103 A Review of Reviews of Emergency Department Interventions for Older People: Outcomes, Costs and Implementation Factors

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i34-i36
Author(s):  
J van Oppen ◽  
L Preston ◽  
S Ablard ◽  
H Buckley Woods ◽  
S Mason ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older People ◽  
Emergency Care ◽  
Assessment Tool ◽  
Discharge Planning ◽  
Meta Analysis ◽  
Functional Decline ◽  
Reporting Standards ◽  
Inclusion Criteria ◽  
Review Of Reviews

Abstract Introduction Older people’s emergency care is an international public health priority and remains sub-optimal in the UK. Strategies are needed to manage older patients sensitively and effectively. We reviewed emergency care interventions, evaluating evidence for outcomes, costs, and implementation. Methods We developed and registered (with PROSPERO, CRD42018111461) a review of reviews protocol. Screening was according to inclusion criteria for subject and reporting standards. Data were extracted and summarised in tabular and narrative form. Quality was assessed using AMSTAR2 and Joanna Briggs Institute tools. Due to intervention and outcome heterogeneity, findings were synthesised narratively. McCusker’s Elder-Friendly Emergency Department assessment tool was used as a classification framework. Results Eighteen review articles and three conference abstracts fulfilled inclusion criteria. The majority were systematic reviews, with four using meta-analysis. Fourteen reviews reported interventions initiated or wholly delivered within the ED, and four focussed on quality indicators or patient preferences. Confidence was limited to each review’s interpretation of primary studies. Descriptions of interventions were inconsistent, and there was high variability in reporting standards. Interventions mostly focussed on screening and assessment, discharge planning, referrals and follow-up, and multi-disciplinary team composition and professional activities. 26 patient and health service outcomes were reported, including admissions and readmissions, length of stay, mortality, functional decline, and quality of life. Conclusions Our review of reviews demonstrated that the current, extensive evidence base of review studies lacks complexity, with limited or no evidence for the effectiveness of interventions; reviews commonly called for more primary research using rigorous methods. There is little review evidence for factors influencing implementation. There was evidence that among interventions initiated in ED, those continued into the community yielded better outcomes. Service metrics (as valued by care commissioners) were evaluated as intervention outcomes more frequently than person-centred attributes (as valued by older people). Interventions were broadly holistic in nature.

scholarly journals Reporting standards for literature searches and report inclusion criteria: Making research syntheses more transparent and easy to replicate

2016 ◽  
Author(s):  
Hannah Moshontz
Keyword(s):  
Literature Search ◽  
Meta Analysis ◽  
Research Synthesis ◽  
Search Strategies ◽  
Reference Database ◽  
Synthesis Methods ◽  
Reporting Standards ◽  
Inclusion Criteria ◽  
Literature Searches ◽  
Made In

A complete description of the literature search, including the criteria used for the inclusion of reports after they have been located, used in a research synthesis or meta-analysis is critical if subsequent researchers are to accurately evaluate and reproduce a synthesis' methods and results. Based on previous guidelines and new suggestions, we present a set of focused and detailed standards for reporting the methods used in a literature search. The guidelines cover five search strategies: reference database searches, journal and bibliography searches, searches of the reference lists of reports, citation searches, and direct contact searches. First, we bring together all the unique recommendations made in existing guidelines for research synthesis. Second, we identify gaps in reporting standards for search strategies. Third, we address these gaps by providing new reporting recommendations. Our hope is to facilitate successful evaluation and replication of research synthesis results.

Rapid Emergency Department Intervention for Older People Reduces Risk of Functional Decline: Results of a Multicenter Randomized Trial

2001 ◽  
Vol 49 (10) ◽  
pp. 1272-1281 ◽  
Author(s):  
Jane McCusker ◽  
Josee Verdon ◽  
Pierre Tousignant ◽  
Louise Poulin de Courval ◽  
Nandini Dendukuri ◽  
...  
Keyword(s):  
Emergency Department ◽  
Older People ◽  
Randomized Trial ◽  
Functional Decline ◽  
Multicenter Randomized Trial

Maintaining independence in older people

2010 ◽  
Vol 20 (2) ◽  
pp. 128-153 ◽  
Author(s):  
AD Beswick ◽  
R Gooberman-Hill ◽  
A Smith ◽  
V Wylde ◽  
S Ebrahim
Keyword(s):  
Older People ◽  
Social Engagement ◽  
Hospital Admissions ◽  
Meta Analysis ◽  
Functional Decline ◽  
Complex Interventions ◽  
Preventive Strategies ◽  
Health And Social Care ◽  
Quality Trial ◽  
High Quality Trial

SummaryAppropriate social and medical interventions may help maintain independence in older people. Determinants of functional decline, disability and reduced independence are recognized and specific interventions target the treatment of clinical conditions, multiple health problems and geriatric conditions, prevention of falls and fractures, and maintenance of physical and cognitive function and social engagement.Preventive strategies to identify and treat diverse unmet needs of older people have been researched extensively. We reviewed systematically recent randomized controlled trials evaluating these ‘complex’ interventions and incorporated the findings of 21 studies into an established meta-analysis that included 108,838 people in 110 trials. There was an overall benefit of complex interventions in helping older people to live at home, explained by reduced nursing home admissions rather than death rates. Hospital admissions and falls were also reduced in intervention groups. Benefits were largely restricted to earlier studies, perhaps reflecting general improvements in health and social care for older people. The wealth of high-quality trial evidence endorses the value of preventive strategies to help maintain independence in older people.

