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Exploratory Research in Clinical and... Sep 2023Clinical pharmacists have been shown to identify and resolve medication related problems post-discharge, however the impact on patient clinical outcomes is unclear.
BACKGROUND
Clinical pharmacists have been shown to identify and resolve medication related problems post-discharge, however the impact on patient clinical outcomes is unclear.
AIMS
To undertake a systematic review to identify, critically appraise and present the evidence on post-discharge hospital clinics that provide clinical pharmacist medication review; report the patient clinical outcomes measured; and describe the activities of the clinical pharmacist.
METHODS
Published studies evaluating a patient clinical outcome following a post-discharge hospital clinic pharmacy service were included. All studies needed a comparative design (intervention vs control or comparator). Pubmed, Embase, CINAHL, PsycnINFO, Web of Science, IPA and APAIS-Health databases were searched to identify studies. The type of clinic and the clinical pharmacist activities were linked to patient clinical outcomes.
RESULTS
Fifty-seven studies were included in the final analysis, 14 randomised controlled trials and 43 non-randomised studies. Three key clinic types were identified: post-discharge pharmacist review alone, inpatient care plus post-discharge review and post-discharge collaborative clinics. The three main outcome metrics identified were hospital readmission and/or representation, adverse events and improved disease state metrics. There was often a mix of these outcomes reported as primary and secondary outcomes. High heterogeneity of interventions and clinical pharmacist activities reported meant it was difficult to link clinical pharmacist activities with the outcomes reported.
CONCLUSIONS
A post-discharge clinic pharmacist may improve patient clinical outcomes such as hospital readmission and representation rates. Future research needs to provide a clearer description of the clinical pharmacist activities provided in both arms of comparative studies.
PubMed: 37655116
DOI: 10.1016/j.rcsop.2023.100305 -
Cancers Aug 2023Pelvic radiotherapy can damage surrounding tissue and organs, causing chronic conditions including bowel symptoms. We systematically identified quantitative,... (Review)
Review
Pelvic radiotherapy can damage surrounding tissue and organs, causing chronic conditions including bowel symptoms. We systematically identified quantitative, population-based studies of patient-reported bowel symptoms following pelvic radiotherapy to synthesize evidence of symptom type, prevalence, and severity. Medline, CINAHL, EMBASE, and PsychINFO were searched from inception to September 2022. Following independent screening of titles, abstracts, and full-texts, population and study characteristics and symptom findings were extracted, and narrative synthesis was conducted. In total, 45 papers (prostate, = 39; gynecological, = 6) reporting 19 datasets were included. Studies were methodologically heterogeneous. Most frequently assessed was bowel function ('score', 26 papers, 'bother', 19 papers). Also assessed was urgency, diarrhea, bleeding, incontinence, abdominal pain, painful hemorrhoids, rectal wetness, constipation, mucous discharge, frequency, and gas. Prevalence ranged from 1% (bleeding) to 59% (anal bleeding for >12 months at any time since start of treatment). In total, 10 papers compared radiotherapy with non-cancer comparators and 24 with non-radiotherapy cancer patient groups. Symptom prevalence/severity was greater/worse in radiotherapy groups and symptoms more common/worse post-radiotherapy than pre-diagnosis/treatment. Symptom prevalence varied between studies and symptoms. This review confirms that many people experience chronic bowel symptoms following pelvic radiotherapy. Greater methodological consistency, and investigation of less-well-studied survivor populations, could better inform the provision of services and support.
PubMed: 37627064
DOI: 10.3390/cancers15164037 -
BMC Infectious Diseases Aug 2023In 2019, the Coronavirus (SARS-CoV-2) virus was identified, also defined as novel coronavirus or severe acute respiratory syndrome coronavirus 2. The Corona VIrus...
