Real-time locating systems to improve healthcare delivery: A systematic review

Abstract Objective Modern health care requires patients, staff, and equipment to navigate complex environments to deliver quality care efficiently. Real-time locating systems (RTLS) are local tracking systems that identify the physical locations of personnel and equipment in real time. Applications and analytic strategies to utilize RTLS-produced data are still under development. The objectives of this systematic review were to describe and analyze the key features of RTLS applications and demonstrate their potential to improve care delivery. Materials and Methods We searched MEDLINE, SCOPUS, and IEEE following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were articles that utilize RTLS to evaluate or influence workflow in a healthcare setting. We summarized aspects of relevant articles, identified key themes in the challenges of applying RTLS to workflow improvement, and thematically reviewed the state of quantitative analytic methodologies. Results We included 42 articles in the final qualitative synthesis. The most frequent study design was observational (n = 24), followed by descriptive (n = 12) and experimental (n = 6). The most common clinical environment for study was the emergency department (n = 12), followed by entire hospital (n = 7) and surgical ward (n = 6). Discussion The focus of studies changed over time from early experience to optimization to evaluation of an established system. Common narrative themes highlighted lessons learned regarding evaluation, implementation, and information visibility. Few studies have developed quantitative techniques to effectively analyze RTLS data. Conclusions RTLS is a useful and effective adjunct methodology in process and quality improvement, workflow analysis, and patient safety. Future directions should focus on developing enhanced analysis to meaningfully interpret RTLS data.

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Digital health dashboards for improving health systems, healthcare delivery and patient outcomes: a systematic review protocol

10.31219/osf.io/8me96 ◽

2020 ◽

Author(s):

Charis Xuan Xie ◽

Christopher Maher ◽

Gustavo C Machado

Keyword(s):

Systematic Review ◽

Patient Outcomes ◽

Care Delivery ◽

Digital Health ◽

Healthcare Delivery ◽

Healthcare Setting ◽

Systematic Review Protocol ◽

Health Related ◽

Review Protocol ◽

The Impact

With the widespread uptake of EMRs across the world, massive health-related datasets have been generated and clinicians are often overwhelmed with the complexity in analysing those EMR data. To overcome this, digital health dashboards have been integrated into EMR systems to help clinicians make informed decisions and ensure reliable care delivery. Despite its increasing popularity in the healthcare setting, there is limited summary evidence investigating the effectiveness of digital health dashboards to improve healthcare delivery and patient outcomes. In this systematic review, we aim to look at the impact of digital health dashboards on the healthcare system, clinicians and patients. The objectives are to: i) investigate the effectiveness of digital health dashboards for improving healthcare delivery and patient outcomes in primary care and hospital settings, and ii) identify the types of dashboards and describe its features and visualisation techniques. This is the final version of the systematic review protocol, published as a preprint to create full transparency about the review process.

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Prevalence of large vessel occlusion in patients presenting with acute ischemic stroke: a 10-year systematic review of the literature

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014239 ◽

2018 ◽

Vol 11 (3) ◽

pp. 241-245 ◽

Cited By ~ 22

Author(s):

Nikita Lakomkin ◽

Mandip Dhamoon ◽

Kirsten Carroll ◽

Inder Paul Singh ◽

Stanley Tuhrim ◽

...

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Review Of The Literature ◽

Qualitative Synthesis ◽

Vessel Occlusion ◽

Number Of Patients ◽

Meta Analyses

BackgroundAccurate assessment of the prevalence of large vessel occlusion (LVO) in patients presenting with acute ischemic stroke (AIS) is critical for optimal resource allocation in neurovascular intervention.ObjectiveTo perform a systematic review of the literature in order to identify the proportion of patients with AIS presenting with LVO on image analysis.MethodsA systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in order to identify studies reporting LVO rates for patients presenting with AIS. Studies that included patients younger than 18 years, were non-clinical, or did not report LVO rates in the context of a consecutive AIS series were excluded. Characteristics regarding presentation, diagnosis, and LVO classification were recorded for each paper.ResultsSixteen studies, spanning a total of 11 763 patients assessed for stroke, were included in the qualitative synthesis. The majority (10/16) of articles reported LVO rates exceeding 30% in patients presenting with AIS. There was substantial variability in the LVO definitions used, with nine unique classification schemes among the 16 studies. The mean prevalence of LVO was 31.1% across all studies, and 29.3% when weighted by the number of patients included in each study.ConclusionsDespite the wide variability in LVO classification, the majority of studies in the last 10 years report a high prevalence of LVO in patients presenting with AIS. These rates of LVO may have implications for the volume of patients with AIS who may benefit from endovascular therapy.

