-
Heart Failure Reviews Jan 2021To conduct a meta-analysis of observational studies assessing the association between dispensing evidence-based medications (EBMs) at discharge and outcomes, we... (Meta-Analysis)
Meta-Analysis Review
To conduct a meta-analysis of observational studies assessing the association between dispensing evidence-based medications (EBMs) at discharge and outcomes, we extracted published studies in English from PubMed, Medline, and EMBASE from 2007 to early 2019. The EBMs included renin-angiotensin system inhibitors (RASIs), β-blockers, and mineralocorticoid receptor antagonists (MRAs). The main outcomes of interest were all-cause death and heart failure (HF) readmission. Pooled hazard ratios (HRs) were calculated using random effect model from the adjusted HRs or relative risks (RRs) extracted from individual studies, stratified by HF patients with reduced ejection fraction (HFrEF), and preserved ejection fraction (HFpEF). Forty-three studies including a total number of 295,060 patients with an average follow-up time of 2.3 years were identified for systematic review. Dispensing RASI at discharge was independently associated with 30% and 25% lower risks of all-cause death and HF readmission respectively in HFrEF but has a moderate effect on reducing all-cause deaths (HR = 0.88, 95% CI: 0.81-0.95) in HFpEF. By contrast, dispensing β-blockers at discharge was associated with 35% lower risk of all-cause deaths in HFrEF and has a weak association with borderline statistical significance on improving overall survival in HFpEF. Dispensing MRA at discharge was associated with 5% lower risk of all-cause death in HFrEF. This meta-analysis provides evidence to support RASIs and β-blockers as primary pharmacotherapies for HF patients. Our findings suggest that the health professionals maintain use of RASIs and β-blockers at discharge for potential survival improvement.
Topics: Angiotensin-Converting Enzyme Inhibitors; Heart Failure; Humans; Mineralocorticoid Receptor Antagonists; Patient Discharge; Stroke Volume
PubMed: 31848792
DOI: 10.1007/s10741-019-09900-3 -
Acta Medica Indonesiana Apr 2022The use of anticoagulants has been endorsed by different hematological societies as coagulation abnormalities are key features of COVID-19 patients. This systematic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The use of anticoagulants has been endorsed by different hematological societies as coagulation abnormalities are key features of COVID-19 patients. This systematic review and meta-analysis aims to provide the most recent update on available evidence on the clinical benefits and risk of oral and parenteral anticoagulants, as well agents with anticoagulant properties, in hospitalized and post-discharge COVID-19 patients.
METHODS
This systematic review synthesizes data on the outcome of anticoagulation in hospitalized and post-discharge COVID-19 patients. Dichotomous variables from individual studies were pooled by risk ratio (RR) and their 95% confidence interval (95% CI) using the random-effects model. Meta-analyses were performed when feasible.
RESULTS
We included 32 studies from 2.815 unique citations, including 7 randomized clinical trials. A total of 33.494 patients were included. Outcomes measured include mortality and survival rates, the requirement for ICU care and mechanical ventilation. A pooled meta-analysis favors anticoagulant compared to no anticoagulant with reduced mortality in hospitalized patients (RR 0,55; 95%CI 0,43-0,66; p<0,001). Higher dose of anticoagulant also showed treatment benefit compared to standard prophylactic dose in selected populations (RR 0,68; 95%CI 0,40-0,96; p<0,001). Regular, pre-hospital anticoagulation prior to hospitalization yielded mixed result. There are currently no data on the benefit of anticoagulation on post-discharge COVID-19 patients.
CONCLUSION
Determination of the presence of thrombosis in COVID-19 is important, as therapeutic dosage of anticoagulants, rather than prophylatic dose, would be indicated in such clinical situation. Anticoagulants were found to decrease the mortality of hospitalized COVID-19. The results from this study are important in the tailored treatment of COVID-19 patients. Further studies on the need for oral anticoagulation for outpatients or post-discharge is warranted. This study has been registered in PROSPERO database (CRD42020201418).
