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The American Journal of Geriatric... Oct 2018Delirium, defined as an acute disorder of attention and cognition with high morbidity and mortality, can be prevented by multicomponent nonpharmacological interventions.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Delirium, defined as an acute disorder of attention and cognition with high morbidity and mortality, can be prevented by multicomponent nonpharmacological interventions. The Hospital Elder Life Program (HELP) is the original evidence-based approach targeted to delirium risk factors, which has been widely disseminated.
OBJECTIVE
To summarize the current state of the evidence regarding HELP and to highlight its effectiveness and cost savings.
METHODS
Systematic review of Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from 1999 to 2017, using a combination of controlled vocabulary and keyword terms.
RESULTS
Of the 44 final articles included, 14 were included in the meta-analysis for effectiveness and 30 were included for examining cost savings, adherence and adaptations, role of volunteers, successes and barriers, and issues in sustainability. The results for delirium incidence, falls, length of stay, and institutionalization were pooled for meta-analyses. Overall, 14 studies demonstrated significant reductions in delirium incidence (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.37-0.59). The rate of falls was reduced by 42% among intervention patients in three comparative studies (OR 0.58, 95% CI 0.35-0.95). In nine studies on cost savings, the program saved $1600-$3800 (2018 U.S. dollars) per patient in hospital costs and over $16,000 (2018 U.S. dollars) per person-year in long-term care costs in the year following delirium. The systematic review revealed that programs were generally successful in adhering to or appropriately adapting HELP (n = 13 studies) and in finding the volunteer role to be valuable (n = 6 studies). Successes and barriers to implementation were examined in 6 studies, including ensuring effective clinician leadership, finding senior administrative champions, and shifting organizational culture. Sustainability factors were examined in 10 studies, including adapting to local circumstances, documenting positive impact and outcomes, and securing long-term funding.
CONCLUSION
The Hospital Elder Life Program is effective in reducing incidence of delirium and rate of falls, with a trend toward decreasing length of stay and preventing institutionalization. With ongoing efforts in continuous program improvement, implementation, adaptations, and sustainability, HELP has emerged as a reference standard model for improving the quality and effectiveness of hospital care for older persons worldwide.
Topics: Accidental Falls; Aged; Aged, 80 and over; Cost-Benefit Analysis; Delirium; Hospitalization; Humans; Outcome and Process Assessment, Health Care; Program Development; Program Evaluation
PubMed: 30076080
DOI: 10.1016/j.jagp.2018.06.007 -
Obesity Reviews : An Official Journal... Jul 2015Previous reviews of childhood obesity prevention have focused largely on schools and findings have been inconsistent. Funded by the US Agency for Healthcare Research and... (Meta-Analysis)
Meta-Analysis Review
Previous reviews of childhood obesity prevention have focused largely on schools and findings have been inconsistent. Funded by the US Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health, we systematically evaluated the effectiveness of childhood obesity prevention programmes conducted in high-income countries and implemented in various settings. We searched MEDLINE®, Embase, PsycINFO, CINAHL®, ClinicalTrials.gov and the Cochrane Library from inception through 22 April 2013 for relevant studies, including randomized controlled trials, quasi-experimental studies and natural experiments, targeting diet, physical activity or both, and conducted in children aged 2-18 in high-income countries. Two reviewers independently abstracted the data. The strength of evidence (SOE) supporting interventions was graded for each study setting (e.g. home, school). Meta-analyses were performed on studies judged sufficiently similar and appropriate to pool using random effect models. This paper reported our findings on various adiposity-related outcomes. We identified 147 articles (139 intervention studies) of which 115 studies were primarily school based, although other settings could have been involved. Most were conducted in the United States and within the past decade. SOE was high for physical activity-only interventions delivered in schools with home involvement or combined diet-physical activity interventions delivered in schools with both home and community components. SOE was moderate for school-based interventions targeting either diet or physical activity, combined interventions delivered in schools with home or community components or combined interventions delivered in the community with a school component. SOE was low for combined interventions in childcare or home settings. Evidence was insufficient for other interventions. In conclusion, at least moderately strong evidence supports the effectiveness of school-based interventions for preventing childhood obesity. More research is needed to evaluate programmes in other settings or of other design types, especially environmental, policy and consumer health informatics-oriented interventions.