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Use of Augmented Reality in Reconstructive Microsurgery: A Systematic Review and Development of the Augmented Reality Microsurgery Score

Journal of Reconstructive Microsurgery ◽

10.1055/s-0039-3401832 ◽

2019 ◽

Vol 36 (04) ◽

pp. 261-270

Author(s):

Yasser Al Omran ◽

Ali Abdall-Razak ◽

Catrin Sohrabi ◽

Tiffanie-Marie Borg ◽

Hayat Nadama ◽

...

Keyword(s):

Systematic Review ◽

Augmented Reality ◽

Systematic Reviews ◽

Real World ◽

Digital Information ◽

Inclusion Criteria ◽

Qualitative Synthesis ◽

Reconstructive Microsurgery ◽

User Access ◽

Meta Analyses

Abstract Background Augmented reality (AR) uses a set of technologies that overlays digital information into the real world, giving the user access to both digital and real-world environments in congruity. AR may be specifically fruitful in reconstructive microsurgery due to the dynamic nature of surgeries performed and the small structures encountered in these operations. The aim of this study was to conduct a high-quality preferred reporting items for systematic reviews and meta-analyses (PRISMA) and assessment of multiple systematic reviews 2 (AMSTAR 2) compliant systematic review evaluating the use of AR in reconstructive microsurgery. Methods A systematic literature search of Medline, EMBASE, and Web of Science databases was performed using appropriate search terms to identify all applications of AR in reconstructive microsurgery from inception to December 2018. Articles that did not meet the objectives of the study were excluded. A qualitative synthesis was performed of those articles that met the inclusion criteria. Results A total of 686 articles were identified from title and abstract review. Five studies met the inclusion criteria. Three of the studies used head-mounted displays, one study used a display monitor, and one study demonstrated AR using spatial navigation technology. The augmented reality microsurgery score was developed and applied to each of the AR technologies and scores ranged from 8 to 12. Conclusion Although higher quality studies reviewing the use of AR in reconstructive microsurgery is needed, the feasibility of AR in reconstructive microsurgery has been demonstrated across different subspecialties of plastic surgery. AR applications, that are reproducible, user-friendly, and have clear benefit to the surgeon and patient, have the greatest potential utility. Further research is required to validate its use and overcome the barriers to its implementation.

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Particulate Production and Composite Dust during Routine Dental Procedures. A Systematic Review with Meta-Analyses

Materials ◽

10.3390/ma13112513 ◽

2020 ◽

Vol 13 (11) ◽

pp. 2513 ◽

Cited By ~ 3

Author(s):

Anna Iliadi ◽

Despina Koletsi ◽

Theodore Eliades ◽

George Eliades

Keyword(s):