Topics: Aftercare; Anticoagulants; Hospitalization; Humans; Patient Discharge; Venous Thromboembolism; COVID-19 Drug Treatment
PubMed: 35818663
DOI: No ID Found -
Critical Care (London, England) Jun 2013The discharge of patients from the intensive care unit (ICU) to a hospital ward is a common transition of care that is associated with error and adverse events. Risk... (Review)
Review
INTRODUCTION
The discharge of patients from the intensive care unit (ICU) to a hospital ward is a common transition of care that is associated with error and adverse events. Risk stratification tools may help identify high-risk patients for targeted interventions, but it is unclear if proper tools have been developed.
METHODS
We searched Ovid EMBASE, Ovid MEDLINE, CINAHL, PUBMED and Cochrane Central Register of Controlled Trials from the earliest available date through March 2013, plus reference lists and citations of all studies included in the systematic review. Cohort studies were selected that described the derivation, validation or clinical impact of tools for predicting medical emergency team activation, ICU readmission or mortality following patient discharge from the ICU. Data were extracted on the study design, setting, population, sample size, tool (components, measurement properties) and outcomes.
RESULTS
The literature search identified 9,926 citations, of which eight studies describing eight tools met the inclusion criteria. Reported outcomes included ICU readmission (n=4 studies), hospital mortality (n=3 studies) and both ICU readmission and hospital mortality (n=1 studies). Seven of the tools were comprised of distinct measurable component variables, while one tool used subjective scoring of patient risk by intensive care physicians. The areas under receiver operator curves were reported for all studies and ranged from 0.66 to 0.92. A single study provided a direct comparative analysis between two tools. We did not find any studies evaluating the impact of risk prediction on processes and outcomes of care.
CONCLUSIONS
Eight risk stratification tools for predicting severe adverse events following patient discharge from ICU have been developed, but have undergone limited comparative evaluation. Although risk stratification tools may help clinician decision-making, further evaluation of the existing tools' effects on care is required prior to clinical implementation.
Topics: Controlled Clinical Trials as Topic; Hospital Mortality; Humans; Intensive Care Units; Mortality; Patient Discharge; Predictive Value of Tests; Risk Assessment
PubMed: 23718698
DOI: 10.1186/cc12747 -
Journal of Advanced Nursing Jun 2023The aim of this systematic review is to describe and evaluate the effectiveness of transition interventions to safeguard patient safety and satisfaction during patients'... (Review)
Review
AIM
The aim of this systematic review is to describe and evaluate the effectiveness of transition interventions to safeguard patient safety and satisfaction during patients' transition from hospital to home health care.
DESIGN
Systematic review.
DATA SOURCES
MEDLINE, Ovid Nursing Database, PsycINFO, EMBASE, CINAHL, Clinical Trials and SveMed+ was systematic searched in January 2019 and September 2020 to identify peer-reviewed papers. No language, geographical or publication date restrictions.
REVIEW METHODS
Cochrane Handbook for Systematic Reviews of Interventions was used. Data analysis focused on aggregated data and a descriptive synthesis. Risk of bias was rated using Cochrane risk-of-bias tool.
RESULTS
In total, 10,524 references were identified in the literature search, twenty-six articles were included. The interventions were divided into three main groups: (i). systematic patient education pre-discharge; (ii). establishment of contact with the local healthcare services pre-discharge and (iii). follow-up initiated by nurses from the hospital at home post-discharge. The studies either used one intervention or combined two or three interventions. We considered the intervention to improve patient safety or satisfaction when they reported statistically significant results. Only four interventions increased both patient safety and satisfaction, seven interventions increased patient safety and thirteen increased patient satisfaction. Interventions that appear to be quite similar, with the same duration, measured different effects on patients' satisfaction and safety. Interventions that ensured patient safety did not necessarily facilitate patient satisfaction and vice versa.
CONCLUSION
Interventions can improve patient safety and satisfaction during transfer. However, interventions that improve patient safety or satisfaction do not always match.
