Systematic review with meta-analysis of the impact of surgical fellowship training on patient outcomes

2015 ◽  
Vol 102 (10) ◽  
pp. 1156-1166 ◽  
Author(s):  
M. J. Johnston ◽  
P. Singh ◽  
P. H. Pucher ◽  
J. E. F. Fitzgerald ◽  
R. Aggarwal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Meta Analysis ◽  
Fellowship Training ◽  
The Impact

scholarly journals Effect of hospital volume on outcomes of total hip arthroplasty: a systematic review and meta-analysis

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Syed Hamza Mufarrih ◽  
Muhammad Owais Abdul Ghani ◽  
Russell Seth Martins ◽  
Nada Qaisar Qureshi ◽  
Sayyeda Aleena Mufarrih ◽  
...  
Keyword(s):  
Systematic Review ◽  
Total Hip Arthroplasty ◽  
Patient Outcomes ◽  
Hip Arthroplasty ◽  
Hospital Volume ◽  
Meta Analysis ◽  
High Volume ◽  
Total Hip ◽  
Meta Analyses ◽  
The Impact

Abstract Background A shift in the healthcare system towards the centralization of common yet costly surgeries, such as total hip arthroplasty (THA), to high-volume centers of excellence, is an attempt to control the economic burden while simultaneously enhancing patient outcomes. The “volume-outcome” relationship suggests that hospitals performing more treatment of a given type exhibit better outcomes than hospitals performing fewer. This theory has surfaced as an important factor in determining patient outcomes following THA. We performed a systematic review with meta-analyses to review the available evidence on the impact of hospital volume on outcomes of THA. Materials and methods We conducted a review of PubMed (MEDLINE), OVID MEDLINE, Google Scholar, and Cochrane library of studies reporting the impact of hospital volume on THA. The studies were evaluated as per the inclusion and exclusion criteria. A total of 44 studies were included in the review. We accessed pooled data using random-effect meta-analysis. Results Results of the meta-analyses show that low-volume hospitals were associated with a higher rate of surgical site infections (1.25 [1.01, 1.55]), longer length of stay (RR, 0.83[0.48–1.18]), increased cost of surgery (3.44, [2.57, 4.30]), 90-day complications (RR, 1.80[1.50–2.17]) and 30-day (RR, 2.33[1.27–4.28]), 90-day (RR, 1.26[1.05–1.51]), and 1-year mortality rates (RR, 2.26[1.32–3.88]) when compared to high-volume hospitals following THA. Except for two prospective studies, all were retrospective observational studies. Conclusions These findings demonstrate superior outcomes following THA in high-volume hospitals. Together with the reduced cost of the surgical procedure, fewer complications may contribute to saving considerable opportunity costs annually. However, a need to define objective volume-thresholds with stronger evidence would be required. Trial registration PROSPERO CRD42019123776.

The impact of the ALK fusion variant on clinical outcomes in EML4-ALK patients with NSCLC: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Shasha Wang ◽  
Rongrong Luo ◽  
Yuankai Shi ◽  
Xiaohong Han
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Patient Outcomes ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Small Cell Lung ◽  
Free Survival ◽  
Significant Difference ◽  
Alk Positive ◽  
The Impact

Background: Recent studies showed that ALK-fusion variants are associated with heterogeneous clinical outcomes. However, contradictory conclusions have been drawn in other studies showing no correlation between ALK variants and prognoses. Methods: A systematic review and meta-analysis was performed to evaluate the prognostic value of EML4-ALK fusion variants for patient outcomes. Results: 28 studies were included in the analysis. According to the pooled results, patients harboring variant 1 showed equivalent progression-free survival (PFS) and overall survival (OS) with non-v1 patients (hazard ratio [HR] for PFS: 0.91 [0.68–1.21]; p = 0.499; OS: 1.12 [0.73–1.72]; p = 0.610). Similarly, patients with v3 showed the same disease progress as non-v3 patients (pooled HR for PFS = 1.07 [0.72–1.58]; p = 0.741). However, pooled results for OS suggested that patients with v3 had worse survival than non-v3 patients (HR = 3.44 [1.42–8.35]; p = 0.006). Conclusion: Results suggest that patients with v1 exhibited no significant difference from non-v1 in terms of OS and PFS, while v3 was associated with shorter OS in ALK-positive patients with non-small cell lung cancer.

scholarly journals The evidence–practice gap in specialist mental healthcare: Systematic review and meta-analysis of guideline implementation studies

2017 ◽  
Vol 210 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Francesca Girlanda ◽  
Ines Fiedler ◽  
Thomas Becker ◽  
Corrado Barbui ◽  
Markus Koesters
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Meta Analysis ◽  
Guideline Implementation ◽  
Mental Healthcare ◽  
Implementation Strategies ◽  
Routine Care ◽  
Provider Performance ◽  
The Impact ◽  
Positive Effect

BackgroundClinical practice guidelines are not easily implemented, leading to a gap between research synthesis and their use in routine care.AimsTo summarise the evidence relating to the impact of guideline implementation on provider performance and patient outcomes in mental healthcare settings, and to explore the performance of different strategies for guideline implementation.MethodA systematic review of randomised controlled trials, controlled clinical trials and before-and-after studies comparing guideline implementation strategies v. usual care, and different guideline implementation strategies, in patients with severe mental illness.ResultsIn total, 19 studies met our inclusion criteria. The studies did not show a consistent positive effect of guideline implementation on provider performance, but a more consistent small to modest positive effect on patient outcomes.ConclusionsGuideline implementation does not seem to have an impact on provider performance, nonetheless it may influence patient outcomes positively.

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