Quality assessment of weekend discharge: a systematic review and meta-analysis

Abstract Purpose Hospital bed utility and length of stay affect the healthcare budget and quality of patient care. Prior studies already show admission and operation on weekends have higher mortality rates compared with weekdays, which has been identified as the ‘weekend effect.’ However, discharges on weekends are also linked with quality of care, and have been evaluated in the recent decade with different dimensions. This meta-analysis aims to discuss weekend discharges associated with 30-day readmission, 30-day mortality, 30-day emergency department visits and 14-day follow-up visits compared with weekday discharges. Data sources PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov were searched from January 2000 to November 2019. Study selection Preferred reporting items for systematic reviews and meta-analyses guidelines were followed. Only studies published in English were reviewed. The random-effects model was applied to assess the effects of heterogeneity among the selected studies. Data extraction Year of publication, country, sample size, number of weekday/weekend discharges, 30-day readmission, 30-day mortality, 30-day ED visits and 14-day appointment follow-up rate. Results of data synthesis There are 20 studies from seven countries, including 13 articles from America, in the present meta-analysis. There was no significant difference in odds ratio (OR) in 30-day readmission, 30-day mortality, 30-day ED visit, and 14-day follow-up between weekday and weekend. However, the OR for 30-day readmission was significantly higher among patients in the USA, including studies with high heterogeneity. Conclusion In the USA, the 30-day readmission rate was higher in patients who had been discharged on the weekend compared with the weekday. However, interpretation should be cautious because of data limitation and high heterogeneity. Further intervention should be conducted to eliminate any healthcare inequality within the healthcare system and to improve the quality of patient care.

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Clinical Performance of Filled/Nanofilled Versus Nonfilled Adhesive Systems in Noncarious Cervical Lesions: A Systematic Review and Meta-analysis

Operative Dentistry ◽

10.2341/19-252-l ◽

2020 ◽

Vol 46 (1) ◽

pp. E34-E59

Author(s):

JL de Geus ◽

BM Maran ◽

KA Cabral ◽

A Dávila-Sánchez ◽

C Tardem ◽

...

Keyword(s):

Clinical Performance ◽

Meta Analysis ◽

Risk Of Bias ◽

Cochrane Library ◽

Adhesive Systems ◽

Cervical Lesions ◽

Secondary Caries ◽

Significant Difference

Clinical Relevance The use of filled adhesive systems does not influence the clinical performance of the adhesive restoration in noncarious cervical lesions. SUMMARY Objective: The aim of this meta-analysis was to investigate the clinical performance of filled vs unfilled adhesive systems when applied in noncarious cervical lesions. Methods and Materials: A systematic search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and SIGLE. Gray literature was also screened. Only randomized controlled clinical trials were included. The risk of bias of the studies was evaluated using the Cochrane Collaboration’s tool. A random-effects meta-analysis was conducted to compare the retention rate, marginal discoloration, and secondary caries of noncarious cervical lesions restored with filled adhesives vs unfilled adhesives. The quality of the body of evidence was assessed using the GRADE approach. Results: A total of 3662 studies were identified after removal of duplicates. Twenty-nine studies remained for qualitative analyses and 28 studies for the meta-analysis. Only one study was judged to have a low risk of bias, and the other 28 were considered to have unclear risk of bias. There was no statistically significant difference between filled adhesives compared with unfilled adhesives in relation to loss of retention, marginal discoloration, or secondary caries at any of the follow-up periods (12–18 months, 24–30 months, 3 years, and 5 years or longer). The quality of evidence was graded as moderate for most outcomes at the respective follow-ups, except when there was an explained heterogeneity, which occurred mainly for loss of retention at the 12-month to 3-year follow-up. The results did not depend on whether microfilled or nanofilled adhesives had been investigated. Conclusions: The addition of fillers into the composition of adhesive systems did not increase the clinical performance (retention rates, marginal discoloration, or secondary caries) of composite restorations placed in noncarious cervical lesions when compared with unfilled adhesives.