IMPACT
This review suggests that transition interventions can improve patients' safety and satisfaction. However, to compare the impact of future interventions is it important to use standardized measurement tools of satisfaction. There is a need to try out tailored interventions, where interventions are customized to the needs of each patient.
Topics: Humans; Patient Discharge; Patient Satisfaction; Aftercare; Hospital to Home Transition; Patient Safety; Hospitals; Personal Satisfaction
PubMed: 36762670
DOI: 10.1111/jan.15579 -
Advances in Skin & Wound Care May 2022To evaluate if ostomy care pathways improve outcomes for adults anticipating or living with an ostomy.
OBJECTIVE
To evaluate if ostomy care pathways improve outcomes for adults anticipating or living with an ostomy.
DATA SOURCES
In this systematic review, the authors searched the MEDLINE, CINAHL, Cochrane Central, and EMBASE databases.
STUDY SELECTION
Studies were included if they met the following criteria: written in English, targeted adults anticipating or currently living with an ostomy, evaluated the impact of two or more components of an ostomy care pathway, and included one or more of the pertinent outcomes (patient satisfaction, hospital length of stay, hospital readmission rates, and staff satisfaction).
DATA EXTRACTION
Details recorded included design, setting, descriptions of intervention and control groups, patient characteristics, outcomes, data collection tools, effect size, and potential harms.
DATA SYNTHESIS
Of 5,298 total records, 11 met the inclusion criteria: 2 randomized controlled trials and 9 nonrandomized studies. The overall quality of the studies was low. Of the four studies that examined patient satisfaction, all studies reported improvement or positive satisfaction rates. Of the six studies that evaluated hospital length of stay, five noted a decrease in length of stay. Of the eight studies that evaluated hospital readmission rates, five found a reduction in hospital readmission rates. No studies reported on staff satisfaction.
CONCLUSIONS
Ostomy care pathways included preoperative education and counseling, postoperative education and discharge planning, and outpatient home visits and telephone follow-ups. Ostomy care pathways may contribute to patient satisfaction and decrease both hospital length of stay and hospital readmission rates. However, higher-quality literature is needed to be confident in the effectiveness of ostomy care pathways.
Topics: Adult; Critical Pathways; Humans; Length of Stay; Ostomy; Patient Discharge; Patient Readmission
PubMed: 35442921
DOI: 10.1097/01.ASW.0000823976.96962.b6 -
Journal of Neurologic Physical Therapy... Jan 2018To identify the association between outcome measure score and discharge destination in adults following acute or subacute stroke in the United States. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND PURPOSE
To identify the association between outcome measure score and discharge destination in adults following acute or subacute stroke in the United States.
METHODS
A systematic literature search was performed in 3 databases using the PRISMA guidelines. Cohort studies were selected that included patients with acute or subacute stroke, which explored the relationship between scores on outcome measures and discharge destination. Four meta-analyses were performed.
RESULTS
Nine articles met the inclusion criteria for systematic review and 5 for the series of meta-analyses. For every 1-point increase on the Functional Independence Measure (FIM), a patient is approximately 1.08 times more likely to be discharged home than to institutionalized care (odds ratio [OR] = 1.079; 95% confidence interval [CI], 1.056- 1.102). Patients with stroke who performed above-average (FIM ≥80; NIH Stroke Scale [NIHSS] score ≤5; etc) are 12 times (OR = 12.08; 95% CI, 3.550-41.07) more likely to discharge home. Patients who perform poorly (FIM ≤39; NIHSS score ≥14), experience discharge to institutionalized care 3.4 times (OR = 3.385; 95% CI, 2.591-4.422) more likely than home, with skilled nursing facility admission more likely than inpatient rehabilitation facility. Patients who perform average (FIM = 40-79; NIHSS score = 6-13) are 1.9 times (OR = 1.879; 95% CI, 1.227-2.877) more likely to be discharged to institutionalized care.
DISCUSSION AND CONCLUSION
Outcome measure scores are strong predictors of discharge destination among patients with stroke and provide an objective means of early discharge planning. Discharge decisions should be made with consideration for patient-specific biopsychosocial factors that may supersede isolated results of the outcome measures, and further research needs to assess the success of the location that a patient is referred at discharge.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A194).
