management systems, nurse perceptions of adverse events and patient perceptions of safety.
CONCLUSION
A positive safety culture in nursing units and across hospitals resulted in fewer reported adverse patient outcomes. Nurse managers can improve nurses' safety attitudes by promoting a non-punitive response to error reporting and promoting effective teamwork and good communication.
Topics: Communication; Hospitals; Humans; Nurses; Patient Satisfaction
PubMed: 34538027
DOI: 10.1002/nop2.1063 -
Journal of Medical Internet Research Sep 2022Electronic health records (EHRs) and poor system interoperability are well-known issues in the use of health information technologies in most high-income countries... (Review)
Review
BACKGROUND
Electronic health records (EHRs) and poor system interoperability are well-known issues in the use of health information technologies in most high-income countries worldwide. Despite the abundance of literature exploring their relationship, their practical implications on patient safety and quality of care remain unclear.
OBJECTIVE
This study aimed to examine how EHR interoperability affects patient safety, or other dimensions of care quality, in high-income health care settings.
METHODS
A systematic search was conducted using 4 web-based medical journal repositories and grey literature sources. The publications included were published in English between 2010 and 2022, pertaining to EHR use, interoperability, and patient safety or care quality in high-income settings. Screening was completed by 3 researchers in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Risk of bias assessments were performed using the Risk of Bias in Non-randomized Studies of Interventions and the Cochrane Risk of Bias 2 tools. The findings were presented as a narrative synthesis and mapped based on the Institute of Medicine's framework for health care quality.
RESULTS
A total of 12 studies met the inclusion criteria to be included in our review. The findings were categorized into 6 common outcome measure categories: patient safety events, medication safety, data accuracy and errors, care effectiveness, productivity, and cost savings. EHR interoperability positively influenced medication safety, reduced patient safety events, and reduced costs. Improvements in time saving and clinical workflow are mixed. However, true measures of effect are difficult to determine with certainty because of the heterogeneity in the outcome measures used and notable variation in study quality.
CONCLUSIONS
The benefits of EHR interoperability on the quality and safety of care remain unclear and reflect extensive heterogeneity in the interventions, designs, and outcome measures used. The establishment of common health information technology research outcome measures would support higher-quality research on the topic. Future research efforts should focus on both the positive and negative impacts of interoperable EHR interventions and explore patient perspectives, given the growing trend for patient involvement and stewardship over their own electronic clinical data.
TRIAL REGISTRATION
PROSPERO CRD42020209285; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209285.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
RR2-10.1136/bmjopen-2020-044941.
Topics: Developed Countries; Electronic Health Records; Humans; Income; Patient Safety; Quality of Health Care; United States
PubMed: 36107486
DOI: 10.2196/38144 -
Journal of Diabetes Research 2019To compare the efficacy and safety of metformin, glyburide, and insulin in treating gestational diabetes mellitus (GDM), a meta-analysis of randomized controlled trials... (Meta-Analysis)
Meta-Analysis
To compare the efficacy and safety of metformin, glyburide, and insulin in treating gestational diabetes mellitus (GDM), a meta-analysis of randomized controlled trials (RCTs) was conducted. PubMed, Embase, CINAHL, Web of Science, and Cochrane Library to November 13, 2018, were searched for RCT adjusted estimates of the efficacy and safety of metformin, glyburide, and insulin treatments in GDM patients. There were 41 studies involving 7703 GDM patients which were included in this meta-analysis; 12 primary outcomes and 24 secondary outcomes were detected and analyzed. Compared with metformin, insulin had a significant increase in the risk of preeclampsia (RR, 0.57; 95% CI, 0.45 to 0.72; < 0.001), NICU admission (RR, 0.75; 95% CI, 0.64 to 0.87; < 0.001), neonatal hypoglycemia (RR, 0.57; 95% CI, 0.49 to 0.66; < 0.001), and macrosomia (RR, 0.68; 95% CI, 0.55 to 0.86; < 0.05). To the outcomes of birth weight and gestational age at delivery, insulin had a significant increase when compared with metformin (MD, 114.48; 95% CI, 37.32 to 191.64; < 0.01; MD, 0.23; 95% CI, 0.12 to 0.34; < 0.001; respectively). Of the two groups between glyburide and metformin, metformin had lower gestational weight gain compared with glyburide (MD, 1.67; 95% CI, 0.26 to 3.07; < 0.05). Glyburide had a higher risk of neonatal hypoglycemia compared with insulin (RR, 1.76; 95% CI, 1.32 to 2.36; < 0.001). This meta-analysis found that metformin could be a safe and effective treatment for GDM. However, clinicians should pay attention on the long-term offspring outcomes of the relative data with GDM patients treated with metformin. Compared with insulin, glyburide had a higher increase of neonatal hypoglycemia. The use of glyburide in pregnancy for GDM women appears to be unclear.
Topics: Adult; Biomarkers; Blood Glucose; Diabetes, Gestational; Female; Glyburide; Humans; Hypoglycemic Agents; Insulin; Metformin; Patient Safety; Pregnancy; Randomized Controlled Trials as Topic; Risk Assessment; Treatment Outcome; Young Adult
PubMed: 31781670
DOI: 10.1155/2019/9804708 -
Nursing Reports (Pavia, Italy) Sep 2023With the increasingly demanding healthcare environment, patient safety issues are only becoming more complex. This urges nursing leaders to adapt and master effective... (Review)
Review
BACKGROUND
With the increasingly demanding healthcare environment, patient safety issues are only becoming more complex. This urges nursing leaders to adapt and master effective leadership; particularly, transformational leadership (TFL) is shown to scientifically be the most successfully recognized leadership style in healthcare, focusing on relationship building while putting followers in power and emphasizing values and vision.
AIM
To examine how transformational leadership affects nurses' job environment and nursing care provided to the patients and patients' outcomes.
DESIGN
A systematic literature review was conducted. From 71 reviewed, 23 studies were included (studies included questionnaire surveys and one interview, extracting barriers and facilitators, and analyzing using qualitative synthesis).
RESULT
TFL indirectly and directly positively affects nurses' work environment through mediators, including structural empowerment, organizational commitment, and job satisfaction. Nurses perceived that managers' TFL behavior did not attain excellence in any of the included organizations, highlighting the necessity for additional leadership training to enhance the patient safety culture related to the non-reporting of errors and to mitigate the blame culture within the nursing environment.
CONCLUSION
Bringing more focus to leadership education in nursing can make future nursing leaders more effective, which will cultivate efficient teamwork, a quality nursing work environment, and, ultimately, safe and efficient patient outcomes. This study was not registered.
PubMed: 37755351
DOI: 10.3390/nursrep13030108 -
BMJ Open Dec 2019Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology.
DESIGN
Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to 'mental health', 'patient safety', 'inpatient setting' and 'research'. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model.
RESULTS
Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control.
CONCLUSIONS
Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice.
PROSPERO REGISTRATION NUMBER
CRD42016034057.
Topics: Biomedical Research; Humans; Inpatients; Patient Safety; Psychiatric Department, Hospital
PubMed: 31874869
DOI: 10.1136/bmjopen-2019-030230