Topics: Behavior Therapy; Child; Diet, Reducing; Evidence-Based Practice; Exercise; Feeding Behavior; Humans; Motivation; Pediatric Obesity; Program Development; Public Health; United States; Weight Reduction Programs
PubMed: 25893796
DOI: 10.1111/obr.12277 -
Injury Prevention : Journal of the... Dec 2019To determine whether multifactorial falls prevention interventions are effective in preventing falls, fall injuries, emergency department (ED) re-presentations and... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To determine whether multifactorial falls prevention interventions are effective in preventing falls, fall injuries, emergency department (ED) re-presentations and hospital admissions in older adults presenting to the ED with a fall.
DESIGN
Systematic review and meta-analyses of randomised controlled trials (RCTs).
DATA SOURCES
Four health-related electronic databases (Ovid MEDLINE, CINAHL, EMBASE, PEDro and The Cochrane Central Register of Controlled Trials) were searched (inception to June 2018).
STUDY SELECTION
RCTs of multifactorial falls prevention interventions targeting community-dwelling older adults ( ≥ 60 years) presenting to the ED with a fall with quantitative data on at least one review outcome.
DATA EXTRACTION
Two independent reviewers determined inclusion, assessed study quality and undertook data extraction, discrepancies resolved by a third.
DATA SYNTHESIS
12 studies involving 3986 participants, from six countries, were eligible for inclusion. Studies were of variable methodological quality. Multifactorial interventions were heterogeneous, though the majority included education, referral to healthcare services, home modifications, exercise and medication changes. Meta-analyses demonstrated no reduction in falls (rate ratio = 0.78; 95% CI: 0.58 to 1.05), number of fallers (risk ratio = 1.02; 95% CI: 0.88 to 1.18), rate of fractured neck of femur (risk ratio = 0.82; 95% CI: 0.53 to 1.25), fall-related ED presentations (rate ratio = 0.99; 95% CI: 0.84 to 1.16) or hospitalisations (rate ratio = 1.14; 95% CI: 0.69 to 1.89) with multifactorial falls prevention programmes.
CONCLUSIONS
There is insufficient evidence to support the use of multifactorial interventions to prevent falls or hospital utilisation in older people presenting to ED following a fall. Further research targeting this population group is required.
Topics: Accidental Falls; Accidents, Home; Aged; Aged, 80 and over; Emergency Service, Hospital; Environment Design; Hospitalization; Humans; Primary Prevention; Program Development; Program Evaluation; Randomized Controlled Trials as Topic; Risk Assessment; Secondary Prevention
PubMed: 31289112
DOI: 10.1136/injuryprev-2019-043214 -
Journal of the American Medical... Jul 2014To systematically review the efficacy of advance care planning (ACP) interventions in different adult patient populations. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To systematically review the efficacy of advance care planning (ACP) interventions in different adult patient populations.
DESIGN
Systematic review and meta-analyses.
DATA SOURCES
Medline/PubMed, Cochrane Central Register of Controlled Trials (1966 to September 2013), and reference lists.
STUDY SELECTION
Randomized controlled trials that describe original data on the efficacy of ACP interventions in adult populations and were written in English.
DATA EXTRACTION AND SYNTHESIS
Fifty-five studies were identified. Study details were recorded using a predefined data abstraction form. Methodological quality was assessed using the PEDro scale by 2 independent reviewers. Meta-analytic techniques were conducted using a random effects model. Analyses were stratified for type of intervention: 'advance directives' and 'communication.'
MAIN OUTCOMES AND MEASURES
Primary outcome measures were completion of advance directives and occurrence of end-of-life discussions. Secondary outcomes were concordance between preferences for care and delivered care, knowledge of ACP, end-of-life care preferences, quality of communication, satisfaction with healthcare, decisional conflict, use of healthcare services, and symptoms.