Systematic Review ◽

Risk Of Bias ◽

P Value ◽

Dental Practice ◽

Qualitative Synthesis ◽

Eligibility Criteria ◽

Manual Search ◽

Dust Generation ◽

Dental Procedures ◽

Meta Analyses

Composite dust generation is most likely a continuous and daily procedure in dental practice settings. The aim of this systematic review was to identify, compile and evaluate existing evidence on interventions and composite material properties related to the production of aerosolized dust during routine dental procedures. Seven electronic databases were searched, with no limits, supplemented by a manual search, on 27 April 2020 for published and unpublished research. Eligibility criteria comprised of studies of any design, describing composite dust production related to the implementation of any procedure in dental practice. Study selection, data extraction and risk of bias (RoB) assessment was undertaken independently either in duplicate, or confirmed by a second reviewer. Random effects meta-analyses of standardized mean differences (SMD) with associated 95% confidence intervals (CIs) were employed where applicable. A total of 375 articles were initially identified, resulting in 13 articles being included in the qualitative synthesis, of which 5 contributed to meta-analyses overall. Risk of bias recordings ranged between low and high, pertaining to unclear/raising some concerns, in most cases. All types of composites, irrespective of the filler particles, released significant amounts of nano-sized particles after being ground, with potentially disruptive respiratory effects. Evidence supported increased % distribution of particles < 100 nm for nanocomposite Filtek Supreme XTE compared to both conventional hybrid Z100MP (SMD: 1.96, 95% CI: 0.85, 3.07; p-value; 0.001) and nano- hybrid Tetric EvoCeram (SMD: 1.62, 95% CI: 0.56, 2.68; p-value: 0.003). For cytotoxicity considerations of generated aerosolized particles, both nanocomposites Filtek Supreme XTE and nanohybrid GradiO revealed negative effects on bronchial epithelial cell viability, as represented by % formazan reduction at 330–400 μg/mL for 24 hours, with no recorded differences between them (SMD: 0.19; 95% CI: −0.17, 0.55; p-value: 0.30). Effective and more rigorous management of dental procedures potentially liable to the generation of considerable amounts of aerosolized composite dust should be prioritized in contemporary dental practice. In essence, protective measures for the clinician and the practices’ personnel should also be systematically promoted and additional interventions may be considered in view of the existing evidence.

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Patients’ and healthcare professionals’ perceptions of self-management support interactions: Systematic review and qualitative synthesis

Chronic Illness ◽

10.1177/1742395317710082 ◽

2017 ◽

Vol 14 (2) ◽

pp. 79-103 ◽

Cited By ~ 24

Author(s):

Marika Franklin ◽

Sophie Lewis ◽

Karen Willis ◽

Helen Bourke-Taylor ◽

Lorraine Smith

Keyword(s):

Systematic Review ◽

Healthcare Professionals ◽

Care Delivery ◽

Individual Responsibility ◽

Self Management ◽

Chronic Obstructive ◽

Traditional Model ◽

Management Support ◽

Model Of Care ◽

Qualitative Synthesis

Objective To review studies examining the experience of self-management support in patient–provider interactions and the shaping of goals through interactions. Methods We undertook a systematic review and thematic synthesis of the qualitative literature. We searched six databases (2004–2015) for published studies on the provision of self-management support in one-to-one, face-to-face, patient–provider interactions for obesity, type 2 diabetes mellitus and chronic obstructive pulmonary disease, with 14 articles meeting inclusion criteria. Results Themes identified from studies were (1) dominance of a traditional model of care, encompassing the provision of generic information, exclusion of the psychosocial and temporal nature of interactions and (2) a context of individual responsibility and accountability, encompassing self-management as patients’ responsibility and adherence, accountability and the attribution of blame. Interactions were constrained by consultation times, patient self-blame and guilt, desire for autonomy and beliefs about what constitutes ‘effective’ self-management. Discussion Encounters were oriented towards a traditional model of care delivery and this limited opportunity for collaboration. These findings suggest that healthcare professionals remain in a position of authority, limiting opportunities for control to be shared with patients and shared understandings of social context to be developed.

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Bone Density and Clinical Periodontal Attachment in Postmenopausal Women: A Systematic Review and Meta-Analysis

Journal of Dental Research ◽

10.1177/0022034516682017 ◽

2017 ◽

Vol 96 (3) ◽

pp. 261-269 ◽

Cited By ~ 42

Author(s):

D.C. Penoni ◽

T.K.S. Fidalgo ◽

S.R. Torres ◽

V.M. Varela ◽

D. Masterson ◽

...

Keyword(s):

