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Health Expectations : An International... Apr 2024This article addresses the persistent challenge of Delayed Hospital Discharge (DHD) and aims to provide a comprehensive overview, synthesis, and actionable, sustainable...
OBJECTIVE
This article addresses the persistent challenge of Delayed Hospital Discharge (DHD) and aims to provide a comprehensive overview, synthesis, and actionable, sustainable plan based on the synthesis of the systematic review articles spanning the past 24 years. Our research aims to comprehensively examine DHD, identifying its primary causes and emphasizing the significance of effective communication and management in healthcare settings.
METHODS
We conducted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) method for synthesizing findings from 23 review papers published over the last two decades, encompassing over 700 studies. In addition, we employed a practical and comprehensive framework to tackle DHD. Rooted in Linderman's model, our approach focused on continuous process improvement (CPI), which highlights senior management commitment, technical/administrative support, and social/transitional care. Our proposed CPI method comprised several stages: planning, implementation, data analysis, and adaptation, all contributing to continuous improvement in healthcare delivery. This method provided valuable insights and recommendations for addressing DHD challenges.
FINDINGS
Our DHD analysis revealed crucial insights across multiple dimensions. Firstly, examining causes and interventions uncovered issues such as limited discharge destinations, signaling unsustainable solutions, and inefficient care coordination. The second aspect explored the patient and caregiver experience, emphasizing challenges linked to staff uncertainty and negative physical environments, with notable attention to the underexplored area of caregiver experience. The third theme explored organizational and individual factors, including cognitive impairment and socioeconomic influences. The findings emphasized the importance of incorporating patients' data, recognizing its complexity and current avoidance. Finally, the role of transitional and social care and financial strategies was scrutinized, emphasizing the need for multicomponent, context-specific interventions to address DHD effectively.
CONCLUSION
This study addresses gaps in the literature, challenges prevailing solutions, and offers practical pathways for reducing DHD, contributing significantly to healthcare quality and patient outcomes. The synthesis introduces the vital CPI stage, enhancing Linderman's work and providing a pragmatic framework to eradicate delayed discharge. Future efforts will address practitioner consultations to enhance perspectives and further enrich the study.
PATIENT OR PUBLIC CONTRIBUTION
Our scoping review synthesizes and analyzes existing systematic review articles and emphasizes offering practical, actionable solutions. While our approach does not directly engage patients, it strategically focuses on extracting insights from the literature to create a CPI framework. This unique aspect is intentionally designed to yield tangible benefits for patients, service users, caregivers, and the public. Our actionable recommendations aim to improve hospital discharge processes for better healthcare outcomes and experiences. This detailed analysis goes beyond theoretical considerations and provides a practical guide to improve healthcare practices and policies.
Topics: Humans; Caregivers; Delivery of Health Care; Hospitals; Patient Discharge; Patients
PubMed: 38628150
DOI: 10.1111/hex.14050 -
World Journal of Clinical Cases Aug 2023Diabetic ketoacidosis (DKA) manifests as hyperglycemia, metabolic acidosis, and ketosis. However, euglycemic DKA (eu-DKA) conceals severe DKA with glucose levels below...
BACKGROUND
Diabetic ketoacidosis (DKA) manifests as hyperglycemia, metabolic acidosis, and ketosis. However, euglycemic DKA (eu-DKA) conceals severe DKA with glucose levels below 200 mg/dL. Sodium-glucose cotransporter-2 (SGLT2) inhibitors can induce eu-DKA in diabetic patients. Notably, coronavirus disease 2019 (COVID-19) -infected individuals with diabetes using SGLT2 inhibitors face an augmented risk of eu-DKA due to the direct toxic impact of the virus on pancreatic islets. This study aims to comprehensively investigate the association between SGLT2 inhibitors and eu-DKA in COVID-19 patients through meticulous case report analysis. Additionally, we endeavor to examine the outcomes and treatment approaches for COVID-19-infected diabetics receiving SGLT2 inhibitors, providing indispensable insights for healthcare professionals managing this specific patient population.
AIM
To investigate the connection between SGLT2 inhibitors and euglycemic DKA in COVID-19 patients through a meticulous analysis of case reports.
