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Revista Brasileira de Enfermagem 2021Identify the theoretical concepts that have been used in the context of nursing care for hospitalized children. (Review)
Review
OBJECTIVE
Identify the theoretical concepts that have been used in the context of nursing care for hospitalized children.
METHODS
Scoping review was carried out according to the PRISMA-ScR methodology. The research limitations included: primary studies dealing with the use of theoretical concepts of nursing in the provision of care to hospitalized children, access in full text, in Portuguese or English and published between 2000 and 2019. Research was carried out on grassroots platforms (EBSCOhost, PubMed, SciELO and Web of Science), gray literature and in the bibliography of selected articles.
RESULTS
21 studies were found and 10 theoretical conceptions of nursing were identified, with family-centered care being the most used.
FINAL CONSIDERATIONS
The variability of the identified theoretical conceptions is emphasized, with no evidence to support the use of one in detriment of the other. A more integrative theoretical conception, which adds care centered both on the family and the child, emerges as a research trend.
Topics: Child; Child Care; Child Health; Child, Hospitalized; Humans; Nursing Care
PubMed: 34133680
DOI: 10.1590/0034-7167-2020-0265 -
Systematic Reviews Jan 2024Patient misunderstanding of instructions on medication labels is a common cause of medication errors and can result in ineffective treatment. One way to better improve... (Review)
Review
INTRODUCTION
Patient misunderstanding of instructions on medication labels is a common cause of medication errors and can result in ineffective treatment. One way to better improve patient comprehension of medication labels is by optimizing the content and display of the information.
OBJECTIVES
To review comparative studies that have evaluated the design of a medication label to improve patient knowledge or safety.
METHODS
Studies were selected from systematic computerized literature searches performed in PubMed, Embase (Elsevier), Cochrane Central (EBSCO), Cumulative Index to Nursing and Allied Health Literature-CINAHL (EBSCO), and Web of Science (Thomson Reuters). Eligible studies included comparative studies that evaluated the design of a medication label to improve patient knowledge or safety.
RESULTS
Of the 246 articles identified in the primary literature search, 14 studies were selected for data abstraction. Thirteen of these studies significantly impacted the patient understanding of medication labels. Three studies included a measure of patient safety in terms of medication adherence and dosing errors. The utilization of patient-centered language, pictograms/graphics, color/white space, or font optimization was seen to have the most impact on patient comprehension.
CONCLUSION
It is essential to present medication information in an optimal manner for patients. This can be done by standardizing the content, display, and format of medication labels to improve understanding and medication usage. Evidence-based design principles can, therefore, be used to facilitate the standardization of the structure of label content for both print and electronic devices. However, more research needs to be done on validating the implications of label content display to measure its impact on patient safety.
SYSTEMIC REVIEW REGISTRATION
PROSPERO CRD42022347510 ( http://www.crd.york.ac.uk/prospero/ ).
Topics: Humans; Language; Medication Adherence; Patients; Medication Errors; Patient Safety
PubMed: 38167495
DOI: 10.1186/s13643-023-02413-z -
The International Journal of... Sep 2017Systematic screening for active pulmonary tuberculosis (PTB) is recommended for high-risk populations, including people living with the human immunodeficiency virus... (Meta-Analysis)
Meta-Analysis Review
SETTING
Systematic screening for active pulmonary tuberculosis (PTB) is recommended for high-risk populations, including people living with the human immunodeficiency virus (PLHIV); however, currently recommended TB screening tools are inadequate for most high-burden settings.
OBJECTIVE
To determine whether C-reactive protein (CRP) possesses the necessary test characteristics to screen individuals for active PTB.
DESIGN
We performed a systematic review and meta-analysis of studies evaluating the diagnostic accuracy of CRP (10 mg/l cut-off point) for culture-positive PTB. Pooled diagnostic accuracy estimates were generated using random-effects meta-analysis for out-patients and in-patients, and for pre-specified subgroups based on HIV status and test indication.
RESULTS
We identified nine unique studies enrolling 1793 adults from out-patient (five studies, 1121 patients) and in-patient settings (five studies, 672 patients), 72% of whom had confirmed HIV infection. Among out-patients, CRP had high sensitivity (93%, 95%CI 88-98) and moderate specificity (60%, 95%CI 40-75) for active PTB. Specificity was lowest among in-patients (21%, 95%CI 6-52) and highest among out-patients undergoing TB screening (range 58-81%). There was no difference in summary estimates by HIV status.