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Effectiveness of acute geriatric unit care on functional decline and process outcomes among older adults admitted to hospital with acute medical complaints: a protocol for a systematic review

BMJ Open ◽

10.1136/bmjopen-2021-050524 ◽

2021 ◽

Vol 11 (10) ◽

pp. e050524

Author(s):

Íde O’Shaughnessy ◽

Katie Robinson ◽

Margaret O'Connor ◽

Mairéad Conneely ◽

Damien Ryan ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Meta Analysis ◽

Functional Decline ◽

Index Admission ◽

Research Centre ◽

Cochrane Library ◽

Process Outcomes

IntroductionOlder adults are clinically heterogeneous and are at increased risk of adverse outcomes during hospitalisation due to the presence of multiple comorbid conditions and reduced homoeostatic reserves. Acute geriatric units (AGUs) are units designed with their own physical location and structure, which provide care to older adults during the acute phase of illness and are underpinned by an interdisciplinary comprehensive geriatric assessment model of care. This review aims to update and synthesise the totality of evidence related to the effectiveness of AGU care on clinical and process outcomes among older adults admitted to hospital with acute medical complaints.DesignUpdated systematic review and meta-analysisMethods and analysisMEDLINE, Cumulative Index of Nursing and Allied Health Literature, Controlled Trials in the Cochrane Library and Embase electronic databases will be systematically searched from 2008 to February 2021. Trials with a randomised design that deliver an AGU intervention to older adults admitted to hospital for acute medical complaints will be included. The primary outcome measure will be functional decline at discharge from hospital and at follow-up. Secondary outcomes will include length of stay, cost of index admission, incidence of unscheduled hospital readmission, living at home (the inverse of death or institutionalisation combined; used to describe someone who is in their own home at follow‐up), mortality, cognitive function and patient satisfaction with index admission. Title and abstract screening of studies for full-text extraction will be conducted independently by two authors. The Cochrane risk of bias 2 tool will be used to assess the methodological quality of the included trials. The quality of evidence for outcomes reported will be assessed using the Grading of Recommendations Assessment, Development and Evaluations framework. A pooled meta-analysis will be conducted using Review Manager, depending on the uniformity of the data.Ethics and disseminationFormal ethical approval is not required as all data collected will be secondary data and will be analysed anonymously. The authors will present the findings of the review to a patient and public involvement stakeholder panel of older adults that has been established at the Ageing Research Centre in the University of Limerick. This will enable the views and opinions of older adults to be integrated into the discussion section of the paper.PROSPERO registration numberCRD42021237633.

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Adjunctive therapies for the nonsurgical treatment of peri-implant diseases: systemic review and meta-analysis

10.21203/rs.3.rs-15961/v3 ◽

2020 ◽

Author(s):

yuhan xiao ◽

Yichun Qin ◽

Haiyang Yu

Keyword(s):

Photodynamic Therapy ◽

Meta Analysis ◽

Cost Effective ◽

Systemic Review ◽

Cochrane Library ◽

Enamel Matrix Derivative ◽

Local Antibiotics ◽

Significant Difference ◽

Systemic Antibiotics

Abstract Background Peri-implant diseases are caused by biofilms around the implant and may lead to implant failure. Non-surgical mechanical debridement (MD) with different adjunctive therapies has been applied in the treatment of peri-implant diseases. This systematic review aimed to deduce the optimal adjunctive therapy.Methods Two independent authors screened the literature using MEDLINE and Cochrane Library. Only clinical randomized controlled trials (RCTs) about adjunctive therapies for non-surgical treatment of peri-implant diseases were included in this review. Studies selected were published before February 2020. The clinical outcomes were compared in this meta-analysis.Results: A total of 31 RCTs met the inclusion criteria. The following adjunctive interventions were compared in the included studies: modification of the prosthesis; air abrasive; Er:YAG laser; diode laser; photodynamic therapy; local antibiotics; system antibiotics; probiotics; and enamel matrix derivative. Follow-up ranged from 3 months to 1 year. A statistically significant difference was observed between MD with photodynamic therapy and MD alone at 3 months follow-up ( P < 0.01). However, such a difference was not detected between MD with chlorhexidine and MD alone at 3 months follow-up ( P = 0.61), between MD with probiotics and MD alone ( P = 0.47), and between systemic antibiotics and MD alone ( P = 0.96).Conclusion Currently, the optimal non-surgical intervention is not known. Also, among the interventions with similar efficiency, that with fewer side effects, easy to use, and cost-effective is yet to be identified. Thus, well-designed RCTs with prolonged follow-ups to assess the accurate effectiveness of therapies are imperative.

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The relationship between delivery mode and postpartum depression: a systematic review and meta-analysis

10.21203/rs.3.rs-30402/v1 ◽

2020 ◽

Author(s):

Yu-Xin Chen ◽

Pei Zhao ◽

ZhuLiduzi Jiesisibieke ◽

Pei-En Chen ◽

Tao-Hsin Tung ◽

...