METHODS
We conducted an exhaustive search across prominent electronic databases, including PubMed, SCOPUS, Web of Science, and Google Scholar. This search encompassed the period from December 2019 to May 2022, incorporating published studies and pre-prints. The search terms employed encompassed "SGLT2 inhibitors", "euglycemic DKA", "COVID-19", and related variations. By incorporating these diverse sources, our objective was to ensure a thorough exploration of the existing literature on this subject, thereby augmenting the validity and robustness of our findings.
RESULTS
Our search yielded a total of seven case reports and one case series, collectively comprising a cohort of twelve patients. These reports detailed instances of eu-DKA in individuals with COVID-19. Crucially, all twelve patients were utilizing SGLT2 as their primary anti-diabetic medication. Upon admission, all oral medications were promptly discontinued, and the patients were initiated on intravenous insulin therapy to effectively manage the DKA. Encouragingly, eleven patients demonstrated a favorable outcome, while regrettably, one patient succumbed to the condition. Subsequently, SGLT2 were discontinued for all patients upon their discharge from the hospital. These findings provide valuable insights into the clinical management and outcomes of eu-DKA cases associated with COVID-19 and SGLT2, underscoring the critical importance of prompt intervention and vigilant medication adjustments.
CONCLUSION
Our study sheds light on the possibility of diabetic patients developing both drug-related and unrelated DKA, as well as encountering adverse outcomes in the context of COVID-19, despite maintaining satisfactory glycemic control. The relationship between glycemic control and clinical outcomes in COVID-19 remains ambiguous. Consequently, this systematic review proposes that COVID-19-infected diabetic patients using SGLT2 should contemplate alternative treatment protocols until their recovery from the disease.
PubMed: 37727728
DOI: 10.12998/wjcc.v11.i24.5700 -
International Journal of Pediatric... Jan 2024Paediatric otorrhoea (PO) describes a middle ear infection that results in a perforation of the tympanic membrane and ear discharge, in children and young people (CYP)....
INTRODUCTION
Paediatric otorrhoea (PO) describes a middle ear infection that results in a perforation of the tympanic membrane and ear discharge, in children and young people (CYP). Prolonged infection may be associated with hearing loss and developmental delay. The current management of paediatric otorrhoea is variable, including non-invasive treatments (conservative, oral antibiotics, topical antibiotics) and surgery, reflecting the lack of a sufficiently strong evidence base. Outcome reporting is fundamental to producing reliable and meaningful evidence to inform best practice.
OBJECTIVES
Primary objective: to determine which outcome measures are currently used to evaluate treatment success in studies of non-surgical treatments for paediatric otorrhoea.
SECONDARY OBJECTIVES
to identify outcome measurement instruments used in the literature and assess their applicability for use in clinical trials of PO.
METHODS
This systematic review was registered with PROSPERO (CRD42023407976). Database searches of EMBASE, MEDLINE and Cochrane was performed on June 6, 2023, covering from Jan 1995 to May 2023. Randomised controlled trials or study protocols involving CYP with PO were included following PRISMA guidelines. Risk of bias was assessed with Cochrane's tool.
RESULTS
Of the 377 papers identified, six were included in the systematic review. The primary outcome of five of the studies related to otorrhoea cessation; both time to cessation and proportion recovered at various time points were used as measures. Two measurement instruments were identified: Otitis Media-6 Questionnaire and the Institute for Medical Technology Assessment Productivity Cost Questionnaire. Both were shown to be applicable measurement instruments when used in clinical trials of PO.
CONCLUSIONS
To promote homogeneity and facilitate meaningful comparison and combination of studies, we propose that time to cessation of otorrhoea from onset of otorrhoea should be used as the primary outcome in future studies. Further research is needed to establish if this is the most important outcome to children and their caregivers.
Topics: Child; Humans; Adolescent; Otitis Media; Anti-Bacterial Agents; Ear Diseases; Treatment Outcome; Deafness
PubMed: 38103308
DOI: 10.1016/j.ijporl.2023.111820 -
Journal of Telemedicine and Telecare Jun 2024We compared the impact of accessing healthcare (1) by telehealth (via telephone or video) vs face-to-face; and (2) by telephone vs video telehealth care, on escalation...