Topics: Humans; Outcome Assessment, Health Care; Patient Discharge; Stroke; Stroke Rehabilitation; United States
PubMed: 29232307
DOI: 10.1097/NPT.0000000000000211 -
Australian Occupational Therapy Journal Dec 2021Advances in cancer treatment over the last decade have led to increased survival rates. As a result, survivors are living longer with and beyond cancer, often with... (Review)
Review
INTRODUCTION
Advances in cancer treatment over the last decade have led to increased survival rates. As a result, survivors are living longer with and beyond cancer, often with greater levels of morbidity. Occupational therapists, with their focus on remedial and compensatory strategies to improve function and participation, are well suited to assess and intervene with this population. Despite this, little research exists to demonstrate the efficacy of interventions and value of the occupational therapy role. This systematic review aimed to review how and when occupational therapists provide services for adult patients with cancer and identify where they add the most value.
METHODS
A systematic search was conducted of six electronic databases. Eligible studies reported on occupational therapy interventions targeting management of cancer symptoms, rehabilitation or environmental modifications for adult cancer patients discharged from acute hospital services. Data extraction and quality assessment were undertaken by two reviewers. Narrative synthesis summarised the attributes and treatment outcomes of each intervention.
RESULTS
Nine articles were included from a total of 309 articles retrieved. Eight different interventions were reported for people with cancer (n = 531). Small sample sizes and methodological quality precluded any formal analysis; however, intervention components that showed positive results were person-centred, individualised and included regular monitoring and flexibility in care, with input from multidisciplinary health professionals. Therapists also need to reflect upon the optimal duration of interventions and selection of outcome measures that specifically match intervention components.
CONCLUSION
Despite inconclusive support of any particular type of intervention, this systematic review identified several successful intervention components for occupational therapists working with people with or beyond cancer. Overall, findings suggest that monitored tailored programmes compensating for fluctuations in a patient's condition have efficacy to improve patient outcomes and should be considered when delivering intervention with patients post hospital discharge.
Topics: Adult; Hospitals; Humans; Neoplasms; Occupational Therapy; Patient Discharge; Survivors
PubMed: 34533212
DOI: 10.1111/1440-1630.12750 -
Resuscitation Oct 2020To conduct a systematic review to evaluate the impact of emergency medical service (EMS) practitioner's years of career experience and exposure to out-of-hospital... (Review)
Review
AIM
To conduct a systematic review to evaluate the impact of emergency medical service (EMS) practitioner's years of career experience and exposure to out-of-hospital cardiac arrest (OHCA) on patient outcomes.
METHODS
We searched electronic databases (Ovid MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Web of Science Core Collection) from inception until 10 April 2020. Studies were included that examined the exposures of interest on OHCA patient outcomes: good neurological outcome at discharge/30 days, survival to hospital discharge/30 days, survival to hospital and return of spontaneous circulation (ROSC). Prospero Registration: CRD42019153599.
RESULTS
We included 7 of 22 observational studies shortlisted. Four of these studies examined the years of career experience of EMS practitioners, and four studies examined their exposure to attempted resuscitation. The evidence for both exposures of interest was assessed as very-low certainty. Overall, we found no association between patient outcomes and years of career experience. However, the best evidence found, from two large studies, suggests greater recent exposure to cases of attempted resuscitation is associated with better outcomes (ROSC/survival to hospital discharge). One of these studies also reports lower survival to hospital discharge when the team attempting resuscitation had no exposure in the previous six-months.
CONCLUSION
Very low certainty evidence suggests higher exposure to attempted resuscitation cases, but not years of clinical EMS experience, is associated with improved OHCA patient outcomes. This review highlights the need for EMS to monitor OHCA exposure, and the need for further research exploring the relationship between EMS exposure and patient outcomes.
