-
The European Respiratory Journal Jan 2020This document provides recommendations for monitoring and treatment of children in whom bronchopulmonary dysplasia (BPD) has been established and who have been...
This document provides recommendations for monitoring and treatment of children in whom bronchopulmonary dysplasia (BPD) has been established and who have been discharged from the hospital, or who were >36 weeks of postmenstrual age. The guideline was based on predefined Population, Intervention, Comparison and Outcomes (PICO) questions relevant for clinical care, a systematic review of the literature and assessment of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. After considering the balance of desirable (benefits) and undesirable (burden, adverse effects) consequences of the intervention, the certainty of the evidence, and values, the task force made conditional recommendations for monitoring and treatment of BPD based on very low to low quality of evidence. We suggest monitoring with lung imaging using ionising radiation in a subgroup only, for example severe BPD or recurrent hospitalisations, and monitoring with lung function in all children. We suggest to give individual advice to parents regarding daycare attendance. With regards to treatment, we suggest the use of bronchodilators in a subgroup only, for example asthma-like symptoms, or reversibility in lung function; no treatment with inhaled or systemic corticosteroids; natural weaning of diuretics by the relative decrease in dose with increasing weight gain if diuretics are started in the neonatal period; and treatment with supplemental oxygen with a saturation target range of 90-95%. A multidisciplinary approach for children with established severe BPD after the neonatal period into adulthood is preferable. These recommendations should be considered until new and urgently needed evidence becomes available.
Topics: Adult; Bronchopulmonary Dysplasia; Child; Humans; Infant, Newborn; Infant, Premature; Patient Discharge
PubMed: 31558663
DOI: 10.1183/13993003.00788-2019 -
World Journal of Urology Jun 2022Day case or same-day discharge (SDD) pure laparoscopic or robot-assisted radical prostatectomy (RP) has risen over the last few years with the aim of discharging...
PURPOSE
Day case or same-day discharge (SDD) pure laparoscopic or robot-assisted radical prostatectomy (RP) has risen over the last few years with the aim of discharging patients within 24 h, reducing costs and length of stay, and facilitating return to active life. We perform a systematic review of literature to evaluate the feasibility of SDD RP.
METHODS
A systematic review search was performed and the following bibliographic databases were accessed: PubMed, Science Direct, Scopus, and Embase. This was carried out in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines.
RESULTS
Based on the literature search of 509 articles, 12 (1378 patients) met the inclusion criteria (mean age: 63 years). All studies were unicentric except one. The mean SDD surgeries experience per centre was 66 cases .The means operative time and blood loss were 154 min and 126.5 ml, respectively. Mean SDD failure was 7.4%. Concomitant lymph node dissection was performed in 56.2%. The overall complication rate was 10.2% of cases; with a majority of Clavien grade I or II. Mean readmission rate after discharge was 5%. SDD generated cost reductions compared to inpatient surgery with variable differences according to the considered healthcare system.
CONCLUSIONS
Day-case RP is a safe and feasible strategy in selected cases with multicentre proofs of concept. Its widespread use in routine practice needs further research due to biases in patient selection. Implementation of peri-operative pathways such as ERAS and prehabilitation improves patient adherence to SDD.
Topics: Feasibility Studies; Humans; Laparoscopy; Male; Middle Aged; Patient Discharge; Prostate; Prostatectomy
PubMed: 35157103
DOI: 10.1007/s00345-022-03944-1 -
Patient-Reported Opioid Analgesic Use After Discharge from Surgical Procedures: A Systematic Review.Pain Medicine (Malden, Mass.) Jan 2022This systematic review synthesizes evidence on patient-reported outpatient opioid analgesic use after surgery.
OBJECTIVE
This systematic review synthesizes evidence on patient-reported outpatient opioid analgesic use after surgery.
METHODS
We searched PubMed (February 2019) and Web of Science and Embase (June 2019) for U.S. studies describing patient-reported outpatient opioid analgesic use. Two reviewers extracted data on opioid analgesic use, standardized the data on use , and performed independent quality appraisals based on the Cochrane Risk of Bias Tool and an adapted Newcastle-Ottawa scale.