In 2019, the Coronavirus (SARS-CoV-2) virus was identified, also defined as novel coronavirus or severe acute respiratory syndrome coronavirus 2. The Corona VIrus Disease (COVID-19) pandemic generated several changes in society in 2020 as a result of its rapid spread in humans. The main symptoms are high fever (≥ 37.8 °C), dry cough, dyspnea, upper respiratory symptoms, myalgia, fatigue and diarrhea in the most uncommon cases. Considering the emergency situation caused by the COVID-19 pandemic and the effects attributed to it, rehabilitation professionals have a fundamental role in the functional recovery of patients, independence and improvement of quality of life. This is a systematic review of the literature, with the aim of discussing the main findings on physical therapy management in functional changes in post-COVID-19 patients. Pubmed, Scielo, Sciencedirect, BVS and PEDro databases were used. The terms MESH/DECs used for the searches were: Rehabilitation, Physical Therapy Modalities, Covid-19, Post-acute Syndromes COVID-19 and Physical Fitness, the keywords were also used: rehabilitation, physiotherapy, Covid-19, post- acute syndrome COVID-19 and functional capacity. To cross the terms, Boolean operators (AND and OR) were used. Randomized trials, recommendations, quasi-randomized or prospective controlled trials, reports, guidelines, and field updates were included. As for the selected population, studies were included in individuals of both sexes, with no age restriction, that evaluated physiotherapeutic interventions in patients who had COVID-19. Literature reviews, case studies, conferences, abstracts of articles published in conference proceedings and letters to the editor were excluded from the research. To measure methodological quality, the PEDro scale was used.Searches for articles were performed restricting the period of publication between the years 2019 to 2022. The electronic search strategy identified a total of 364 records from the selected databases. After screening for duplicates, 14 articles were excluded, followed by screening by titles and abstracts, another 298 articles were excluded, of these 47 potentially relevant records were submitted to full text review and of these 5 randomized clinical trials were included in this review. In view of the findings of this study, it can be concluded that physical therapy rehabilitation should continue after hospital discharge, with the aim of improving physical performance and activities of daily living (ADL) in post-COVID-19 patients.
Topics: Female; Male; Humans; Patient Discharge; COVID-19; Activities of Daily Living; Pandemics; Prospective Studies; Quality of Life; SARS-CoV-2; Virus Diseases; Hospitals
PubMed: 37587411
DOI: 10.1186/s12879-023-08313-w -
Clinical Neurology and Neurosurgery Oct 2023Hemifacial spasm (HFS) is a disabling condition that imposes significant burden upon patients. Microvascular decompression (MVD) surgery is the most effective and... (Meta-Analysis)
Meta-Analysis
OBJECTIVES AND BACKGROUND
Hemifacial spasm (HFS) is a disabling condition that imposes significant burden upon patients. Microvascular decompression (MVD) surgery is the most effective and long-lasting treatment for HFS, but outcomes following this surgery may vary based on a variety of clinical and operative factors. A more thorough understanding of the variables that impact patient outcome after MVD surgery is needed.
METHODS
A systematic review and meta-analysis of Medline, Embase, and Central was conducted (n = 2108 screened; n = 86 included) with the goal of determining the impact of the following variables on outcome: duration of disease, geographic location, intraoperative use of an endoscope, and intraoperative finding of single versus multi-vessel neurovascular compression.
RESULTS
Most cases of hemifacial spasm occur on the left side (53.9%, p < 0.001) and are more common in women than men (66.5% versus 33.5%, p < 0.0001). The offending vessel frequencies were: 40.8% anterior inferior cerebellar artery [AICA], 24.9% posterior inferior cerebellar artery [PICA], 17.2% multiple vessels, and 4.7% vertebral artery [VA]. Multiple vessel combinations involved: 26.5% PICA + AICA, 24.6% PICA + VA, 23.1% AICA + VA, and 4.7% AICA + PICA + VA. Relative to the Americas, AICA was less frequent in Europe (p = 0.005), while PICA more frequent in Europe (p = 0.009) and Asia (p < 0.0001). With endoscope assistance, frequency of multiple vessels identified was 31.7% (versus 14.7% with non-endoscopic, p = 0.005), and 27.4% for AICA (43.5% with non-endoscopic, p = 0.003). Spasm improvement was 94.1% near discharge and 96.0% at maximum follow-up. Complications occurred in 16.5% of cases, with spasm recurrence in 2.4%. Greatest frequency of spasm improvement (p < 0.0001) and lowest spasm recurrence rates (p = 0.0005) were reported in series from Asia. For every additional month of pre-operative spasm, the effect size of post-operative improvement decreased (p = 0.04). With every subsequent postoperative month, the effect size of spasm improvement increased (p = 0.0497). The frequency of spasm improvement was significantly higher in series published after 2005 (94.4% versus 97.4%, p = 0.005).