OBJECTIVE
We compared the impact of accessing healthcare (1) by telehealth (via telephone or video) vs face-to-face; and (2) by telephone vs video telehealth care, on escalation to emergency care.
METHODS
We searched Medline, Embase and Cochrane CENTRAL to 24 July 2023; and conducted a citation analysis on 19 September 2023. We included randomised controlled trials. Risk of bias was assessed using Cochrane Tool 2. We calculated risk ratios for dichotomous outcomes and standardised mean difference for continuous outcomes.
RESULTS
Ten trials compared telehealth (five telephone, four video, one both) to face-to-face care. Six were overall low, three some concerns and one high risk of bias. There were no differences between telehealth and face-to-face for visits to the emergency department (RR 1.07, 95% CI 0.89 to 1.29), hospitalisations up to 12 months (RR 0.89, 95% CI 0.56 to 1.41), deaths or other adverse events. Costs of care were similar, as were patient satisfaction scores.Six trials compared telephone to video telehealth: three were overall low, two some concerns, and one high risk of bias. There were no differences between telephone and video for visits to the emergency department (RR 0.67, 95% CI 0.41 to 1.12), hospitalisations (RR 1.04, 95% CI 0.73 to 1.48), deaths, other adverse events, costs, or patient satisfaction. Healthcare provider satisfaction was high.
CONCLUSIONS
Telehealth care - delivered by telephone or by video - may be an appropriate alternative to face-to-face provision of care, as it does not increase the likelihood of escalation of care to the emergency department for patients in primary care, hospital outpatients, post-discharge patients or residents in aged care.
PubMed: 38839244
DOI: 10.1177/1357633X241259525 -
Annals of Palliative Medicine May 2024In the United States (US), nearly one third of skilled home health (HH) patients and nearly one half of hospice patients have diagnoses of Alzheimer's disease and...
BACKGROUND
In the United States (US), nearly one third of skilled home health (HH) patients and nearly one half of hospice patients have diagnoses of Alzheimer's disease and related dementias (ADRD), conditions often characterized by a slow decline in cognition and function. Many persons living with dementia (PLWDs) are cared for at home yet may transition between care settings such as skilled HH or hospice, potentially leading to fragmented and poorer care. The purpose of this systematic review was to examine literature pertaining to (I) care transitions for PLWD who are enrolled in skilled HH and hospice in the US, and (II) specifically, care transitions between skilled HH and hospice for PLWD.
METHODS
We conducted a systematic review. From March to November 16, 2023, we searched CINAHL, PsychInfo (EBSCO version), and PubMed databases inputting keywords and index terms related to HH, care transition, hospice, and dementia. Articles were included if they were peer-reviewed, primary research studies that were published between 2017-2023 and addressed care transitions for PLWD enrolled in US skilled HH and hospice or transitions between the two settings. We evaluated the quality of each article and extracted relevant data. We described studies by setting while analyzing for similarities and differences between them.
RESULTS
Of 230 studies, 14 met our inclusion criteria. We found that PLWD are at higher risk for early, unsuccessful discharge from-and readmission to-skilled HH; and PLWD are at higher risk for being discharged alive from hospice. Only one study pertained to care transitions for PLWD between skilled HH and hospice.
CONCLUSIONS
We included only studies set in the US, as skilled HH and hospice may differ in policy and practice in other countries, which limits our findings. Future work should explore assessment approaches specific to PLWD that lead to higher quality of coordination of care to, from, and between skilled HH and hospice.
Topics: Humans; Dementia; Hospice Care; United States; Home Care Services; Patient Transfer
PubMed: 38509644
DOI: 10.21037/apm-23-524 -
Arthroscopy, Sports Medicine, and... Apr 2024To perform a systematic review of clinical studies evaluating the pericapsular nerve group (PENG) block in patients undergoing hip arthroscopy. (Review)
Review
PURPOSE
To perform a systematic review of clinical studies evaluating the pericapsular nerve group (PENG) block in patients undergoing hip arthroscopy.
