Associations of workflow disruptions in the operating room with surgical outcomes: a systematic review and narrative synthesis

2020 ◽  
Vol 29 (12) ◽  
pp. 1033-1045 ◽  
Author(s):  
Amelie Koch ◽  
Jacob Burns ◽  
Ken Catchpole ◽  
Matthias Weigl
Keyword(s):  
Operating Room ◽  
Patient Outcomes ◽  
Surgical Outcomes ◽  
Operating Time ◽  
Medical Specialty ◽  
Evidence Base ◽  
Future Research ◽  
Narrative Synthesis ◽  
Surgical Safety ◽  
The Impact

BackgroundPerformance in the operating room is an important determinant of surgical safety. Flow disruptions (FDs) represent system-related performance problems that affect the efficiency of the surgical team and have been associated with a risk to patient safety. Despite the growing evidence base on FDs, a systematic synthesis has not yet been published.ObjectiveOur aim was to identify, evaluate and summarise the evidence on relationships between intraoperative FD events and provider, surgical process and patient outcomes.MethodsWe systematically searched databases MEDLINE, Embase and PsycINFO (last update: September 2019). Two reviewers independently screened the resulting studies at the title/abstract and full text stage in duplicate, and all inconsistencies were resolved through discussion. We assessed the risk of bias of included studies using established and validated tools. We summarised effects from included studies through a narrative synthesis, stratified based on predefined surgical outcome categories, including surgical process, provider and patient outcomes.ResultsWe screened a total of 20 481 studies. 38 studies were found to be eligible. Included studies were highly heterogeneous in terms of methodology, medical specialty and context. Across studies, 20.5% of operating time was attributed to FDs. Various other process, patient and provider outcomes were reported. Most studies reported negative or non-significant associations of FDs with surgical outcomes.ConclusionApart from the identified relationship of FDs with procedure duration, the evidence base concerning the impact of FDs on provider, surgical process and patient outcomes is limited and heterogeneous. We further provide recommendations concerning use of methods, relevant outcomes and avenues for future research on associated effects of FDs in surgery.

The Impact of Cash Transfers: A Review of the Evidence from Low- and Middle-income Countries

2018 ◽  
Vol 48 (03) ◽  
pp. 569-594 ◽  
Author(s):  
FRANCESCA BASTAGLI ◽  
JESSICA HAGEN-ZANKER ◽  
LUKE HARMAN ◽  
VALENTINA BARCA ◽  
GEORGINA STURGE ◽  
...  
Keyword(s):  
Evidence Base ◽  
Cash Transfers ◽  
Cash Transfer ◽  
Future Research ◽  
Unintended Effects ◽  
Screening Process ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Impact ◽  
Low And Middle Income

AbstractThis article presents the findings of a review of the impact of non-contributory cash transfers on individuals and households in low- and middle-income countries, covering the literature of 15 years, from 2000 to 2015. Based on evidence extracted from 165 studies, retrieved through a systematic search and screening process, this article discusses the impact of cash transfers on 35 indicators covering six outcome areas: monetary poverty; education; health and nutrition; savings, investment and production; work; and empowerment. For most of the studies, cash transfers contributed to progress in the selected indicators in the direction intended by policymakers. Despite variations in the size and strength of the underlying evidence base by outcome and indicator, this finding is consistent across all outcome areas. The article also investigates unintended effects of cash transfer receipt, such as potential reductions in adult work effort and increased fertility, finding limited evidence for such unintended effects. Finally, the article highlights gaps in the evidence base and areas which would benefit from additional future research.