CONCLUSION
Clinical outcomes following MVD for HFS have improved since 2005. Consideration should be given to earlier operation (shorter disease duration) and use of an endoscope may increase detection of multiple offending vessels. Further studies are needed to understand regional differences in culprit vessel incidence and surgical outcomes in the Americas, Europe, and Asia.
Topics: Male; Humans; Female; Hemifacial Spasm; Treatment Outcome; Microvascular Decompression Surgery; Retrospective Studies; Vertebral Artery; Vascular Diseases
PubMed: 37544024
DOI: 10.1016/j.clineuro.2023.107841 -
Vaccine Aug 2023Hospital settings represent an opportunity to offer and/or promote childhood vaccination. The purpose of the systematic review was to assess the effectiveness of... (Review)
Review
BACKGROUND
Hospital settings represent an opportunity to offer and/or promote childhood vaccination. The purpose of the systematic review was to assess the effectiveness of different hospital-based strategies for improving childhood vaccination coverage.
METHODS
A systematic search of multiple bibliographic databases, thesis databases, and relevant websites was conducted to identify peer-reviewed articles published up to September 20, 2021. Articles were included if they evaluated the impact of a hospital (inpatient or emergency department)-based intervention on childhood vaccination coverage, were published in English or French, and were conducted in high-income countries. High quality studies were included in a narrative synthesis.
RESULTS
We included 25 high quality studies out of 7,845 unique citations. Studies focused on routine, outbreak, and influenza vaccines, and interventions included opportunistic vaccination (i.e. vaccination during hospital visit) (n = 7), patient education (n = 2), community connection (n = 2), patient reminders (n = 2), and opportunistic vaccination combined with patient education and/or reminders (n = 12). Opportunistic vaccination interventions were generally successful at improving vaccine coverage, though results ranged from no impact to vaccinating 71 % of eligible children with routine vaccines and 9-61 % of eligible children with influenza vaccines. Interventions that aimed to increase vaccination after hospital discharge (community connection, patient education, reminders) were less successful.
CONCLUSIONS
Some interventions that provide vaccination to children accessing hospitals improved vaccine coverage; however, the baseline coverage level of the population, as well as implementation strategies used impact success. There is limited evidence that interventions promoting vaccination after hospital discharge are more successful if they are tailored to the individual.
Topics: Child; Humans; Vaccination Coverage; Influenza Vaccines; Vaccination; Income; Data Management; Immunization
PubMed: 37500415
DOI: 10.1016/j.vaccine.2023.07.036 -
Clinical Rehabilitation Dec 2023This systematic review and meta-analysis sought to identify the physical functioning factors associated with home discharge after inpatient stroke rehabilitation. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This systematic review and meta-analysis sought to identify the physical functioning factors associated with home discharge after inpatient stroke rehabilitation.
DATA SOURCES
A search of PubMed, Embase, CINHAL, The Cochrane Library (Trials), Web of Science, and PEDro were conducted up until May 2023.
METHODS
Two independent reviewers selected studies for population (patients with stroke), predictive factors (physical functioning), outcome (discharge destination), setting (inpatient rehabilitation), and study designs (observational and experimental studies). Predictive factors were identified among assessments of the "body function" and "activity" components of the International Classification of Functioning. Methodological quality was assessed with the Newcastle-Ottawa Scale. The findings used quantitative and narrative syntheses. Meta-analyses were performed with the inverse variance method and the random-effects model using included studies with sufficient data.