Effect of home-based follow-up intervention on readmissions and mortality in heart failure patients: a meta-analysis

2019 ◽  
Vol 15 (5) ◽  
pp. 377-386 ◽  
Author(s):  
Aaqib H Malik ◽  
Senada S Malik ◽  
Wilbert S Aronow ◽  
Keyword(s):  
Heart Failure ◽  
Discharge Planning ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Readmission Rates ◽  
Randomized Controlled ◽  
Home Based ◽  
Home Based Intervention ◽  
The Impact

Aim: We investigated whether the home-based intervention (HBI) for heart failure (HF), restricted to education and support, improves readmissions or mortality compared with usual care. Patients & methods: We searched PubMed and Embase for randomized controlled trials that examined the impact of HBI in HF. A random-effects meta-analysis was performed using R. Result: Total 17/409 articles (3214 patients) met our inclusion criteria. The pooled estimate showed HBI was associated with a reduction in readmission rates and mortality (22 and 16% respectively; p < 0.05). Subgroup analysis confirmed that the benefit of HBI increases significantly with a longer follow-up. Conclusion: HBI in the form of education and support significantly reduces readmission rates and improves survival of HF patients. HBI should be considered in the discharge planning of HF patients.

scholarly journals Microplastic contamination of salt intended for human consumption: a systematic review and meta-analysis

2020 ◽  
Vol 2 (12) ◽  
Author(s):  
Evangelos Danopoulos ◽  
Lauren Jenner ◽  
Maureen Twiddy ◽  
Jeanette M. Rotchell
Keyword(s):  
Systematic Review ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Future Research ◽  
Human Consumption ◽  
Inclusion Criteria ◽  
Research Findings ◽  
Human Health Effects ◽  
Potential Human Health

Abstract Microplastics (MPs) are an emerging contaminant ubiquitous in the environment. There is growing concern regarding potential human health effects, a major human exposure route being dietary uptake. We have undertaken a systematic review (SR) and meta-analysis to identify all relevant research on MP contamination of salt intended for human consumption. Three thousand nine hundred and nineteen papers were identified, with ten fitting the inclusion criteria. A search of the databases MEDLINE, EMBASE and Web of Science, from launch date to September 2020, was conducted. MP contamination of salt varied significantly between four origins, sea salt 0–1674 MPs/kg, lake salt 8–462 MPs/kg, rock and well salt 0–204 MPs/kg. The majority of samples were found to be contaminated by MPs. Corresponding potential human exposures are estimated to be 0–6110 MPs per year (for all origins), confirming salt as a carrier of MPs. A bespoke risk of bias (RoB) assessment tool was used to appraise the quality of the studies, with studies demonstrating moderate to low RoB. These results suggest that a series of recurring issues need to be addressed in future research regarding sampling, analysis and reporting to improve confidence in research findings.

scholarly journals P151: Occupational therapy in the emergency department: sustaining results

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S110-S111
Author(s):  
J. Trenholm
Keyword(s):  
Emergency Department ◽  
Occupational Therapy ◽  
Hospital Admissions ◽  
Discharge Planning ◽  
Functional Decline ◽  
Pilot Project ◽  
Added Value ◽  
Functional Impairments ◽  
Chart Audit ◽  
Number Of Patients

Introduction: An emergency department visit may represent a sentinel event for someone who is older and frail, signalling a slide into dependence and functional decline. The gold standard for the treatment of frail older adults is a comprehensive geriatric assessment, involving consideration of multiple domains including mobility and function in activities of daily living. Despite this, when a chart audit was conducted in a Canadian metropolitan emergency department, none of the patients age 65 and older had a documented assessment of their function or mobility. In response, an occupational therapy program was implemented. The goals of this program were to reduce the number of unnecessary hospital admissions related to patient functional impairments, and to increase function, safety, and independence for patients upon discharge from the emergency department. Methods: The pilot project, which was completed in 2013, was evaluated using a mixed methods approach. Positive patient outcomes at that time included a reduction in avoidable admissions and better support for patients upon discharge from the emergency department. A survey of emergency department staff indicated that occupational therapy consultation added value to the diagnostic and discharge planning processes. However, due to changes in administrative priorities, several service redesigns were required. Multiple PDSA cycles were completed, and the development of a logic model guided and focused program development. Results: A reassessment of program objectives was conducted using 2015 data, which found that the number of patients seen by the occupational therapist remained the same, as did the percentage of patients discharged with support of occupational therapy intervention, such as provision of adaptive equipment or referral to community rehabilitation referrals. The percentage of patients discharged due to occupational therapy as a primary contributing factor rose slightly, and staff satisfaction with the program remained high. Conclusion: This evaluation proves that the provision of occupational therapy services in the emergency department is sustainable, benefits patients, and can be incorporated into the emergency department workflow and culture.

