VP25 HTA Enables Nurses To Discontinue Continuous ECG Monitoring

2019 ◽  
Vol 35 (S1) ◽  
pp. 81-81
Author(s):  
Matthew Mitchell ◽  
Julia Lavenberg ◽  
Sara Holland ◽  
Nikhil Mull ◽  
Kendal Williams
Keyword(s):  
Health Technology ◽  
Cochrane Library ◽  
Ecg Monitoring ◽  
Order Entry ◽  
Computerized Order Entry ◽  
Methodologic Quality ◽  
Letter Form ◽  
The Cochrane Library ◽  
Order Entry Systems ◽  
Hospital Inpatients

IntroductionProviders frequently issue orders for telemetry (continuous ECG monitoring) of hospital inpatients, but they rarely issue orders to discontinue telemetry. This can cause telemetry beds to be unavailable for patients who need them.MethodsOur hospital health technology assessment (HTA) center conducted a rapid systematic review of evidence on algorithms, guidelines, and other tools for nurses to identify patients who no longer need telemetry. Databases searched included Medline, CINAHL, the Cochrane Library, National Guideline Clearinghouse, and Joanna Briggs Institute.ResultsWe found no guidelines or existing systematic reviews of nurse-driven protocols for discontinuing telemetry. There were three published articles describing projects where protocols for discontinuing telemetry were tested. All three of these studies were of low methodologic quality. They all found that use of the protocol reduced the number of hours of telemetry monitoring that were used in the hospital. Two studies published in letter form reported adaptations of computerized order entry systems where nurses assess the patient's readiness for discontinuing telemetry and either discontinue telemetry or report to the ordering physician when the stated discontinuation criteria are met.ConclusionsOur hospitals are now implementing the HTA findings in our electronic ordering system.

scholarly journals Effect of dexmedetomidine on postoperative cognitive dysfunction in elderly patients after general anaesthesia: A meta-analysis

2016 ◽  
Vol 44 (6) ◽  
pp. 1182-1190 ◽  
Author(s):  
Chengmao Zhou ◽  
Yu Zhu ◽  
Zhen Liu ◽  
Lin Ruan
Keyword(s):  
General Anaesthesia ◽  
Cognitive Dysfunction ◽  
Mini Mental State Examination ◽  
Mmse Score ◽  
Meta Analysis ◽  
Postoperative Cognitive Dysfunction ◽  
Cochrane Library ◽  
Methodologic Quality ◽  
The Cochrane Library ◽  
State Examination

Objective We undertook a meta-analysis to investigate the effect of dexmedetomidine on postoperative cognitive dysfunction (POCD). Methods We searched PubMed, EMBASE, the Cochrane Library, CNKI and Google Scholar to find randomized controlled trials (RCTs) of the influence of dexmedetomidine on POCD in elderly adults who had undergone general anaesthesia. Two researchers independently screened the literature, extracted data, and evaluated methodologic quality against inclusion and exclusion criteria. We used RevMan 5.2 to undertake our meta-analysis. Results Thirteen RCTs were included. Compared with controls, dexmedetomidine: 1) significantly reduced the incidence of POCD (relative risk = 0.59, 95% confidence interval [CI] 0.45–2.95) and improved Mini-Mental State Examination (MMSE) score (mean difference, MD = 1.74, 95% CI 0.43–3.05) on the first postoperative day; and 2) reduced the incidence of POCD after the first postoperative day (MD = 2.73, 95% CI 1.33–4.12). Conclusion Dexmedetomidine reduces the incidence of POCD and improves postoperative MMSE score.

scholarly journals Rapid reviews versus full systematic reviews: An inventory of current methods and practice in health technology assessment

2008 ◽  
Vol 24 (02) ◽  
pp. 133-139 ◽  
Author(s):  
Amber Watt ◽  
Alun Cameron ◽  
Lana Sturm ◽  
Timothy Lathlean ◽  
Wendy Babidge ◽  
...  
Keyword(s):  
Health Technology Assessment ◽  
Technology Assessment ◽  
Health Technology ◽  
Rapid Review ◽  
Cochrane Library ◽  
Survey Tool ◽  
Program Evaluations ◽  
Rapid Reviews ◽  
Definition Of ◽  
The Cochrane Library