METHODS
A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify comparative studies of patients undergoing the PENG block before hip arthroscopy. The search phrase used was . Patients were evaluated based on analgesic consumption, time to discharge from the postanesthesia care unit (PACU), and pain scores (Numeric Rating Scale and visual analog scale). The Modified Coleman Methodology Score was used to evaluate study methodology quality.
RESULTS
Five studies (2 Level I, 3 Level III) met inclusion criteria. The 5 studies included the following comparison groups: 0.9% normal saline injection, general anesthesia alone, and general anesthesia with intraoperative pericapsular bupivacaine injection. The 2 randomized controlled trials included in this review reported no significant difference between groups regarding opioid consumption. One of these did not find any statistically significant differences in their secondary outcomes either, including patient satisfaction with analgesia, opioid-related adverse events, or persistent opioid use at 1 week. However, the other 3 studies found significantly lower opioid consumption in patients receiving the PENG block versus the control group intraoperatively, in the PACU, and/or postoperatively. Four studies reported significantly lower pain levels in the PENG block group compared with the control groups, measured differently in each study: 24 hours postoperatively, initial pain score in the PACU, mean score in the PACU, and highest score in the PACU. None of the studies found significantly worse outcomes in the PENG block group compared to the comparison group.
CONCLUSIONS
Systematic review of randomized controlled trials shows that patients undergoing hip arthroscopy who receive a PENG block do not consume fewer opioids for postoperative pain control than patients who do not receive the block.
LEVEL OF EVIDENCE
Level III, systematic review of Level I-III studies.
PubMed: 38379602
DOI: 10.1016/j.asmr.2024.100894 -
Journal of Racial and Ethnic Health... Apr 2024Despite being the fastest growing minority group in the USA, Asian Americans are among the least studied ones, particularly in the home and community-based services...
OBJECTIVE
Despite being the fastest growing minority group in the USA, Asian Americans are among the least studied ones, particularly in the home and community-based services settings. This study aimed to review and synthesize extant evidence on Asian American's access, utilization, and outcomes of home health care.
METHODS
This is a systematic review study. A comprehensive literature search was conducted in PubMed and CINAHL as well as hand search. Each study was screened, reviewed, and evaluated for quality by at least two reviewers independently.
RESULTS
Twelve articles were determined eligible and included for review. Asian Americans were less likely to be discharged to home health care following hospitalization. At admission to home health care, Asian Americans had a high rate of inappropriate medication issues (28%) and they also had poorer functional status compared to White Americans. Asian Americans were also reported with less improvement in functional status at the end of home health care; however, there were some inconsistencies in the evidence on Asian Americans' utilization of formal/skilled home health care. Quality evaluation indicated that findings from some studies were limited by small sample size, single site/home health agency, analytic approaches, and other methodologic limitations.
CONCLUSIONS
Asian Americans often experience inequities in home health care access, utilization, and outcomes. Multilevel factors may contribute to such inequities, including structural racism. Robust research using population-based data and advanced methodology is needed to better understand home health care to Asian Americans.
Topics: Humans; Asian; Home Care Services; Hospitalization; Patient Discharge
PubMed: 36940075
DOI: 10.1007/s40615-023-01568-8 -
BMC Nursing Mar 2024Antimicrobial resistance has become one of the world's most important public health problems. Accordingly, nursing strategies to manage antimicrobials in hospital...
BACKGROUND
Antimicrobial resistance has become one of the world's most important public health problems. Accordingly, nursing strategies to manage antimicrobials in hospital environments are fundamental to promoting patient health. The aim of this study was to summarise the best evidence available on nursing strategies for the safe management of antimicrobials in hospital environments.
METHODS
This qualitative systematic review used meta-aggregation in accordance with the recommendations of the Joanna Briggs Institute. The protocol was registered in the data base of the Prospective Register of Systematic Reviews under No. CRD42021224804. The literature search was conducted, in April and May 2021, in the following data bases and journal repositories: Latin American and Caribbean Health Sciences Literature (LILACS) via the Virtual Health Library (VHL), Medical Literature Analysis and Retrieval System on-line (Medline) via PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scientific Electronic Library Online (SciELO) and Excerpta Medica Database (EMBASE). The findings of each study were summarized and the results were meta-aggregated in JBI SUMARI software.