scholarly journals Meta-analysis of effect of renin–angiotensin–aldosterone system blockers on contrast-induced nephropathy

2020 ◽  
Vol 21 (2) ◽  
pp. 147032032091958
Author(s):  
Weidong Wang ◽  
Wei Qu ◽  
Dan Sun ◽  
Xiaodan Liu
Keyword(s):  
Older People ◽  
Sample Size ◽  
Meta Analysis ◽  
Control Group ◽  
Inclusion Criteria ◽  
Contrast Induced Nephropathy ◽  
Renin Angiotensin Aldosterone System ◽  
Renin Angiotensin ◽  
Increased Risk ◽  
Larger Sample

Background: The purpose of this study was to systematically evaluate the effect of renin–angiotensin–aldosterone system blockers on the incidence of contrast-induced nephropathy in patients undergoing coronary angiography or percutaneous coronary intervention. Methods: A systematic literature search of several databases was conducted to identify studies that met the inclusion criteria. A total of 12 studies with 14 trials that performed studies on a total of 4864 patients (2484 treated with renin–angiotensin–aldosterone system blockers and 2380 in the control group) were included. The primary endpoint was the overall incidence of contrast-induced nephropathy. Analyses were performed with STATA version 12.0. Results: The overall contrast-induced nephropathy incidence in renin–angiotensin–aldosterone system blocker and control groups was 10.43% and 6.81%, respectively. The pooled relative risk of contrast-induced nephropathy incidence was 1.22 (95% confidence interval: 0.81–1.84) in the renin–angiotensin–aldosterone system blocker group. An increased risk of developing contrast-induced nephropathy in the renin–angiotensin–aldosterone system blocker group was observed among older people, non-Asians, chronic users, and studies with larger sample size, and the pooled RRs and 95% confidence intervals were 2.02 (1.21–3.36), 2.30 (1.41–3.76), 1.69 (1.10–2.59) and 1.83 (1.28–2.63), respectively. Conclusions: Intervention with renin–angiotensin–aldosterone system blockers was associated with an increased risk of contrast-induced nephropathy among non-Asians, chronic users, older people, and studies with larger sample size. Large clinical trials with strict inclusion criteria are needed to confirm our results and to evaluate the effect further.

scholarly journals Prevalence and risk factors for food allergy in older people: protocol for a systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e029633 ◽  
Author(s):  
Inês Laia-Dias ◽  
Carlos Lozoya-Ibáñez ◽  
Isabel Skypala ◽  
Jorge M R Gama ◽  
Ulugbek Nurmatov ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Food Allergy ◽  
Older People ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Clinical Manifestations ◽  
Cochrane Library ◽  
Older Individuals ◽  
Statistical Heterogeneity

IntroductionStudies suggest that the prevalence of food allergy may be increasing worldwide. Results regarding the prevalence and features of adverse food reactions older people have, however, scarcely been analysed in the literature. Thus, the objective of the present systematic review will be to describe the prevalence of food allergy in older individuals, its risk factors, clinical features, as well as the most frequently and commonly involved foods.Methods and analysisWe will conduct a systematic review and meta-analysis of the incidence, prevalence and risk factors for food allergy in older individuals. We will search international electronic databases including MEDLINE, EMBASE, Cochrane Library, CINAHL, AMED and ISI Web of Science for published, unpublished and ongoing studies from 1980 toJanuary 2019. There will be no restriction on the language or geography of publication. We will use the critical appraisal skills programme quality assessment tool to appraise the methodological quality of included studies. A descriptive summary with data tables will be elaborated, and if deemed clinically relevant and statistically adequate, meta-analysis using random-effects modelling will be carried out, given the expected clinical, methodological and statistical heterogeneity of studies. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist will guide reporting of the systematic review.Ethics and disseminationSince this systematic review will be solely based on published and retrievable literature, no ethics approval will be obtained. This study will allow us to draw up-to-date estimates of the prevalence of adverse food reactions in older individuals, worldwide, besides allowing the identification of its major risk factors, clinical manifestations and predominant foods responsible for such reactions. A multidisciplinary team has been assembled for this systematic review and will participate in relevant dissemination activities, namely reports, publications and presentations.PROSPERO registration numberCRD42018102140

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