RESULTS
Ninety-six studies met the eligibility criteria; 56 had sufficient information to standardize use in oxycodone 5-mg tablets. Patient-reported opioid analgesic use varied widely by procedure type; knee and hip arthroplasty had the highest postoperative opioid use, and use after many procedures was reported as <5 tablets. In studies that examined excess tablets, 25-98% of the total tablets prescribed were reported to be excess, with most studies reporting that 50-70% of tablets went unused. Factors commonly associated with higher opioid analgesic use included preoperative opioid analgesic use, higher inpatient opioid analgesic use, higher postoperative pain scores, and chronic medical conditions, among others. Estimates also varied across studies because of heterogeneity in study design, including length of follow-up and inclusion/exclusion criteria.
CONCLUSION
Self-reported postsurgery outpatient opioid analgesic use varies widely both across procedures and within a given procedure type. Contributors to within-procedure variation included patient characteristics, prior opioid use, intraoperative and perioperative factors, and differences in the timing of opioid use data collection. We provide recommendations to help minimize variation caused by study design factors and maximize interpretability of forthcoming studies for use in clinical guidelines and decision-making.
Topics: Analgesics, Opioid; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Pain, Postoperative; Patient Discharge; Patient Reported Outcome Measures
PubMed: 34347101
DOI: 10.1093/pm/pnab244 -
Journal of Nursing Care Quality 2019This article reports on a systematic review conducted to critique safety, quality, length of stay, and implementation factors regarding criteria-led discharge.
BACKGROUND
This article reports on a systematic review conducted to critique safety, quality, length of stay, and implementation factors regarding criteria-led discharge.
PURPOSE
Improving patient flow and timely bed capacity is a global issue. Criteria-led discharge enables accelerated patient discharge in accordance with patient selection.
METHODS
A systematic review was conducted to identify literature on criteria-led discharge from 2007 to 2017. The quality of articles was appraised using a tool for disparate studies. Two reviewers extracted relevant data independently.
RESULTS
Fifteen studies were identified that showed no increase in patient readmission or complication rates with criteria-led discharge, demonstrating patient safety. The quality of the patient discharge was unremarkable. None of the studies showed an increase in length of stay.
CONCLUSIONS
The safety, quality, and length of stay for patients discharged through criteria-led discharge are inextricably linked to the process adopted for its implementation.
Topics: Humans; Length of Stay; Patient Discharge; Patient Readmission; Patient Selection; Time Factors
PubMed: 30198948
DOI: 10.1097/NCQ.0000000000000356 -
Journal of Affective Disorders Dec 2017Patients with depression require treatment continuity when discharged from inpatient care. Interventions aimed at optimizing transition into outpatient care may be... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Patients with depression require treatment continuity when discharged from inpatient care. Interventions aimed at optimizing transition into outpatient care may be effective in preventing symptom deterioration and readmission. We aimed to evaluate the effectiveness of care transition interventions for patients with depression after psychiatric hospitalization.
METHODS
Systematic review and random-effects meta-analysis of controlled trials. Primary outcomes were readmissions and symptoms of depression. The control condition was treatment as usual.
RESULTS
We included 16 publications reporting the results of 13 different studies. Studies were heterogeneous concerning patient selection and interventional approach. Effects on readmissions and depression symptoms were non-significant in meta-analysis of 8 studies/710 patients and 7 studies/592 patients, respectively. Overall risk ratio for readmission during follow-up was 0.65 (95% CI [0.42;1.01], p=0.06), standardized mean difference for depression symptoms was -0.09 (95% CI [-0.37;0.19], p=0.53). Subgroup analyses indicated no preference for a specific interventional strategy. Data point to considerable risk for selection and publication bias.
LIMITATIONS
Included studies are heterogeneous; subgroups are often small and may not attain the power to detect effects. Reasonable classification of interventions into groups of comparable approaches was a challenge and may be arbitrary in some cases.
CONCLUSIONS
This systematic review and meta-analysis could not identify any convincingly effective interventional transition approach for patients with depression after psychiatric hospitalization. Current evidence regarding discharge management for depression is limited, heterogeneous and potentially prone to bias. Interventions might be more appropriate for patients with other diagnoses than depression. Further high-quality randomized studies are required.