RESULTS
The search resulted in a total of 447 studies and, after selection, the review included 26 studies, in which 42 nursing strategies were identified. The strategies were first categorised as care- or stewardship-related and then into the subcategories: Screening, Administration, Monitoring and Discharge, Nursing Team, Multi-professional Teams, Patients and Institutional Leadership. The 42 strategies were meta-aggregated and represented in flow diagrams. The best evidence was synthesized related to nursing strategies in the safe management of antimicrobials in the hospital environment.
CONCLUSIONS
Nurses play an indispensable function in antimicrobial stewardship in the hospital environment, because they work directly at the core of safe patient care. Significant contributions by nursing towards reducing antimicrobial resistance were found in care-related practice, education activities, research and policy.
PubMed: 38429699
DOI: 10.1186/s12912-024-01753-y -
European Review For Medical and... Mar 2024Leaving Against Medical Advice (LAMA) is a prevalent issue in healthcare settings that may lead to negative patient outcomes. We conducted a systematic review and... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Leaving Against Medical Advice (LAMA) is a prevalent issue in healthcare settings that may lead to negative patient outcomes. We conducted a systematic review and meta-analysis to assess the impact of LAMA on patient outcomes.
MATERIALS AND METHODS
A comprehensive literature search was performed across PubMed, MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, Web of Science, and Scopus. Studies reporting adverse outcomes, including mortality and hospital readmission rates, in patients who underwent LAMA were included. The odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model.
RESULTS
Eight studies were included in the review, with four contributing to the meta-analysis on 1-year mortality and five to the meta-analysis on hospital readmission rates. LAMA was not significantly associated with higher 1-year mortality [OR = 0.66, 95% CI (0.38, 1.16), p = 0.15] or hospital readmission rates [OR = 0.61, 95% CI (0.30, 1.23), p = 0.16] across the studies. However, there was substantial heterogeneity in the results (I2 = 91% for mortality; I2 = 99% for readmissions).
CONCLUSIONS
While individual studies reported varying outcomes, the pooled results did not show a significant association between LAMA and increased 1-year mortality or hospital readmission rates. However, the high degree of heterogeneity suggests the influence of diverse patient populations, healthcare settings, and study methodologies on these outcomes. Further research is needed to better understand the factors contributing to the adverse outcomes associated with LAMA and to develop targeted interventions to mitigate them.
Topics: Humans; Patient Readmission; Patient Discharge; Treatment Refusal; Mortality
PubMed: 38497880
DOI: 10.26355/eurrev_202403_35612 -
Journal of Comparative Effectiveness... Apr 2024The overall goal of this review was to examine the cost-utility of robotic-arm assisted surgery versus manual surgery. We performed a systematic review of all health... (Review)
Review
The overall goal of this review was to examine the cost-utility of robotic-arm assisted surgery versus manual surgery. We performed a systematic review of all health economic studies that compared CT-based robotic-arm assisted unicompartmental knee arthroplasty, total knee arthroplasty and total hip arthroplasty with manual techniques. The papers selected focused on various cost-utility measures. In addition, where appropriate, secondary aims encompassed various clinical outcomes (e.g., readmissions, discharges to subacute care, etc.). Only articles directly comparing CT-based robotic-arm assisted joint arthroplasty with manual joint arthroplasty were included, for a resulting total of 21 reports. Almost all twenty-one studies demonstrated a positive effect of CT scan-guided robotic-assisted joint arthroplasty on health economic outcomes. For studies reporting on 90-day episodes of costs, 10 out of 12 found lower costs in the robotic-arm assisted groups. Robotic-arm assisted joint arthroplasty patients had shorter lengths of stay and cost savings based on their 90-day episodes of care, among other metrics. Payors would likely benefit from encouraging the use of this CT-based robotic technology.
Topics: Humans; Knee Joint; Osteoarthritis, Knee; Robotic Surgical Procedures; Cost-Benefit Analysis; Arthroplasty, Replacement, Knee; Lower Extremity; Tomography, X-Ray Computed
PubMed: 38488048
DOI: 10.57264/cer-2023-0040