Objectives:This review assessed current practice in the preparation of rapid reviews by health technology assessment (HTA) organizations, both internationally and in the Australian context, and evaluated the available peer-reviewed literature pertaining to the methodology used in the preparation of these reviews.Methods:A survey tool was developed and distributed to a total of fifty International Network of Agencies for Health Technology Assessment (INAHTA) members and other selected HTA organizations. Data on a broad range of themes related to the conduct of rapid reviews were collated, discussed narratively, and subjected to simple statistical analysis where appropriate. Systematic searches of the Cochrane Library, EMBASE, MEDLINE, and the Australian Medical Index were undertaken in March 2007 to identify literature pertaining to rapid review methodology. Comparative studies, guidelines, program evaluations, methods studies, commentaries, and surveys were considered for inclusion.Results:Twenty-three surveys were returned (46 percent), with eighteen agencies reporting on thirty-six rapid review products. Axiomatic trends were identified, but there was little cohesion between organizations regarding the contents, methods, and definition of a rapid review. The twelve studies identified by the systematic literature search did not specifically address the methodology underpinning rapid review; rather, many highlighted the complexity of the area. Authors suggested restricted research questions and truncated search strategies as methods to limit the time taken to complete a review.Conclusions:Rather than developing a formalized methodology by which to conduct rapid reviews, agencies should work toward increasing the transparency of the methods used for each review. It is perhaps the appropriate use, not the appropriate methodology, of a rapid review that requires future consideration.

scholarly journals Systematic Steps to Diminish Multi-Fold Medication Errors in Neonates

2003 ◽  
Vol 8 (4) ◽  
pp. 266-273 ◽  
Author(s):  
Joaquim M. B. Pinheiro ◽  
Amy L. Mitchell ◽  
Timothy S. Lesar
Keyword(s):  
Intensive Care Unit ◽  
Medication Errors ◽  
Neonatal Intensive Care ◽  
Human Error ◽  
Error Reduction ◽  
Adverse Outcomes ◽  
Order Entry ◽  
Multiple Dosing ◽  
Computerized Order Entry ◽  
Order Entry Systems

Tenfold and other multiple-of-dose errors are particularly common in the neonatal intensive care unit (NICU), where the fragility of the patients increases the potential for significant adverse outcomes. Such errors can originate at any of the sequential phases of the process, from medication ordering to administration. Each step of calculation, prescription writing, transcription, dose preparation, and administration is an opportunity for generating and preventing medication errors. A few simple principles and practical tips aimed at avoiding decimal and other multiple-dosing errors can be systematically implemented through the various steps of the process. The authors describe their experience with the implementation of techniques for error reduction in a NICU setting. The techniques described herein rely on simple, inexpensive technologies for information and automation, and on standardization and simplification of processes. They can be immediately adapted and applied in virtually any NICU and could be integrated into the development of computerized order entry systems appropriate to NICU settings. Either way, they should decrease the likelihood of undetected human error.

scholarly journals Chloroquine Related to Malaria and its Promising Applications for Covid-19 Treatment

2020 ◽  
Vol 33 (3) ◽  
pp. 125-128
Author(s):  
Alberto Nicodemus Gomes Lopes ◽  
Luciano Barreto Silva
Keyword(s):  
Sudden Cardiac Death ◽  
Qt Interval ◽  
Cardiac Death ◽  
Web Of Science ◽  
Cochrane Library ◽  
Ecg Monitoring ◽  
Pubmed Central ◽  
The Usa ◽  
Online Searches ◽  
The Cochrane Library

Objective: this article described the use of chloroquine as an antimalarial agent with potential antiviral indications for COVID-19 infections. Methods: this article consisted of online searches and gray literature whose database included PUBMED Central, BVS/BIREME, Web of Science, Science Direct, Higher Level Personnel Improvement Coordinator (CAPES), Periodic Door (Portal de Periódicos da CAPES, The Cochrane Library, and PROSPERO). Results: chloroquine and hydroxychloroquine have shown appropriate clinical reports when associated with the antibiotic Azithromycin. It has been authorized for the clinical treatment of severe acute forms of COVID infections by countries such as Brazil and the USA. Conclusions: Chloroquine seems to have potential antiviral properties that may be useful in the treatment of these severe acute forms of COVID-19 associated with Azithromycin. Nevertheless, its indication must include ECG monitoring due to the risk of prolongation of QT interval, leading to sudden cardiac death.

scholarly journals Antimalarial chloroquine indicated for viral infections: myth ou hope?

2021 ◽  
Vol 10 (10) ◽  
pp. e486101018220
Author(s):  
Guilherme Marinho Sampaio ◽  
Gabriel Henrique Queiroz Oliveira ◽  
Hadassa Fonsêca Silva ◽  
Alice Pinho André Gomes Morais ◽  
Jatiacynan Andrade Souza ◽  
...  
Keyword(s):  
Web Of Science ◽  
Viral Infections ◽  
Qt Prolongation ◽  
Cochrane Library ◽  
Ecg Monitoring ◽  
Pubmed Central ◽  
Antimalarial Agent ◽  
Line Searches ◽  
On Line ◽  
The Cochrane Library

Aim: this article describes the use of chloroquine as an antimalarial agent with potential antivirotic indications for COVID-19 infections. Methods: On line searches and gray literature have been used in the construction of this articles, whose database include PUBMED Central, BVS/BIREME, Web of Science, Science Direct, Higher Level Personnel Improvement Coordinator (CAPES), Periodic Door (Portal de Periódicos da CAPES, The Cochrane Library and PROSPERO). Results: chloroquine and hydroxychloroquine has shown appropriate clinical reports when associated with the antibiotic Azithromycin. It has been authorized for the clinical treatment of grave acute forms of COVID infections by countries like Brazil and USA. Conclusions: Chloroquine seems to have potential antivirotic properties that may be useful in the treatment of the grave acute forms of COVID-19 associated with Azithromycin. Nevertheless, Its indication must include ECG monitoring due to the risk of cardiac QT prolongation able to cause sudden deaths.