Topics: Cognitive Behavioral Therapy; Continuity of Patient Care; Depressive Disorder; Hospitalization; Humans; Patient Discharge; Transitional Care
PubMed: 28734149
DOI: 10.1016/j.jad.2017.07.026 -
Professioni Infermieristiche 2020Stroke is the second cause of death worldwide and the third cause of death in industrialized countries. To investigate the effectiveness of the nurse's role the...
AIM
Stroke is the second cause of death worldwide and the third cause of death in industrialized countries. To investigate the effectiveness of the nurse's role the management for people affected by stroke after discharge from hospital to home.
METHOD
A systematic review was performed. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was carried out. MEDLINE, CINAHL, Web of Science and Scopus were searched for studies on the effectiveness of the nurse's role in managing the stroke rehabilitation process after discharge from the home hospital from 2000 to June 2018 in English. The methodological quality was assessed by the Cochrane Collaboration's tool for assessing Risk of Bias (RoB). The GRADE system was used for evaluating evidence quality of each outcome.
RESULTS
7,025 studies were identified, 12 met the inclusion criteria. The outcomes in the literature are quality of life related to the degree of independence and depression, to the perception and health management and to the adaptation and stress tolerance. No primary outcome is reported in the literature with a high degree of confidence.
DISCUSSION
The nurse's role the management for people affected by stroke after discharge from hospital to home represent an effective strategy for an improvement in the functional outcome, quality of life and reduction of costs.
Topics: Hospitals; Humans; Nurse's Role; Patient Discharge; Quality of Life; Stroke
PubMed: 33780612
DOI: 10.7429/pi.2020.734278 -
Journal of the American Medical... Mar 2022To systematically synthesize and appraise the evidence on the effectiveness of health information technology (HIT)-based discharge care transition interventions (CTIs)...
OBJECTIVE
To systematically synthesize and appraise the evidence on the effectiveness of health information technology (HIT)-based discharge care transition interventions (CTIs) on readmissions and emergency room visits.
MATERIALS AND METHODS
We conducted a systematic search on multiple databases (MEDLINE, CINAHL, EMBASE, and CENTRAL) on June 29, 2020, targeting readmissions and emergency room visits. Prospective studies evaluating HIT-based CTIs published as original research articles in English language peer-reviewed journals were eligible for inclusion. Outcomes were pooled for narrative analysis.
RESULTS
Eleven studies were included for review. Most studies (n = 6) were non-RCTs. Several studies (n = 9) assessed bridging interventions comprised of at least 1 pre- and 1 post-discharge component. The narrative analysis found improvements in patient experience and perceptions of discharge care.
DISCUSSION
Given the statistical and clinical heterogeneity among studies, we could not ascertain the cumulative effect of CTIs on clinical outcomes. Nevertheless, we found gaps in current research and its implications for future work, including the need for a HIT-based care transition model for guiding theory-driven design and evaluation of HIT-based discharge CTIs.
CONCLUSIONS
We appraised and aggregated empirical evidence on the cumulative effectiveness of HIT-based interventions to support discharge transitions from hospital to home, and we highlighted the implications for evidence-based practice and informatics research.
Topics: Aftercare; Emergency Service, Hospital; Humans; Medical Informatics; Patient Discharge; Patient Readmission; Prospective Studies
PubMed: 35167689
DOI: 10.1093/jamia/ocac013 -
Neurosurgical Review Apr 2023Overlapping surgery (OS) is a common practice in neurosurgery that has recently come under scrutiny. This study includes a systematic review and meta-analysis on... (Meta-Analysis)
Meta-Analysis Review
Overlapping surgery (OS) is a common practice in neurosurgery that has recently come under scrutiny. This study includes a systematic review and meta-analysis on articles evaluating the effects of OS on patient outcomes. PubMed and Scopus were searched for studies that analyzed outcome differences between overlapping and non-overlapping neurosurgical procedures. Study characteristics were extracted, and random-effects meta-analyses were performed to analyze the primary outcome (mortality) and secondary outcomes (complications, 30-day readmissions, 30-day operating room returns, home discharge, blood loss, and length of stay). Mantel-Haenszel tests were completed for binary outcomes, whereas the inverse variance tests were conducted for continuous outcomes. Heterogeneity was measured using the I and X tests. The Egger's test was conducted to evaluate publication bias. Eight of 61 non-duplicate studies were included. Overall, 21,249 patients underwent non-OS (10,504 female) and 15,863 patients underwent OS (8393 female). OS was associated with decreased mortality (p = 0.002), 30-day returns to OR (p < 0.001), and blood loss (p < 0.001) along with increased home discharges (p < 0.001). High heterogeneity was observed for home discharge (p = 0.002) and length of stay (p < 0.001). No publication bias was observed. OS was not associated with worse patient outcomes compared to non-OS. However, considering multiple sources of limitation in the methodology of the included studies (such as limited number of studies, reports originating from mostly high-volume academic centers, discrepancy in the definition of "critical portion(s)" of the surgery across studies, and selection bias), extra caution is advised in interpretation of our results and further focused studies are warranted.