Topics: Cardiopulmonary Resuscitation; Emergency Medical Services; Hospitals; Humans; Out-of-Hospital Cardiac Arrest; Patient Discharge; Retrospective Studies
PubMed: 32768497
DOI: 10.1016/j.resuscitation.2020.07.025 -
Pediatrics Aug 2017Parents often manage complex instructions when their children are discharged from the inpatient setting or emergency department (ED); misunderstanding instructions can... (Review)
Review
CONTEXT
Parents often manage complex instructions when their children are discharged from the inpatient setting or emergency department (ED); misunderstanding instructions can put children at risk for adverse outcomes. Parents' ability to manage discharge instructions has not been examined before in a systematic review.
OBJECTIVE
To perform a systematic review of the literature related to parental management (knowledge and execution) of inpatient and ED discharge instructions.
DATA SOURCES
We consulted PubMed/Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, and Cochrane CENTRAL (from database inception to January 1, 2017).
STUDY SELECTION
We selected experimental or observational studies in the inpatient or ED settings in which parental knowledge or execution of discharge instructions were evaluated.
DATA EXTRACTION
Two authors independently screened potential studies for inclusion and extracted data from eligible articles by using a structured form.
RESULTS
Sixty-four studies met inclusion criteria; most ( = 48) were ED studies. Medication dosing and adherence errors were common; knowledge of medication side effects was understudied ( = 1). Parents frequently missed follow-up appointments and misunderstood return precaution instructions. Few researchers conducted studies that assessed management of instructions related to diagnosis ( = 3), restrictions ( = 2), or equipment ( = 1). Complex discharge plans (eg, multiple medicines or appointments), limited English proficiency, and public or no insurance were associated with errors. Few researchers conducted studies that evaluated the role of parent health literacy (ED, = 5; inpatient, = 0).
LIMITATIONS
The studies were primarily observational in nature.
CONCLUSIONS
Parents frequently make errors related to knowledge and execution of inpatient and ED discharge instructions. Researchers in the future should assess parental management of instructions for domains that are less well studied and focus on the design of interventions to improve discharge plan management.
Topics: Child; Child, Hospitalized; Emergency Service, Hospital; Health Knowledge, Attitudes, Practice; Health Literacy; Humans; Parents; Patient Discharge
PubMed: 28739657
DOI: 10.1542/peds.2016-4165 -
International Journal of Cardiology Oct 2016The 2015 Guidelines for Resuscitation recommend amiodarone as the antiarrhythmic drug of choice in the treatment of resistant ventricular fibrillation or pulseless... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The 2015 Guidelines for Resuscitation recommend amiodarone as the antiarrhythmic drug of choice in the treatment of resistant ventricular fibrillation or pulseless ventricular tachycardia. We reviewed the effects of amiodarone on survival and neurological outcome after cardiac arrest.
METHODS
We systematically searched MEDLINE and Cochrane Library from 1940 to March 2016 without language restrictions. Randomized control trials (RCTs) and observational studies were selected.
RESULTS
Our search initially identified 1663 studies, 1458 from MEDLINE and 205 from Cochrane Library. Of them, 4 randomized controlled studies and 6 observational studies met the inclusion criteria and were selected for further review. Three randomized studies were included in the meta-analysis. Amiodarone significantly improves survival to hospital admission (OR=1.402, 95% CI: 1.068-1.840, Z=2.43, P=0.015), but neither survival to hospital discharge (RR=0.850, 95% CI: 0.631-1.144, Z=1.07, P=0.284) nor neurological outcome compared to placebo or nifekalant (OR=1.114, 95% CI: 0.923-1.345, Z=1.12, P=0.475).
CONCLUSIONS
Amiodarone significantly improves survival to hospital admission. However there is no benefit of amiodarone in survival to discharge or neurological outcomes compared to placebo or other antiarrhythmics.
Topics: Amiodarone; Anti-Arrhythmia Agents; Heart Arrest; Humans; Observational Studies as Topic; Patient Admission; Patient Discharge; Randomized Controlled Trials as Topic; Survival Rate
PubMed: 27434349
DOI: 10.1016/j.ijcard.2016.07.138