Keyword(s):

Systematic Review ◽

Postpartum Depression ◽

Meta Analysis ◽

Cochrane Library ◽

Control Group ◽

Depression Symptoms ◽

Delivery Mode ◽

Significant Difference ◽

The Relationship

Abstract Background: To assess the relationship between delivery mode and postpartum depression and to examine whether cesarean section (CS) has a higher risk of postpartum depression than vaginal delivery (VD). Methods: We searched the Cochrane Library, PubMed, and EMBASE from inception to 30 April 2019 without language limitations. Two authors independently selected studies, assessed the quality of included studies, and extracted data. Any disagreements were resolved by discussion with a third author. We used the Newcastle-Ottawa Scale and GRADE methods to assess the quality of the included studies and evidences. This study had four included cohort studies data and carried out fixed-effect model meta-analysis. Results: The findings demonstrated a significant difference in the risk of postpartum depression between CS and VD. Compared with the control group, the CS group was associated with a higher prevalence of postpartum depression symptoms (Risk Ratio =1.29; 95% CI: 1.11-1.51). Conclusions: The findings supported a relationship between delivery mode and postpartum depression. Particularly, we found that CS is associated with a higher risk of postpartum depression. Therefore, we ought to encourage pregnant women who are without medical indication of CS to select VD.r Trial registration: The protocol of this systematic review was registered in the PROSPERO under the number CRD42019148154.

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A Comprehensive Systematic Review In Search Of Evidence for Pragmatic Altercations in Simplified Denture

Journal of Advanced Oral Research ◽

10.1177/2320206820953965 ◽

2020 ◽

pp. 232020682095396

Author(s):

Saloni Kachhara ◽

Deepak Nallaswamy ◽

Dhanraj M. Ganapathy ◽

Subhabrata Maiti

Keyword(s):

Meta Analysis ◽

Cochrane Library ◽

Complete Dentures ◽

Significant Difference ◽

Related Quality ◽

Health Related ◽

Pubmed Search ◽

Boolean Search ◽

Gothic Arch

Aim: To explore the evidence available to evaluate if simplified dentures could be as effective as the conventional complete dentures. Materials and Methods: A total of 1,482 articles were obtained using keywords in a Boolean search operator in the PubMed search engine, Google Scholar and Cochrane Library. Duplicates were removed and the remaining articles were subjected to a title analysis which yielded a total of 20. Further analysis of the article abstracts led to an exclusion of four articles. The remaining 16 articles were subjected to full text analysis which finally yielded a total of 11 articles. Results: The cumulative results of the meta-analysis for oral health-related quality of life, patient satisfaction and professional quality of denture show no significant difference ( P > .05) between conventional and simplified dentures. Conclusion: Based on the available evidence adjusted for the potential literature/geographic bias, we conclude that the conventional procedures in complete denture fabrication such as facebow and gothic arch tracing do not improve the quality of the denture outcome from patients’ perspective and simplified dentures are equally effective as conventional complete dentures.

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Abstract 1122‐000132: Fuoxetine for Recovery After Stroke: A Pooled Analysis of 7165 Patients

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000132 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Mohamed Fahmy Doheim ◽

Ahmed Elsnhory ◽

Mohammed Elgammal ◽

Abdulrahman Ibrahim Hagrass ◽

Ahmed Hanbal ◽

...

Keyword(s):

Randomized Clinical Trials ◽

Bone Fractures ◽

Meta Analysis ◽

Cochrane Library ◽

Stroke Patients ◽

Permanent Disability ◽

Safety And Efficacy ◽

Nihss Score ◽

Significant Difference

Introduction : Stroke is one of the predominant causes of permanent disability, mortality, significant cognitive, physical, and psychosocial morbidity in the world. We conducted this systematic review and meta‐analysis to assess the safety and efficacy of fluoxetine for recovery stroke patients through different time points of follow up. Methods : We searched in PubMed, Cochrane Library, Scopus, and Web of Science databases/ search engines until June 2021. Mean difference (MD) with 95% confidence interval (CI) was applied for continuous data, while risk ratio (RR) with 95% CI was used for dichotomous data. Results : Seventeen randomized clinical trials were identified which assessed the safety and efficacy of fluoxetine compared to placebo for stroke patients. Fluoxetine enhances the National Institutes of Health Stroke Scale (NIHSS) score [MD = ‐0.67, 95 % CI (‐1.19 to ‐0.15), P = 0.01] and the Fugl‐Meyer Motor Scale (FMMS) score [MD = 17.36, 95 % CI (12.12 to 22.61), P <0.00001] at three months follow up. However, the NIHSS score showed no significant difference between the two groups at two weeks [MD = ‐0.32, 95% CI (‐0.72 to 0.07), p = 0.11] or at six months [MD = ‐0.17,95% CI (‐0.47 to 0.14), p = 0.29]. Fluoxetine and placebo‐treated patients had the same overall impact on FMMS scores at one month [MD = 7.77, 95 % CI (‐10.57 to 26.11), P = 0.41]. The fluoxetine arm had a higher risk of broken bone (RR = 2.30, 95% CI [1.59, 3.32], p < 0.001) and hyponatremia (RR = 2.12, 95% CI [1.19, 3.76], p = 0.01) with lower risk of new depression (RR = 0.72, 95% CI [0.61, 0.84], p< 0.001) in comparison to the placebo arm. Conclusions : The efficacy of fluoxetine is likely to take time to emerge, and is expected to be transient. The use of fluoxetine increased the incidence of hyponatremia and bone fractures while decreasing the risk of new‐onset depression.