Abstract P274: Relationship Between Stroke Quality Metrics and Patient Outcomes: A Systematic Review

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Carol J Parker ◽  
Mathew J Reeves
Keyword(s):  
Systematic Review ◽  
Acute Care ◽  
Patient Outcomes ◽  
Stroke Care ◽  
Evidence Base ◽  
Quality Metrics ◽  
Care Quality ◽  
Stroke Recurrence ◽  
The Impact ◽  
The Relationship

Background: Stroke quality metrics play an increasingly important role in quality improvement efforts and policies, but the relationship between quality metrics and patient-orientated outcomes are not well described. We conducted a systematic review of observational hospital-based studies examining this relationship. Methods: We searched MEDLINE and EMBASE for studies published before December 31, 2010 that examined the relationship between 2 or more stroke quality metrics and patient-oriented outcomes in acute stroke admissions. Outcomes included mortality, length of stay, discharge to home, functional status, and stroke recurrence. Results: A total of 470 hits were identified. After screening the titles and abstracts, 27 studies underwent full review, and 14 were deemed eligible. Given the variation in study characteristics, quality metrics, and outcomes utilized, it was not possible to generate summary estimates describing the relationship between quality metric compliance and patient-oriented outcomes. Evidence of a positive relationship between quality metrics and improved patient outcomes was limited by the lack of high quality studies. Four of the 14 studies found a statistically significant relationship between increased compliance with acute care quality metrics and improved patient-oriented outcomes. Two studies failed to find an association between acute care measures and improved outcomes, but did find statistically significant positive relationships between compliance with post-acute rehabilitation measures and improved patient outcomes. Five other studies reported mixed findings, while the remaining three found no relationships. Conclusions: We found a limited evidence-base addressing the impact of compliance on stroke quality metrics and patient-oriented outcomes. Generation of data clarifying the relationship between compliance with stroke quality metrics and stroke-related outcomes should be prioritized so that the current investments undertaken to improve stroke care can be sustained.

Family interventions in psychosis

2020 ◽  
pp. 531-537
Author(s):  
Juliana Onwumere ◽  
Elizabeth Kuipers
Keyword(s):  
Patient Outcomes ◽  
Family Involvement ◽  
Lived Experiences ◽  
Treatment Guidelines ◽  
Well Being ◽  
Evidence Base ◽  
Family Interventions ◽  
Improved Outcomes ◽  
The Impact

Families can play an important role in supporting individuals living with psychosis disorders and helping to facilitate their improved outcomes. This chapter, offered by Juliana Onwumere and Elizabeth Kuipers, provides an overview of the literature reporting on family involvement in the care of adults with lived experiences of psychosis, the impact of the caregiving role on carer well-being, and the predictive links between caregiving relationships and key patient outcomes including relapse. The chapter reports on the application of family interventions, the evidence base supporting its application and inclusion in treatment guidelines, and implementation issues.

scholarly journals Lesbian, Gay, Bisexual, and Trans Aging in a U.K. Context: Critical Observations of Recent Research Literature

2019 ◽  
Vol 89 (1) ◽  
pp. 93-107 ◽  
Author(s):  
Kathryn Almack ◽  
Andrew King
Keyword(s):  
Older Adults ◽  
Empirical Research ◽  
Evidence Base ◽  
Research Literature ◽  
Future Research ◽  
Policy And Practice ◽  
International Evidence ◽  
Care Systems ◽  
The Impact ◽  
People’S Perceptions

In this article, we provide critical observations of empirical research from leading U.K. researchers relating to the lives of lesbian, gay, bisexual, and trans older adults. We suggest learning that may be applied in differing global contexts as well as contributing to the development of an international evidence base. We illustrate the importance of paying attention to distinct health and care systems and legislation, which present global differences as well as similarities in terms of lesbian, gay, bisexual, and trans people’s perceptions and access to resources. With this contextual background, we then discuss the cutting-edge U.K. research in this field from 2010 onward. We identify key strengths including the contribution our evidence has made to policy and practice and the development of theoretical insights such as the impact of intersectionality. The article concludes with a discussion of future research in this field which has relevance at national and international levels.

scholarly journals What is the impact of clinically assisted hydration in the last days of life? A systematic literature review and narrative synthesis

2020 ◽  
pp. bmjspcare-2020-002600
Author(s):  
Arjun Kingdon ◽  
Anna Spathis ◽  
Robert Brodrick ◽  
Gemma Clarke ◽  
Isla Kuhn ◽  
...  
Keyword(s):  
Literature Review ◽  
Systematic Literature Review ◽  
Weight Of Evidence ◽  
Future Research ◽  
Narrative Synthesis ◽  
Evidence Framework ◽  
Clinically Assisted Hydration ◽  
Registration Number ◽  
Review Protocol ◽  
The Impact