Systematic Review ◽

Postmenopausal Women ◽

Meta Analysis ◽

Risk Of Bias ◽

Qualitative Synthesis ◽

Mineral Density ◽

Clinical Attachment Loss ◽

Attachment Loss ◽

Meta Analyses ◽

Periodontal Attachment

Osteoporosis is a systemic skeletal disease characterized by low bone mineral density (BMD) and has been considered a risk factor for periodontal disease. The aim of this systematic review and meta-analysis was to verify the scientific evidence for the association of periodontal attachment loss with low BMD in postmenopausal women. A systematic search of the literature was performed in databases until August 2016, in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Eligibility criteria included studies that compared clinical attachment loss (CAL) between postmenopausal women with low and normal BMD. Studies using similar methodology, with lower and higher risk of bias, were pooled into 3 different meta-analyses to compare CAL among women with normal BMD, osteoporosis, and osteopenia. In the first meta-analysis, mean CAL was compared among groups. In the other 2 meta-analyses, the mean percentages of sites with CAL ≥4 mm and ≥6 mm were respectively compared among groups. From 792 unique citations, 26 articles were selected for the qualitative synthesis. Eleven of the studies were appraised as presenting low risk of bias, and the association between low BMD and CAL was observed in 10 of these studies. Thirteen cross-sectional articles were included in the meta-analysis for osteoporosis and 9 in the osteopenia analysis. Women with low BMD presented greater mean CAL than those with normal BMD (osteoporosis = 0.34 mm [95% confidence interval (CI), 0.20–0.49], P < 0.001; osteopenia = 0.07 mm [95% CI, 0.01–0.13], P = 0.02). Only studies with lower risk of bias were available for the analysis of CAL severity. Women with low BMD presented more severe attachment loss, represented as mean percentage of sites with CAL ≥4 mm (osteoporosis = 3.04 [95% CI, 1.23–4.85], P = 0.001; osteopenia = 1.74 [95% CI, 0.36–3.12], P = 0.01) and CAL ≥6 mm (osteoporosis = 5.07 [95% CI, 2.74–7.40], P < 0.001). This systematic review and meta-analysis indicates that postmenopausal women with osteoporosis or osteopenia may exhibit greater CAL compared with women with normal BMD.

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New-Onset and Relapsed Kidney Histopathology Following COVID-19 Vaccination: A Systematic Review

Vaccines ◽

10.3390/vaccines9111252 ◽

2021 ◽

Vol 9 (11) ◽

pp. 1252

Author(s):

Henry H. L. Wu ◽

Philip A. Kalra ◽

Rajkumar Chinnadurai

Keyword(s):

Systematic Review ◽

English Language ◽

Published Data ◽

Scleroderma Renal Crisis ◽

Qualitative Synthesis ◽

Vaccination Programs ◽

Relapsed Disease ◽

Meta Analyses ◽

New Onset

Introduction: The introduction of COVID-19 vaccination programs has become an integral part of the major strategy to reduce COVID-19 numbers worldwide. New-onset and relapsed kidney histopathology have been reported following COVID-19 vaccination, sparking debate on whether there are causal associations. How these vaccines achieve an immune response to COVID-19 and the mechanism that this triggers kidney pathology remains unestablished. We describe the results of a systematic review for new-onset and relapsed kidney histopathology following COVID-19 vaccination. Methods: A systematic literature search of published data up until 31 August 2021 was completed through the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guideline. Research articles reporting new onset or relapsed kidney histopathology in adult patients (>18 years) following COVID-19 vaccination were included for qualitative review. Only full-text articles published in the English language were selected for review. Results: Forty-eight cases from thirty-six articles were included in the qualitative synthesis of this systematic review. Minimal change disease (19 cases) was the most frequent pathology observed, followed by IgA nephropathy (14 cases) and vasculitis (10 cases). Other cases include relapse of membranous nephropathy, acute rejection of kidney transplant, relapse of IgG4 nephritis, new-onset renal thrombotic microangiopathy, and scleroderma renal crisis following COVID-19 vaccination. There was no mortality reported in any of the included cases. Patients in all but one case largely recovered and did not require long-term renal replacement therapy. Conclusion: This systematic review provides insight into the relationship between various kidney pathologies that may have followed COVID-19 vaccination. Despite these reported cases, the protective benefits offered by COVID-19 vaccination far outweigh its risks. It would be recommended to consider early biopsy to identify histopathology amongst patients presenting with symptoms relating to new-onset kidney disease following vaccination and to monitor symptoms for those with potential relapsed disease.

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Environmental and Occupational Short-Term Exposure to AirBorne Particles and FEV1 and FVC in Healthy Adults: A Systematic Review and Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182010571 ◽

2021 ◽

Vol 18 (20) ◽

pp. 10571

Author(s):

Alan da Silveira da Silveira Fleck ◽

Margaux L. Sadoine ◽

Stéphane Buteau ◽

Eva Suarthana ◽

Maximilien Debia ◽

...