CONCLUSION
CRP, which is available as a simple, inexpensive and point-of-care test, can be used to screen PLHIV presenting for routine HIV/AIDS (acquired immune-deficiency syndrome) care for active TB.
Topics: C-Reactive Protein; HIV Infections; Humans; Mass Screening; Mycobacterium tuberculosis; Outpatients; Point-of-Care Testing; Sensitivity and Specificity; Sputum; Tuberculosis, Pulmonary
PubMed: 28826451
DOI: 10.5588/ijtld.17.0078 -
BMJ Open Sep 2023It is unclear whether remote interventions are effective in improving outcomes of informal caregivers of patients who had a stroke. We synthesised evidence for the... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
It is unclear whether remote interventions are effective in improving outcomes of informal caregivers of patients who had a stroke. We synthesised evidence for the impact of remote interventions on informal caregivers of patients who had a stroke. Moreover, we also analysed its potential effects on patients who had a stroke.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
PubMed, Excerpta Medica Database, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, Wanfang Database and China Science and Technology Journal Database were searched from inception up to 1 February 2022.
ELIGIBILITY CRITERIA
We included randomised controlled trials (RCTs) that assessed the effect of remote interventions on informal caregivers who provide unpaid care for patients who had a stroke living at home compared with traditional interventions, including with respect to caregivers' mood, care burden, life satisfaction and perceived competence. Moreover, we considered the potential impact of remote interventions on the depressive and anxiety symptoms, functional rehabilitation and re-admission of patients who had a stroke. Only studies published in Chinese or English were included. We excluded studies of interventions aimed at healthcare professionals or patients who had a stroke and those that could not provide complete data.
DATA EXTRACTION AND SYNTHESIS
Data analyses were performed using RevMan V.5.3. The Cochrane Collaboration risk of bias tool for RCTs was used to evaluate the quality of the included studies, and the review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. For continuous outcomes, we calculated the mean difference or standardised mean difference (SMD) and 95% CIs. The Grading of Recommendations, Assessment, Development, and Evaluations method was used to assess the certainty of the evidence.
RESULTS
Eight RCTs with a total of 733 participants were included. Compared with traditional interventions, for informal caregivers, we found that remote interventions did not produce significant effects on depressive symptoms (SMD -0.04, 95% CI -0.24 to 0.15), anxiety symptoms (SMD -0.26, 95% CI -0.94 to 0.43), care burden (SMD -0.06, 95% CI -0.56 to 0.45), life satisfaction (SMD -0.16, 95% CI -0.43 to 0.11), or perceived competence (SMD 0.37, 95% CI -0.23 to 0.96). Similarly, for patients who had a stroke, remote interventions had no significant effect on depression (SMD 0.16, 95% CI -0.61 to 0.93) or anxiety symptoms (SMD -0.34, 95% CI -0.72 to 0.04). The effects of remote interventions on functional rehabilitation and re-admission in patients who had a stroke were evaluated by three studies and two studies, respectively, but the studies were too varied to combine their data in meta-analysis.
CONCLUSIONS
Current evidence suggests that remote interventions for informal caregivers of patients who had a stroke have no significant superiority over traditional interventions. However, the quality of the included studies was low and more high-quality evidence is required to determine the possible impacts of remote interventions.
PROSPERO REGISTRATION NUMBER
CRD42022313544.
Topics: Humans; Caregivers; Caregiver Burden; Health Personnel; Patients; Stroke
PubMed: 37696638
DOI: 10.1136/bmjopen-2022-071461 -
Critical Care (London, England) Mar 2023Management of bleeding trauma patients is still a difficult challenge. Massive transfusion (MT) requires resources to ensure the safety and timely delivery of blood... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Management of bleeding trauma patients is still a difficult challenge. Massive transfusion (MT) requires resources to ensure the safety and timely delivery of blood products. Early prediction of MT need may be useful to shorten the time process of blood product preparation. The primary aim of this study was to assess the accuracy of shock index to predict the need for MT in adult patients with trauma. For the same population, we also assessed the accuracy of SI to predict mortality.