BackgroundClinically assisted hydration (CAH) can be provided in the last days of life as drinking declines. The impact of this practice on quality of life or survival in the last days of life is unclear. Practice varies worldwide concerning this emotive issue.MethodSystematic literature review and narrative synthesis of studies evaluating the impact of, or attitudes toward, CAH in the last days of life. Databases were searched up to December 2019. Studies were included if the majority of participants were in the last 7 days of life, and were evaluated using Gough’s 'Weight of Evidence' framework. Review protocol registered with PROSPERO, registration number CRD42019125837.ResultsFifteen studies were included in the synthesis. None were judged to be both of high quality and relevance. No evidence was found that the provision of CAH has an impact on symptoms or survival. Patient and family carer attitudes toward assisted hydration were diverse.ConclusionThere is currently insufficient evidence to draw firm conclusions on the impact of CAH in the last days of life. Future research needs to focus on patients specifically in the last days of life, include those with non-malignant diagnoses, and evaluate best ways to communicate effectively about this complex topic with patients and their families.

scholarly journals Should we expect bilingualism to confer cognitive benefits in children with Autism Spectrum Disorders?

2020 ◽  
Author(s):  
Rachael Davis ◽  
Lewis Montgomery ◽  
Hugh Rabagliati ◽  
Antonella Sorace ◽  
Sue Fletcher-Watson
Keyword(s):  
Research Priorities ◽  
Evidence Base ◽  
Autism Spectrum ◽  
Future Research ◽  
High Quality Research ◽  
Research Directions ◽  
Cognitive Benefits ◽  
Future Research Directions ◽  
The Impact

This article examines the ways in which bilingualism influences social and cognitive development and identifies intersections between corresponding aspects of autism, to inform future research directions. Three key domains are identified: social cognition; executive functions; and social-cultural factors. In each case we describe the evidence for the impact of bilingualism in typical development and map this onto what is known about the domain in autism. We examine the methodological quality of the existing literature to make recommendations for future approaches. Results suggest a dearth of high-quality research and lack of consensus. Research priorities include the need for innovative designs to explore potential impacts of bilingualism in order to increase the validity of the evidence base for caregivers and professionals.

scholarly journals Does Cancer Type Influence the Impact of Recurrence? A Review of the Experience of Patients With Breast or Prostate Cancer Recurrence

2021 ◽  
Vol 12 ◽  
Author(s):  
Ross James Stewart ◽  
Gerald Michael Humphris ◽  
Jayne Donaldson ◽  
Susanne Cruickshank
Keyword(s):  
Prostate Cancer ◽  
Cancer Recurrence ◽  
Evidence Base ◽  
Future Research ◽  
Cancer Type ◽  
Prostate Cancer Recurrence ◽  
Health And Social Care ◽  
Research Designs ◽  
The Individual ◽  
The Impact

Objective: Patients will experience a plethora of issues when faced with a recurrence of their cancer. It is unclear if cancer type is a significant factor in how recurrence is experienced by an individual. The aim of the current review is to explore the evidence base and summarise the experiences of patients specifically with a recurrence of breast or prostate cancer (the most common for women and men, respectively) and then provide a comparison of these experiences. These experiences include the physical, psychological and psychosocial issues that arise at this time.Methods: A systematic search was conducted of studies published between January 1994 and April 2019. Due to the mix of research designs used previously in the literature, this review was conducted in an integrative manner; allowing for inclusion of diverse research designs. Results were synthesised narratively, with data categorised according to physical, psychological, and psychosocial indices of quality of life. The review protocol was registered in the international database of prospective systematic reviews in health and social care- (CRD42019137381).Results: Fifteen breast cancer and six prostate cancer articles were identified, each reporting one relevant study. Patients reported several negative issues at the time of a breast or prostate cancer recurrence. Similarities were found between cancer types, with physical problems such as fatigue, psychological issues including anxiety and depressive symptoms, and psychosocial concerns such as issues with healthcare professionals common in both cancers. Certain findings were inconsistent across studies, with some experiences differing between studies rather than due to cancer type.Conclusions: Differences in the experience of recurrent cancer appear to be more heavily influenced by individual factors, rather than cancer type. Findings are confounded by gender; and should be considered preliminary. Effects of recurrence should be studied in samples where cancer type and gender are not confounded. Concerns are raised about available study quality and differing outcome measures in this interpretation. Care and support of the individual at the time of a cancer recurrence is a key focus. Future research suggestions with implications for clinical practise are included.Systematic Review Registration: PROSPERO 2019 CRD42019137381.