Keyword(s):

Systematic Review ◽

Fine Particles ◽

Meta Analysis ◽

Healthy Adults ◽

Airborne Particles ◽

Qualitative Synthesis ◽

Short Term ◽

Respiratory Effects ◽

Short Term Exposure ◽

Meta Analyses

Background: No study has compared the respiratory effects of environmental and occupational particulate exposure in healthy adults. Methods: We estimated, by a systematic review and meta-analysis, the associations between short term exposures to fine particles (PM2.5 and PM4) and certain parameters of lung function (FEV1 and FVC) in healthy adults. Results: In total, 33 and 14 studies were included in the qualitative synthesis and meta-analyses, respectively. In environmental studies, a 10 µg/m3 increase in PM2.5 was associated with an FEV1 reduction of 7.63 mL (95% CI: −10.62 to −4.63 mL). In occupational studies, an increase of 10 µg/m3 in PM4 was associated with an FEV1 reduction of 0.87 mL (95% CI: −1.36 to −0.37 mL). Similar results were observed with FVC. Conclusions: Both occupational and environmental short-term exposures to fine particles are associated with reductions in FEV1 and FVC in healthy adults.

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Diabetes, Care Homes, and the Influence of Technology on Practice and Care Delivery in Care Homes: Systematic Review and Qualitative Synthesis

JMIR Diabetes ◽

10.2196/11526 ◽

2019 ◽

Vol 4 (2) ◽

pp. e11526 ◽

Cited By ~ 1

Author(s):

Rebecca Mathews ◽

Chris O'Malley ◽

Jenny M Hall ◽

Leah Macaden ◽

Sandra MacRury

Keyword(s):

Systematic Review ◽

Diabetes Care ◽

Care Delivery ◽

Care Homes ◽

Qualitative Synthesis

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Implementation of EMR and effects on health care delivery.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.31_suppl.250 ◽

2013 ◽

Vol 31 (31_suppl) ◽

pp. 250-250

Author(s):

Leonardo Viana Nicacio ◽

Nat Turner ◽

Zach Weinberg ◽

Dorothy Dulko ◽

Geoffrey Calkins ◽

...

Keyword(s):

Health Care ◽

Real Time ◽

Care Delivery ◽

Healthcare Delivery ◽

Quality Measures ◽

Clinical Decision ◽

Free Text ◽

Data Systems ◽

Billing Data ◽

Colorectal Cancer Patients

250 Background: Electronic health records have potential to enhance health care safety and quality by enabling effective communication, Clinical Decision Support technology, and generation of structured data for analysis. Despite the fact that EHRs have been shown to improve health care processes, the rapid growth of technology used to support medical care has resulted in the creation of enormous volumes of data used to assess and manage healthcare delivery. Valuable data is often siloed in multiple IT systems or captured in free-text clinical notes and non-searchable documents (unstructured data) making it impossible to quickly develop and act on real-time longitudinal data. Methods: Flatiron (FI) operates a "big data" software platform that aggregates, cleans and structures deep clinical oncology data thus facilitating understanding of operational, clinical and financial analytics related to cancer care. The platform proposes to solve these fundamental data challenges, enabling a range of real-time quality measures. It is best understood as three related components: the first is the technical integration between FI and providers' IT and data systems. That integration serves as the plumbing through which data flows securely from the provider to FI. The second is FI’s structured database, which transforms raw clinical, operational, and billing data into clean, structured, longitudinal, real-time patient data. The third is the FI user interface portal, which is a web-based analytics tool that facilitates access to the continually updated structured database. Results: Over 10 institutions have partnered with FI to deploy the platform. The full integration of an institution can be achieved in 12 to 16 weeks with daily updates to the analytics after the initial phase. Over 15,000 patients are expected to be fully integrated in the next 3-6 months. Initial QOPI and other quality measures have been included and customizable dashboards linking charge databases with clinical outcomes have been created. Dashboards with quality metrics will be presented in the conference. Conclusions: Implementation of EMRs alone does not improve healthcare delivery. Data on colorectal cancer patients will be presented at the meeting.

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