METHODS
This systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. We performed a systematic search on MEDLINE, Scopus, and Web of Science from inception to March 2022. Studies were included if they reported MT or mortality with SI recorded at arrival in the field or the emergency department. The risk of bias was assessed using the QUADAS-2.
RESULTS
Thirty-five studies were included in the systematic review and meta-analysis, for a total of 670,728 patients. For MT the overall sensibility was 0.68 [0.57; 0.76], the overall specificity was 0.84 [0.79; 0.88] and the AUC was 0.85 [0.81; 0.88]. Positive and Negative Likelihood Ratio (LR+; LR-) were 4.24 [3.18-5.65] and 0.39 [0.29-0.52], respectively. For mortality the overall sensibility was 0.358 [0.238; 0.498] the overall specificity 0.742 [0.656; 0.813] and the AUC 0.553 (confidence region for sensitivity given specificity: [0.4014; 0.6759]; confidence region for specificity given sensitivity: [0.4799; 0.6332]). LR+ and LR- were 1.39 [1.36-1.42] and 0.87 [0.85-0.89], respectively.
CONCLUSIONS
Our study demonstrated that SI may have a limited role as the sole tool to predict the need for MT in adult trauma patients. SI is not accurate to predict mortality but may have a role to identify patients with a low risk of mortality.
Topics: Adult; Humans; Blood Transfusion; Emergency Service, Hospital; Patients
PubMed: 36872322
DOI: 10.1186/s13054-023-04386-w -
Sexually Transmitted Infections Oct 2009Measuring patient satisfaction is an important aspect of making services attractive to patients and improving service delivery, and outpatient-based clinics are... (Review)
Review
OBJECTIVES
Measuring patient satisfaction is an important aspect of making services attractive to patients and improving service delivery, and outpatient-based clinics are increasingly assessing service quality using patient-based outcome measures. No systematic review of patient satisfaction in sexually transmitted infection clinics has previously been performed. The objectives of the review were: (1) to establish how patient satisfaction with sexual health services has been defined and measured; (2) to identify whether a "gold standard" method exists; and (3) to identify the themes regarded by patients as priorities for delivering a quality service within a sexually transmitted infection clinic setting.
METHODS
A search of eight electronic journal databases and unpublished data sources was used to identify studies measuring patient satisfaction in a sexually transmitted infection clinic setting. Following initial review of each abstract, data from eligible studies were extracted by two independent reviewers and content analysis used to identify common themes.
RESULTS
Eighteen questionnaire-based studies, nine semistructured interviews and four other studies, including three focus groups, fulfilled the selection criteria for inclusion. Three studies incorporated more than one method of analysis. No common validated method of assessing patient satisfaction was identified. Themes reported to be of greatest importance were the convenience of clinic location, availability of appointments, staff attitude to patients, effective provision of information and maintenance of confidentiality.
CONCLUSIONS
This review has identified the need for a validated and standardised approach to assess patient satisfaction in sexually transmitted infection clinics. Comparing studies which have measured satisfaction, clear themes for the provision of a high quality service, from a patient perspective, have emerged. These themes should be incorporated into assessment tools, such as questionnaires, when reviewing service delivery.
Topics: Ambulatory Care Facilities; Data Collection; Health Services Research; Humans; Outpatients; Patient Satisfaction; Process Assessment, Health Care; Sexually Transmitted Diseases; South Africa; United Kingdom; United States; Zimbabwe
PubMed: 19826065
DOI: 10.1136/sti.2009.037358 -
International Journal of Environmental... Nov 2019Patient-centred care is tailored to the needs of patients and is necessary for better health outcomes, especially for individuals with limited health literacy (LHL)....
Patient-centred care is tailored to the needs of patients and is necessary for better health outcomes, especially for individuals with limited health literacy (LHL). However, its implementation remains challenging. The key to effectively address patient-centred care is to include perspectives of patients with LHL within the curricula of (future) healthcare providers (HCP). This systematic review aimed to explore and synthesize evidence on the needs, experiences and preferences of patients with LHL and to inform an existing educational framework. We searched three databases: PsychInfo, Medline and Cinahl, and extracted 798 articles. One-hundred and three articles met the inclusion criteria. After data extraction and thematic synthesis, key themes were identified. Patients with LHL and chronic diseases encounter multiple problems in the care process, which are often related to a lack of person-centeredness. Patient perspectives were categorized into four key themes: (1) Support system; (2) Patient self-management; (3) Capacities of HCPs; (4) Barriers in healthcare systems. "Cultural sensitivity" and "eHealth" were identified as recurring themes. A set of learning outcomes for (future) HCPs was developed based on our findings. The perspectives of patients with LHL provided valuable input for a comprehensive and person-centred educational framework that can enhance the relevance and quality of education for (future) HCPs, and contribute to better person-centred care for patients with LHL.