scholarly journals Impact of Interprofessional Primary Care Practice on Patient Outcomes: A Scoping Review

SAGE Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. 215824402093589
Author(s):  
Livia R. M. McCutcheon ◽  
Stuart T. Haines ◽  
Ruta Valaitis ◽  
Deborah A. Sturpe ◽  
Grant Russell ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Outcomes ◽  
Primary Care Practice ◽  
Collaborative Practice ◽  
Economic Outcomes ◽  
Future Research ◽  
Care Practice ◽  
Interprofessional Collaborative Practice ◽  
Primary Care Settings ◽  
The Impact

Systematic reviews have provided some insight into the impact of interprofessional collaborative practice on patient outcomes. Despite strong interest in interprofessional collaborative practice, relatively little is known about its impact in primary care settings. This scoping literature review describes the essential elements of an interprofessional primary care practice and explores what is known about its impact on patient care including clinical, humanistic, and economic outcomes. We completed a review of the literature examining the breadth of knowledge related to interprofessional collaborative practice in primary care settings. A search was conducted to identify studies based on predefined criteria. A total of 51 studies met the criteria. A total of 27 studies reported a significantly positive clinical outcome with the interprofessional collaborative practice model, 27 studies reported no difference, and one study reported negative outcome in mortality. A total of 15 studies reported a significantly positive humanistic outcome. There was little to no difference in economic outcomes. This study provides new insights for future research that examines the impact of interprofessional primary care practice.

Systematic review and meta-analysis of interventions for operating room to intensive care unit handoffs

2021 ◽  
pp. bmjqs-2020-012474
Author(s):  
Joanna Abraham ◽  
Alicia Meng ◽  
Sanjna Tripathy ◽  
Michael S Avidan ◽  
Thomas Kannampallil
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Operating Room ◽  
Meta Analysis ◽  
Intervention Group ◽  
Future Research ◽  
Original Research ◽  
Cochrane Central Register ◽  
The Impact

ObjectiveTo conduct a systematic review and meta-analysis to ascertain the impact of operating room (OR) to intensive care unit (ICU) handoff interventions on process-based and clinical outcomes.MethodWe included all English language, prospective evaluation studies of OR to ICU handoff interventions published as original research articles in peer-reviewed journals. The search was conducted on 11 November 2019 on MEDLINE, CINAHL, EMBASE, Scopus and the Cochrane Central Register of Controlled Trials databases, with no prespecified criteria for the type of comparison or outcome. A meta-analysis of similar outcomes was conducted using a random effects model. Quality was assessed using a modified Downs and Black (D&B) checklist.Results32 studies were included for review. 31 studies were conducted at a single site and 28 studies used an observational study design with a control. Most studies (n=28) evaluated bundled interventions which comprised information transfer/communication checklists and protocols. Meta-analysis showed that the handoff intervention group had statistically significant improvements in time to analgesia dosing (mean difference (MD)=−42.51 min, 95% CI −60.39 to −24.64), fewer information omissions (MD=−2.22, 95% CI −3.68 to –0.77), fewer technical errors (MD=−2.38, 95% CI −4.10 to –0.66) and greater information sharing scores (MD=30.03%, 95% CI 19.67% to 40.40%). Only 15 of the 32 studies scored above 9 points on the modified D&B checklist, indicating a lack of high-quality studies.DiscussionBundled interventions were commonly used to support OR to ICU handoff standardisation. Although the meta-analysis showed significant improvements for a number of clinical and process outcomes, the statistical and clinical heterogeneity must be accounted for when interpreting these findings. Implications for OR to ICU handoff practice and future research are discussed.

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