RESULTS
Forty-five studies were included with 204,787 participants. Included studies assessed the association of independence in activities of daily living, walking, rolling, transferring, and balance on admission with a probability of returning home. Motor (odds ratio = 1.23, 95% confidence interval: 1.12-1.35, < .001) and total (odds ratio = 1.34, 95% confidence interval: 1.14-1.57, < .001) Functional Independence Measure scores on admission were significantly associated with home discharge in meta-analyses. Additionally, included studies showed that independence in motor activities, such as sitting, transferring, and walking, and scores above thresholds for the Functional Independence Measure and Berg Balance Scale on admission were associated with discharge destination.
CONCLUSION
This review showed that higher independence in activities of daily living on admission is associated with home discharge after inpatient stroke rehabilitation.
Topics: Humans; Stroke Rehabilitation; Activities of Daily Living; Stroke; Patient Discharge; Walking
PubMed: 37424501
DOI: 10.1177/02692155231185446 -
Systematic Reviews Jul 2023Voiding trials are used to identify women at risk for postoperative urinary retention while performing optimal voiding trial management with minimal burden to the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Voiding trials are used to identify women at risk for postoperative urinary retention while performing optimal voiding trial management with minimal burden to the patient and medical service team. We performed a systematic review and meta-analysis of postoperative void trials following urogynecologic surgery to investigate (1) the optimal postoperative void trial methodology and (2) the optimal criteria for assessing void trial.
METHOD
We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and relevant reference lists of eligible articles from inception to April 2022. We identified any randomized controlled trials (RCTs) in English that studied void trials in patients undergoing urogynecologic surgery. Study selection (title/abstract and full text), data extraction, and risk of bias assessment were conducted by two independent reviewers. Extracted study outcomes included the following: the correct passing rate, time to discharge, discharge rate without a catheter after the initial void trial, postoperative urinary tract infection, and patient satisfaction.
RESULTS
Void trial methodology included backfill-assisted and autofill studies (2 RCTs, n = 95). Backfill assistance was more likely to be successful than autofill (RR 2.12, 95% CI 1.29, 3.47, P = 0.00); however, no significant difference was found in the time to discharge (WMDs = - 29.11 min, 95% CI - 57.45, 1.23, P = 0.06). The criteria for passing void trial included subjective assessment of the urinary force of stream and objective assessment of the standard voiding trial (3 RCTs, n = 377). No significant differences were found in the correct passing rate (RR 0.97, 95% CI 0.93, 1.01, P = 0.14) or void trial failure rate (RR 0.78, 95% CI 0.52, 1.18, P = 0.24). Moreover, no significant differences were found in the complication rates or patient satisfaction between the two criteria.
CONCLUSION
Bladder backfilling was associated with a lower rate of catheter discharge after urogynecologic surgery. The subjective assessment of FOS is a reliable and safe method for assessing postoperative voiding because it is less invasive.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42022313397.
Topics: Female; Humans; Urination; Urinary Tract Infections; Postoperative Complications
PubMed: 37420310
DOI: 10.1186/s13643-023-02233-1 -
The American Journal of Emergency... Aug 2023VA-ECMO can greatly reduce mortality in critically ill patients, and hypothermia attenuates the deleterious effects of ischemia-reperfusion injury. We aimed to study the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
VA-ECMO can greatly reduce mortality in critically ill patients, and hypothermia attenuates the deleterious effects of ischemia-reperfusion injury. We aimed to study the effects of hypothermia on mortality and neurological outcomes in VA-ECMO patients.
METHODS
A systematic search of the PubMed, Embase, Web of Science, and Cochrane Library databases was performed from the earliest available date to 31 December 2022. The primary outcome was discharge or 28-day mortality and favorable neurological outcomes in VA-ECMO patients, and the secondary outcome was bleeding risk in VA-ECMO patients. The results are presented as odds ratios (ORs) and 95% confidence intervals (CIs). Based on the heterogeneity assessed by the I statistic, meta-analyses were performed using random or fixed-effects models. GRADE methodology was used to rate the certainty in the findings.