Topics: Health Literacy; Health Personnel; Humans; Patient Education as Topic; Patients; Qualitative Research
PubMed: 31694299
DOI: 10.3390/ijerph16214300 -
American Journal of Preventive Medicine Aug 2015A central premise of the literature on healthcare quality is that improving the quality of care will lead to improvements in health outcomes. A systematic review was... (Review)
Review
CONTEXT
A central premise of the literature on healthcare quality is that improving the quality of care will lead to improvements in health outcomes. A systematic review was conducted to better inform quality improvement efforts in the area of family planning. The objective of this systematic review is to update a previous review focused on the quality of family planning services, namely, the impact of quality improvement efforts and client perspectives about what constitutes quality family planning services. In addition, this review includes new literature examining provider perspectives.
EVIDENCE ACQUISITION
Multiple databases from January 1985 through January 2015 were searched within the peer-reviewed literature that described the quality of family planning services. The retrieval and inclusion criteria included full-length articles published in English, which described studies occurring in a clinic-based setting to include family planning services.
EVIDENCE SYNTHESIS
Search strategies identified 16,145 articles, 16 of which met the inclusion criteria. No new intervention studies addressing the impact of quality improvement efforts on family planning outcomes were identified. Sixteen articles provided information relevant to client or provider perspectives about what constitutes quality family planning services. Clients and providers mostly identified the need for services that were accessible, client-centered, and equitable. Themes related to effectiveness, efficiency, and safety were mentioned less frequently.
CONCLUSIONS
Family planning services that account for both patient and provider perspectives may be more effective. Further research is needed to examine the impact of improved quality on provider practices, client behavior, and health outcomes.
Topics: Family Planning Services; Health Personnel; Humans; Patients; Quality of Health Care
PubMed: 26190852
DOI: 10.1016/j.amepre.2015.03.017 -
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 -
Health Expectations : An International... Oct 2017Measures exist to improve early recognition of, and response to, deteriorating patients in hospital. However, deteriorating patients continue to go unrecognized. To... (Review)
Review
BACKGROUND
Measures exist to improve early recognition of, and response to, deteriorating patients in hospital. However, deteriorating patients continue to go unrecognized. To address this, interventions have been developed that invite patients and relatives to escalate patient deterioration to a rapid response team (RRT).
OBJECTIVE
To systematically review articles that describe these interventions and investigate their effectiveness at reducing preventable deterioration.
SEARCH STRATEGY
Following PRISMA guidelines, four electronic databases and two web search engines were searched to identify literature investigating patient and relative led escalation.
INCLUSION CRITERIA
Articles investigating the implementation or use of systems involving patients and relatives in the detection of clinical patient deterioration and escalation of patient care to address any clinical or non-clinical outcomes were included. Articles' eligibility was validated by a second reviewer (20%).
DATA EXTRACTION
Data were extracted according to pre-defined criteria.
DATA SYNTHESIS
Narrative synthesis was applied to included studies.
MAIN RESULTS
Nine empirical studies and 36 grey literature articles were included in the review. Limited studies were conducted to establish the clinical effectiveness of patient and relative led escalation. Instead, studies investigated the impact of this intervention on health-care staff and available resources. Although appropriate, this reflects the infancy of research in this area. Patients and relatives did not overwhelm resources by activating the RRT. However, they did activate it to address concerns unrelated to patient deterioration.
CONCLUSIONS
Activating a RRT may not be the most appropriate or cost-effective method of resolving non-life-threatening concerns.
Topics: Clinical Deterioration; Cost-Benefit Analysis; Family; Hospital Administration; Hospital Rapid Response Team; Humans; Inservice Training; Patient Education as Topic; Patients
PubMed: 27785868
DOI: 10.1111/hex.12496