The effectiveness of interruptive prescribing alerts in ambulatory CPOE to change prescriber behaviour & improve safety

2021 ◽  
pp. bmjqs-2020-012283
Author(s):  
Oliver Cerqueira ◽  
Mohsain Gill ◽  
Bishr Swar ◽  
Katherine Ann Prentice ◽  
Shannon Gwin ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Search Strategy ◽  
Outcome Measure ◽  
Time Lapse ◽  
Current Evidence ◽  
Cochrane Library ◽  
Order Entry ◽  
Rapid Transition ◽  
Collection Form ◽  
The Cochrane Library

BackgroundPrescribing alerts of an electronic health record are meant to be protective, but often are disruptive to providers. Our goal was to assess the effectiveness of interruptive medication-prescriber alerts in changing prescriber behaviour and improving patient outcomes in ambulatory care settings via computerised provider order entry (CPOE) systems.MethodsA standardised search strategy was developed and applied to the following key bibliographical databases: PubMed, Embase, CINAHL and The Cochrane Library. Non-comparison studies and studies on non-interrupted alerts were eliminated. We developed a standardised data collection form and abstracted data that included setting, study design, category of intervention alert and outcomes measured. The search was completed in August 2018 and repeated in November of 2019 and of 2020 to identify any new publications during the time lapse.ResultsUltimately, nine comparison studies of triggered alerts were identified. Each studied at least one outcome measure illustrating how the alert affected prescriber decision-making. Provider behaviour was influenced in the majority, with most noting a positive change. Alerts decreased pharmaceutical costs, moved medications toward preferred medications tiers and steered treatments toward evidence-based choices. They also decreased prescribing errors. Clinician feedback, rarely solicited, expressed frustration with alerts creating a time delay.ConclusionThe current evidence shows a clear indication that many categories of alerts are effective in changing prescriber behaviour. However, it is unclear whether these behavioural changes lead to improved patient outcomes. Despite the rapid transition to CPOE use for patient care, there are few rigorous studies of triggered alerts and how workflow interruptions impact patient outcomes and provider acceptance.

Efficacy of compression stockings in preventing post-thrombotic syndrome in patients with deep venous thrombosis: a systematic review and metaanalysis

VASA ◽  
2016 ◽  
Vol 45 (2) ◽  
pp. 141-147 ◽  
Author(s):  
Jakob Martin Burgstaller ◽  
Johann Steurer ◽  
Ulrike Held ◽  
Beatrice Amann-Vesti
Keyword(s):  
Systematic Review ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Cochrane Library ◽  
Compression Stockings ◽  
Post Thrombotic Syndrome ◽  
Study Results ◽  
Preventive Efficacy ◽  
One Year ◽  
The Cochrane Library

Abstract. Background: Here, we update an earlier systematic review on the preventive efficacy of active compression stockings in patients with diagnosed proximal deep venous thrombosis (DVT) by including the results of recently published trials. The aims are to synthesize the results of the original studies, and to identify details to explain heterogeneous results. Methods: We searched the Cochrane Library, PubMed, Scopus, and Medline for original studies that compared the preventive efficacy of active compression stockings with placebo or no compression stockings in patients with diagnosed proximal DVT. Only randomized controlled trials (RCTs) were included. Results: Five eligible RCTs with a total of 1393 patients (sample sizes ranged from 47 to 803 patients) were included. In three RCTs, patients started to wear compression stockings, placebo stockings or no stockings within the first three weeks after the diagnosis of DVT. The results of two RCTs indicate a statistically significant reduction in post-thrombotic syndrome (PTS) of 50% or more after two or more years. The result of one RCT shows no preventive effect of compression stockings at all. Due to the heterogeneity of the study results, we refrained from pooling the results of the RCTs. In a further RCT, randomization to groups with and without compression stockings took place six months after the diagnosis of DVT, and in another RCT, only patients with the absence of PTS one year after the diagnosis of DVT were analyzed. One RCT revealed a significant reduction in symptoms, whereas another RCT failed to show any benefit of using compression stockings. Conclusions: At this time, it does not seem to be justifiable to entirely abandon the recommendations regarding compression stockings to prevent PTS in patients with DVT. There is evidence favoring compression stockings, but there is also evidence showing no benefit of compression stockings.

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