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Effect of vitamins C and E supplementation onHelicobacter pylorieradication: a meta-analysis

British Journal Of Nutrition ◽

10.1017/s0007114511003813 ◽

2011 ◽

Vol 106 (11) ◽

pp. 1632-1637 ◽

Cited By ~ 11

Author(s):

Guogang Li ◽

Lan Li ◽

Chaohui Yu ◽

Li Chen

Keyword(s):

Methodological Quality ◽

Eradication Rate ◽

Small Sample Size ◽

Meta Analysis ◽

Small Sample ◽

Cochrane Library ◽

Significant Difference ◽

H Pylori ◽

Randomised Controlled

Vitamins C and E can act as potent antioxidants to reduce the damage caused by reactive oxygen species in gastric mucosa. Whether vitamin supplements forHelicobacter pylorieradication regimen could improve the rate of eradication remains uncertain. Therefore, we performed a meta-analysis to evaluate the efficacy of vitamins C and E supplementation for the eradication ofH. pylori. Searches were conducted in the databases PubMed, EMBASE and Cochrane Library. Randomised controlled trials (RCT) that fulfilled the inclusion criteria and addressed the clinical questions of this analysis were further assessed. Of the six RCT included, five had a low methodological quality. Of the six RCT, three compared the efficacy of the eradication regimenv.eradication regimen plus vitamins C and E. The result of the meta-analysis showed a non-significant difference in the eradication rate ofH. pyloribetween the two groups (risk ratio (RR) 0·93,P = 0·76). Another three RCT compared the eradication regimenv.eradication regimen plus vitamin C only, and there too there was no significant difference in the eradication rate (RR 0·83,P = 0·32). In conclusion, vitamins C and/or E supplements to theH. pylorieradication regimen could not improve the eradication rate. However, currently available data do not draw a definitive conclusion about the effectiveness of antioxidant vitamins onH. pylorieradication, owing to the small sample size and low-to-moderate methodological quality.

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PP44 Effectiveness Of Insulin Glargine Versus Detemir In Type 1 Diabetes

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462318002076 ◽

2018 ◽

Vol 34 (S1) ◽

pp. 82-83

Author(s):

Thales Silva ◽

Paulo Henrique Ribeiro Fernandes Almeida ◽

Vânia Araújo ◽

Augusto Guerra ◽

Francisco Acurcio ◽

...

Keyword(s):

Type 1 Diabetes ◽

Weight Gain ◽

Latin American ◽

Glycated Hemoglobin ◽

Meta Analysis ◽

Severe Hypoglycemia ◽

Cochrane Library ◽

Significant Difference

Introduction:The use of long-acting insulin analogues have been reported in patients with type 1 diabetes mellitus who exhibit important oscillations of their daily blood glucose, although the therapeutic benefits are lacking. The aim of this study was to evaluate the effectiveness and safety of the insulin analogue glargine compared detemir to support health decision-making.Methods:We performed a systematic review with meta-analysis of observational studies (cohort and registry), available in the MEDLINE (Pubmed), Latin American and Caribbean Health Sciences (LILACS), EMBASE and Cochrane Library databases (accessed August 2017), including research in the electronic journal Diabetes Care and gray literature. Several combinations of terms were used, including disease terms, interventions and type of study. The results evaluated were: glycated hemoglobin; weight gain; occurrence of severe hypoglycemia; total insulin dose; and, fasting capillary glycemia. Methodological quality was assessed using the Newcastle scale. The meta-analyses were performed in Review Manager® 5.2 software using a random effects model. Protocol number CRD42017054925 (International Prospective Register of Ongoing Systematic Reviews).Results:A total of 705 publications, eight cohort studies were included. The quality of included studies was classified as high. In the meta-analysis, the results for episodes of severe hypoglycemia (p = 0.002), measurements of fasting capillary glycemia (p = 0.01), and weight gain (p = 0.001) were favorable for detemir. The glycated hemoglobin endpoint (p = 0.49, heterogeneity = 89 percent) revealed high heterogeneity and no statistically significant difference between groups, showing no difference between the interventions for glycemic control.Conclusions:Although some results are favorable to detemir, it was not possible to identify significant differences in effectiveness and safety between the two analogues evaluated, requiring new long term studies and better quality of methodological studies.