Topics: Humans; Female; Neurosurgical Procedures; Patient Discharge; Operating Rooms; Neurosurgery
PubMed: 37072635
DOI: 10.1007/s10143-023-01993-7 -
Mechanisms of Ageing and Development Apr 2022Nervous system maladaptation is linked to the loss of maximal strength and motor control with aging. Motor unit discharge rates are a critical determinant of force... (Meta-Analysis)
Meta-Analysis Review
Nervous system maladaptation is linked to the loss of maximal strength and motor control with aging. Motor unit discharge rates are a critical determinant of force production; thus, lower discharge rates could be a mechanism underpinning maximal strength and motor control losses during aging. This meta-analysis summarized the findings of studies comparing motor unit discharge rates between young and older adults, and examined the effects of the selected muscle and contraction intensity on the magnitude of discharge rate difference between these two groups. Estimates from 29 studies, across a range of muscles and contraction intensities, were combined in a multilevel meta-analysis, to investigate whether discharge rates differed between young and older adults. Motor unit discharge rates were higher in younger than older adults, with a pooled standardized mean difference (SMD) of 0.66 (95%CI= 0.29-1.04). Contraction intensity had a significant effect on the pooled SMD, with a 1% increase in intensity associated with a 0.009 (95%CI= 0.003-0.015) change in the pooled SMD. These findings suggest that reductions in motor unit discharge rates, especially at higher contraction intensities, may be an important mechanism underpinning age-related losses in maximal force production.
Topics: Aged; Aging; Humans; Isometric Contraction; Motor Neurons; Muscle Contraction; Muscle, Skeletal; Patient Discharge
PubMed: 35218849
DOI: 10.1016/j.mad.2022.111647 -
Annals of Emergency Medicine Mar 2020We conduct a systematic review with meta-analysis to provide an overview of the different manners of providing discharge instructions in the emergency department (ED)... (Meta-Analysis)
Meta-Analysis
STUDY OBJECTIVE
We conduct a systematic review with meta-analysis to provide an overview of the different manners of providing discharge instructions in the emergency department (ED) and to assess their effects on comprehension and recall of the 4 domains of discharge instructions: diagnosis, treatment, follow-up, and return instructions.
METHODS
We performed a systematic search in the PubMed, EMBASE, Web of Science Google Scholar, and Cochrane databases for studies published before March 15, 2018. A quality assessment of included articles was performed. Pooled proportions of correct recall by manner of providing discharge instructions were calculated.
RESULTS
A total of 1,842 articles were screened, and after selection, 51 articles were included. Of the 51 included studies, 12 used verbal discharge instructions only, 30 used written discharge instructions, and 7 used video. Correct recall of verbal, written, and video discharge instructions ranged from 8% to 94%, 23% to 92%, and 54% to 89%, respectively. Meta-analysis was performed on data of 1,460 patients who received verbal information only, 3,395 patients who received written information, and 459 patients who received video information. Pooled data showed differences in correct recall, with, on average, 47% for patients who received verbal information (95% confidence interval 32.2% to 61.7%), 58% for patients who received written information (95% confidence interval 44.2% to 71.2%), and 67% for patients who received video information (95% confidence interval 57.9% to 75.7%).
CONCLUSION
Communicating discharge instructions verbally to patients in the ED may not be sufficient. Although overall correct recall was not significantly higher, adding video or written information to discharge instructions showed promising results for ED patients.
Topics: Comprehension; Emergency Service, Hospital; Humans; Mental Recall; Patient Discharge; Patients
PubMed: 31439363
DOI: 10.1016/j.annemergmed.2019.06.008