RESULTS
Interventions focusing on advance directives as well as interventions that also included communication about end-of-life care increased the completion of advance directives and the occurrence of end-of-life care discussions between patients and healthcare professionals. In addition, interventions that also included communication about ACP, improved concordance between preferences for care and delivered care and may improve other outcomes, such as quality of communication.
CONCLUSIONS
ACP interventions increase the completion of advance directives, occurrence of discussions about ACP, concordance between preferences for care and delivered care, and are likely to improve other outcomes for patients and their loved ones in different adult populations. Future studies are necessary to reveal the effective elements of ACP and should focus on the best way to implement structured ACP in standard care.
Topics: Advance Care Planning; Advance Directives; Communication; Humans; Terminal Care
PubMed: 24598477
DOI: 10.1016/j.jamda.2014.01.008 -
Nutrients Jun 2022Background: Overweight/obesity is associated with pregnancy-related disorders, such as gestational diabetes mellitus (GDM) and excessive gestational weight gain (GWG).... (Meta-Analysis)
Meta-Analysis Review
Background: Overweight/obesity is associated with pregnancy-related disorders, such as gestational diabetes mellitus (GDM) and excessive gestational weight gain (GWG). Although multiple interventions have been proposed to prevent GDM and restrict GWG, our knowledge of their comparative efficacy is limited. Objective: To evaluate the effectiveness and identify the optimal intervention strategy to prevent GDM and restrict GWG among overweight/obese pregnant women. Methods: Randomized controlled trials that recruited overweight/obese pregnant women at <20 gestational week were obtained. Predictive and confidence interval plot and surface under the cumulative ranking (SUCRA) were performed using Stata statistical software to determine and compare the efficacy of interventions (diet, physical activity (PA), diet + PA intervention and medication). Results: 23 studies with a total of 8877 participants were eligible for analysis. Our results indicated that although neither PA, diet + PA, diet nor medication intervention could significantly protect overweight/obese women from the development of GDM, there was a trend that PA and diet + PA intervention were preventive factors of GDM. Of these, PA intervention (SUCRA, 82.8%) ranked as the superior strategy, and diet intervention (SUCRA, 19.7%) was the least efficacious regimen. Furthermore, interventions of diet, PA and diet + PA were significantly beneficial for GWG restriction, whereas medication intervention could not restrict GWG. In detail, diet intervention (SUCRA, 19.7%) ranked as the optimal regimen, whilst PA intervention (SUCRA, 62.3%) ranked as the least efficacious regimen. Conclusion: Although none of the interventions could offer remarkable benefit for GDM prevention, interventions of diet, PA and diet + PA were significant factors to restrict GWG. In aggregate, diet + PA intervention seemed the superior choice for the prevention of both GDM and excessive GWG. Registration: PROSPERO CRD42022313542.
Topics: Diabetes, Gestational; Female; Gestational Weight Gain; Humans; Network Meta-Analysis; Obesity; Overweight; Pregnancy; Pregnancy Complications; Pregnant Women; Weight Gain
PubMed: 35745114
DOI: 10.3390/nu14122383 -
International Journal of Yoga 2022In the past decades, more than fifty different yoga styles have been implemented in the therapeutic context to manage various diseases. Yet, not all of these yoga styles... (Review)
Review
In the past decades, more than fifty different yoga styles have been implemented in the therapeutic context to manage various diseases. Yet, not all of these yoga styles have been validated or standardized as a program. The aim of this article is to review the different methodologies used for yoga module development and to assess their quality. Three databases (PubMed, Web of Science, and Scopus) were searched using the following keywords and Boolean operators: (validation OR development OR design) AND (yoga OR mind-body) AND (module OR protocol OR program). Three thousand six hundred and seventy-one articles were enlisted, and based on the inclusion and exclusion criteria, 37 articles were narrowed down for review. Since no checklist exists to assess the quality of yoga modules, the authors designed a 23-item checklist to categorize each having low, medium, or high quality. As per the yoga module quality checklist, only 21.6% of the studies had high quality, while 75.3% of the articles had medium quality and 8.11% had low quality. A commonly used development method was literature review, while for validation, experts' scoring of the Likert scale was the preferred means. The feasibility of the module was carried out only by half of the studies. Few diseases such as cardiovascular disease, diabetes mellitus, obesity, Parkinson's disease, and obesity had more than one yoga module developed. The findings of this systematic review have shed some light on the growing need for standardized methods of yoga module development. The 23-item checklist can guide researchers in the homogeneous development strategies when designing yoga interventions in the future.