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How to Choose Platelet-Rich Plasma or Hyaluronic Acid for the Treatment of Knee Osteoarthritis in Overweight or Obese Patients: A Meta-Analysis

Pain Research and Management ◽

10.1155/2020/7587936 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12

Author(s):

Pan Luo ◽

Zhencheng Xiong ◽

Wei Sun ◽

Lijun Shi ◽

Fuqiang Gao ◽

...

Keyword(s):

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Cochrane Library ◽

Obese Patients ◽

Knee Oa ◽

Significant Difference ◽

Better Than

Objective. The purpose of this meta-analysis was to determine whether platelet-rich plasma (PRP) was better than hyaluronic acid (HA) for the treatment of knee osteoarthritis (OA) in overweight or obese patients. Design. Two reviewers independently used the keywords combined with free words to search English-based electronic databases according to Cochrane Collaboration guidelines, such as PubMed, Embase, ScienceDirect, and Cochrane library. The pooled data were analyzed using RevMan 5.3. Results. Ten randomized controlled trials (RCTs) with 1096 patients were included. During the first two months of follow-up, there was no significant difference between the two groups. At the 3rd, 6th, and 12th months of follow-up, the pooled analysis showed that PRP was better than HA for the treatment of knee OA in overweight or obese patients. There were significant differences between the two groups at Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score (3 months: MD = −1.35, [95% CI: −2.19 to −0.50], P=0.002, I2 = 0%; 6 months: MD = −7.62, [95% CI: −13.51 to −1.72], P=0.01, I2 = 88%; 12 months: MD = −12.11, [95% CI: −20.21 to −4.01], P=0.003, I2 = 94%). Conclusions. For overweight or obese patients with knee OA, intra-articular injection of PRP in a short time was not necessarily superior to HA, but long-term use was better than HA in pain and functional relief.

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Pulpotomy versus pulpectomy in the treatment of vital pulp exposure in primary incisors. A systematic review and meta-analysis.

F1000Research ◽

10.12688/f1000research.16142.3 ◽

2019 ◽

Vol 7 ◽

pp. 1560 ◽

Cited By ~ 1

Author(s):

Lamia Gadallah ◽

Mahmoud Hamdy ◽

Adel El Bardissy ◽

Mohamed Abou El Yazeed

Keyword(s):

Meta Analysis ◽

Grey Literature ◽

Risk Of Bias ◽

Qualitative Assessment ◽

Cochrane Library ◽

Tooth Pulp ◽

Clinical Failure ◽

Significant Difference ◽

Pulp Exposure

Background: Early childhood caries is a serious public health problem. When caries extend to involve the pulp, various forms of pulp treatment are tried to stimulate tooth repair. Although pulpotomy is the treatment of choice for vital primary tooth pulp exposure but there is a trend among many dentists to perform pulpectomies in vital primary incisors. This study aimed to assess the effect of pulpotomy and pulpecomy in treatment of carious vital pulp exposure in primary incisors. Methods: We searched Pubmed and Cochrane library databases up to March, 2018, OpenGrey for grey literature and ClinicalTrials.gov for ongoing trials. Randomized controlled trials were included and assessed with Cochrane risk of bias tool . Primary outcomes were clinical failure and radiological failure. The effect sizes were calculated as risk ratios with 95%CI using the Mantel-Haenszel method. Results: Four trials were identified for qualitative assessment, only three trials were included in meta-analysis after exclusion of one trial due to its high risk of bias. The pooled results of the longest follow up period for clinical failure showed no statistically significant difference between pulpotomy and pulpectomy. The relative risk (RR) was e 2.69, 95% CI 0.76 to 9.58 for clinical failure. For radiographic failure, the sensitivity analysis showed RR 0.45, 95% CI 0.25 to 0.83 with a higher risk for radiographic failure in pulpectomy. The evidence was limited by the small number of trials included in the meta-analysis. Conclusions: Both pulpotomy and pulpectomy can be used successfully in the treatment of vital pulp exposure in primary incisors. Further high quality studies comparing between pulpotomy and pulpectomy in primary incisors with longer follow up period till exfoliation time are needed.

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