RESULTS
A total of 27 articles (3782 patients) were included. Hypothermia (33-35 °C) lasting at least 24 h can significantly reduce discharge or 28-day mortality (OR, 0.45; 95% CI, 0.33-0.63; I = 41%) and significantly improve favorable neurological outcomes (OR, 2.08; 95% CI, 1.66-2.61; I = 3%) in VA-ECMO patients. Additionally, there was no risk associated with bleeding (OR, 1.15; 95% CI, 0.86-1.53; I = 12%). In our subgroup analysis according to in-hospital or out-of-hospital cardiac arrest, hypothermia reduced short-term mortality in both VA-ECMO-assisted in-hospital (OR, 0.30; 95% CI, 0.11-0.86; I = 0.0%) and out-of-hospital cardiac arrest (OR, 0.41; 95% CI, 0.25-0.69; I = 52.3%). Out-of-hospital cardiac arrest patients assisted by VA-ECMO for favorable neurological outcomes were consistent with the conclusions of this paper (OR, 2.10; 95% CI, 1.63-2.72; I = 0.5%).
CONCLUSIONS
Our results show that mild hypothermia (33-35 °C) lasting at least 24 h can greatly reduce short-term mortality and significantly improve favorable short-term neurologic outcomes in VA-ECMO-assisted patients without bleeding-related risks. As the grade assessment indicated that the certainty of the evidence was relatively low, hypothermia as a strategy for VA-ECMO-assisted patient care may need to be treated with caution.
Topics: Humans; Adult; Hypothermia; Out-of-Hospital Cardiac Arrest; Extracorporeal Membrane Oxygenation; Hospital Mortality; Critical Illness
PubMed: 37327682
DOI: 10.1016/j.ajem.2023.05.027 -
Nursing Open Sep 2023The aims are to describe the key components of family integrated care intervention for preterm infants in the neonatal intensive care unit (NICU) and assess the impact... (Review)
Review
AIMS
The aims are to describe the key components of family integrated care intervention for preterm infants in the neonatal intensive care unit (NICU) and assess the impact on breastfeeding outcomes for those infants.
DESIGN
A scoping review.
METHODS
We conducted a systematic study search based on the databases, including PubMed, Scopus, Cochrane, Web of Science, MEDLINE, CINAHL, CNKI and Wanfang Database in December 2022. The search time ranged from database establishment to 31 December 2022. Papers by manual searching were also listed on the references. We adopted Joanna Briggs Institute Reviewer's Manual methodology and followed the PRISMA guidelines for Scoping Reviews (PRISMA-ScR) to conduct the review. Two independent reviewers filtered the papers, extracted data and synthesized the findings. A table was used to extract data and synthesize results.
RESULTS
After systematic searching, 11 articles that implemented family integrated care (FIcare) were finally included in this scoping review. By analysing the implementation of this nursing model, we identified seven main components: NICU staff training, parent education, parent participation in infants' care, parent involvement in medical plans, peer support, NICU environmental support and mobile app for parents. Based on the extracted breastfeeding data, this scoping review concludes that family integrated care shows a positive effect on increasing breastfeeding rates at discharge. Through this scoping review, we find that family integrated care is feasible and it can support breastfeeding of preterm infants. Further studies will be needed to provide more evidence that family integrated care could facilitate breastfeeding of preterm infants.
IMPACT
This scoping review provides evidence for the positive role of family integrated care on breastfeeding outcomes. The analysis may contribute to the implementation of family integrated care.
NO PATIENT OR PUBLIC CONTRIBUTION
No further public or patient contribution was made in view of the review-based nature of the research.
Topics: Infant; Female; Humans; Infant, Newborn; Infant, Premature; Breast Feeding; Intensive Care Units, Neonatal; Intensive Care, Neonatal; Delivery of Health Care, Integrated
PubMed: 37306324
DOI: 10.1002/nop2.1888