PubMed: 36949837
DOI: 10.4103/ijoy.ijoy_59_22 -
Worldviews on Evidence-based Nursing 2009Important advancements have been made in the care of preterm infants. Health services have introduced various methods aimed at promoting attachment, breastfeeding, and... (Review)
Review
BACKGROUND
Important advancements have been made in the care of preterm infants. Health services have introduced various methods aimed at promoting attachment, breastfeeding, and neurological development. The Newborn Individualized Developmental Care and Assessment Program (NIDCAP), developed to stimulate preterm infants at levels adapted to the child's degree of neurological maturity, is increasingly being used.
OBJECTIVES
The aim was to investigate the impact of NIDCAP on the psychomotor development, neurological status, medical/nursing care outcomes, and parental perceptions. A further aim was to evaluate the cost-related effects of NIDCAP.
DATA EXTRACTION AND ANALYSIS
A literature search up to September 2007 was performed. The reviewed papers were assessed for methodological quality and only statistically significant findings were extracted.
FINDINGS
The evidence compiled on the effects of NIDCAP is based on 12 articles from six randomized controlled trials that included approximately 250 children. Each of the studies was assessed as having medium quality. Most of the studies were small and many investigated a huge number of outcome variables, which decreased their scientific strength. On outcome variables in which a significant difference was found between the intervention (NIDCAP) and control groups, most studies showed better results for the NIDCAP group. This was particularly valid for cognitive and psychomotor development. Four studies also showed a reduced need for respiratory support for the NIDCAP group. No studies were identified that weighed the total cost of NIDCAP against its effects.
CONCLUSIONS
Despite promising findings, primarily on cognitive and motor development, the scientific evidence on the effects of NIDCAP is limited. Shortcomings in design and methods in the reviewed studies hamper far-reaching claims on the effectiveness of the method. Scientific grounds for assessing the effects of NIDCAP would be substantially enhanced by a sufficiently comprehensive study with extended follow-up and a clear focus on a few important outcome variables.
Topics: Child Development; Evidence-Based Nursing; Humans; Infant, Newborn; Infant, Premature; Motor Skills; Neonatal Nursing
PubMed: 19413582
DOI: 10.1111/j.1741-6787.2009.00150.x -
Physical Therapy Jan 2020Most stroke survivors have very low levels of cardiovascular fitness, which limits mobility and leads to further physical deconditioning, increased sedentary behavior,...
Most stroke survivors have very low levels of cardiovascular fitness, which limits mobility and leads to further physical deconditioning, increased sedentary behavior, and heightened risk of recurrent stroke. Although clinical guidelines recommend that aerobic exercise be a part of routine stroke rehabilitation, clinical uptake has been suboptimal. In 2013, an international group of stroke rehabilitation experts developed a user-friendly set of recommendations to guide screening and prescription-the Aerobic Exercise Recommendations to Optimize Best Practices in Care after Stroke (AEROBICS 2013). The objective of this project was to update AEROBICS 2013 using the highest quality of evidence currently available. The first step was to conduct a comprehensive review of literature from 2012 to 2018 related to aerobic exercise poststroke. A working group of the original consensus panel members drafted revisions based on synthesis. An iterative process was used to achieve agreement among all panel members. Final revisions included: (1) addition of 115 new references to replace or augment those in the original AEROBICS document, (2) rewording of the original recommendations and supporting material, and (3) addition of 2 new recommendations regarding prescription. The quality of evidence from which these recommendations were derived ranged from low to high. The AEROBICS 2019 Update should make it easier for clinicians to screen for, and prescribe, aerobic exercise in stroke rehabilitation. Clinical implementation will not only help to narrow the gap between evidence and practice but also reduce current variability and uncertainty regarding the role of aerobic exercise in recovery after stroke.
Topics: Algorithms; Blood Pressure Determination; Exercise; Exercise Test; Heart Rate; Humans; Ischemic Attack, Transient; Meta-Analysis as Topic; Physical Exertion; Program Development; Randomized Controlled Trials as Topic; Stroke Rehabilitation
PubMed: 31596465
DOI: 10.1093/ptj/pzz153 -
Child Health Nursing Research Jan 2023This systematic literature review and meta-analysis explored extended reality (XR)-based pediatric nursing simulation programs and analyzed their effectiveness.
PURPOSE
This systematic literature review and meta-analysis explored extended reality (XR)-based pediatric nursing simulation programs and analyzed their effectiveness.
METHODS
A literature search was conducted between May 1 and 30, 2022 in the following electronic databases: MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and CINAHL. The search period was from 2000 to 2022. In total, 6,095 articles were reviewed according to the inclusion and exclusion criteria, and 14 articles were selected for the final content analysis and 10 for the meta-analysis. Data analysis was performed using descriptive statistics and the Comprehensive Meta- Analysis program.
RESULTS
XR-based pediatric nursing simulation programs have increased since 2019. Studies using virtual reality with manikins or high-fidelity simulators were the most common, with six studies. The total effect size was statistically significant at 0.84 (95% confidence interval=0.50-1.19, z=4.82, p<.001).
CONCLUSION
Based on the findings, we suggest developing standardized guidelines for the operation of virtual pediatric nursing simulation education and practice. Simultaneously, the application of more sophisticated research designs for effect measurement and the combined applications of various virtual simulation methods are needed to validate the most effective simulation methodology.
PubMed: 36760110
DOI: 10.4094/chnr.2023.29.1.24 -
World Psychiatry : Official Journal of... Feb 2023Neurodevelopmental disorders - including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, communication disorders, intellectual disability,...
Neurodevelopmental disorders - including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, communication disorders, intellectual disability, motor disorders, specific learning disorders, and tic disorders - manifest themselves early in development. Valid, reliable and broadly usable biomarkers supporting a timely diagnosis of these disorders would be highly relevant from a clinical and public health standpoint. We conducted the first systematic review of studies on candidate diagnostic biomarkers for these disorders in children and adolescents. We searched Medline and Embase + Embase Classic with terms relating to biomarkers until April 6, 2022, and conducted additional targeted searches for genome-wide association studies (GWAS) and neuroimaging or neurophysiological studies carried out by international consortia. We considered a candidate biomarker as promising if it was reported in at least two independent studies providing evidence of sensitivity and specificity of at least 80%. After screening 10,625 references, we retained 780 studies (374 biochemical, 203 neuroimaging, 133 neurophysiological and 65 neuropsychological studies, and five GWAS), including a total of approximately 120,000 cases and 176,000 controls. While the majority of the studies focused simply on associations, we could not find any biomarker for which there was evidence - from two or more studies from independent research groups, with results going into the same direction - of specificity and sensitivity of at least 80%. Other important metrics to assess the validity of a candidate biomarker, such as positive predictive value and negative predictive value, were infrequently reported. Limitations of the currently available studies include mostly small sample size, heterogeneous approaches and candidate biomarker targets, undue focus on single instead of joint biomarker signatures, and incomplete accounting for potential confounding factors. Future multivariable and multi-level approaches may be best suited to find valid candidate biomarkers, which will then need to be validated in external, independent samples and then, importantly, tested in terms of feasibility and cost-effectiveness, before they can be implemented in daily clinical practice.
PubMed: 36640395
DOI: 10.1002/wps.21037