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.

Neuroimaging Outcomes in Studies of Cognitive Training in Mild Cognitive Impairment and Early Alzheimer’s Disease: A Systematic Review

2020 ◽  
Vol 17 (5) ◽  
pp. 472-486
Author(s):  
Lucy Beishon ◽  
Kannakorn Intharakham ◽  
David Swienton ◽  
Ronney B. Panerai ◽  
Thompson G. Robinson ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cognitive Impairment ◽  
Search Strategy ◽  
Web Of Science ◽  
Cochrane Library ◽  
Functional Magnetic Resonance ◽  
Resonance Imaging ◽  
Early Alzheimer’S Disease ◽  
Magnetic Resonance Imaging Mri ◽  
The Cochrane Library

Background: Cognitive Training (CT) has demonstrated some benefits to cognitive and psychosocial function in Mild Cognitive Impairment (MCI) and early dementia, but the certainty related to those findings remains unclear. Therefore, understanding the mechanisms by which CT improves cognitive functioning may help to understand the relationships between CT and cognitive function. The purpose of this review was to identify the evidence for neuroimaging outcomes in studies of CT in MCI and early Alzheimer’s Disease (AD). Methods: Medline, Embase, Web of Science, PsycINFO, CINAHL, and The Cochrane Library were searched with a predefined search strategy, which yielded 1778 articles. Studies were suitable for inclusion where a CT program was used in patients with MCI or AD, with a structural or functional Magnetic Resonance Imaging (MRI) outcome. Studies were assessed for quality using the Downs and Black criteria. Results: Medline, Embase, Web of Science, PsycINFO, CINAHL, and The Cochrane Library were searched with a predefined search strategy, which yielded 1778 articles. Studies were suitable for inclusion where a CT program was used in patients with MCI or AD, with a structural or functional Magnetic Resonance Imaging (MRI) outcome. Studies were assessed for quality using the Downs and Black criteria. Conclusions: CT resulted in variable functional and structural changes in dementia, and conclusions are limited by heterogeneity and study quality. Larger, more robust studies are required to correlate these findings with clinical benefits from CT.

scholarly journals Practical Considerations for a Military Whole Blood Program

2020 ◽  
Vol 185 (7-8) ◽  
pp. e1032-e1038 ◽  
Author(s):  
Marshall Bahr ◽  
Andrew P Cap ◽  
Devin Dishong ◽  
Mark H Yazer
Keyword(s):  
Whole Blood ◽  
Prehospital Care ◽  
Trauma System ◽  
Current Evidence ◽  
Cochrane Library ◽  
Combat Casualty ◽  
Resuscitation Guidelines ◽  
The Cochrane Library ◽  
The Military ◽  
Combat Environment

Abstract Introduction Prehospital care in the combat environment has always been of great importance to the U.S. military, and trauma resuscitation has remained a cornerstone. More evidence continues to demonstrate the advantages of intervention with early transfusion of blood products at the point of injury. The military has recognized these benefits; as such, the Department of Defense Joint Trauma System and the Committee on Tactical Combat Casualty Care have developed new advanced resuscitation guidelines, which now encourage the use of whole blood (WB) in the prehospital setting. Materials and Methods This general review of peer-reviewed journal articles was performed through an extensive electronic search from the databases of PubMed Central (MEDLINE) and the Cochrane Library. Results Based on this literature search, the current evidence suggests that transfusion with WB is safe and efficacious. Additionally, soldier function is preserved after donating fresh WB in the field. Currently, the collection and implementation of WB is accomplished through several different protocol-driven techniques. Conclusion WB has become the favored transfusion product as it provides all of the components of blood in a convenient package that is easy to store and transport. Specifically, group O WB containing low titers of anti-A and -B antibodies has become the transfusion product of choice, offering the ability to universally fluid resuscitate patients despite not knowing their blood group. This new ability to obtain low titer group O WB has transformed the approach to the management of hemorrhagic shock in the prehospital combat environment.

scholarly journals Augmentation of Meniscal Repair With Platelet-Rich Plasma: A Systematic Review of Comparative Studies

2020 ◽  
Vol 8 (6) ◽  
pp. 232596712092614
Author(s):  
John W. Belk ◽  
Matthew J. Kraeutler ◽  
Stephen G. Thon ◽  
Connor P. Littlefield ◽  
John H. Smith ◽  
...  
Keyword(s):  
Systematic Review ◽  
Platelet Rich Plasma ◽  
Meniscal Repair ◽  
International Knee Documentation Committee ◽  
Current Evidence ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Level 3 ◽  
The Cochrane Library

Background: The effect of platelet-rich plasma (PRP) augmentation for meniscal repair (MR) is unclear, as current evidence is limited to small, mostly nonrandomized studies. Purpose: To systematically review the literature to evaluate the efficacy and safety of MR with PRP augmentation. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify studies (level of evidence 1-3) that compared the clinical efficacy of MR performed with versus without PRP. The search phrase used was platelet-rich plasma meniscus. Patients were assessed based on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the visual analog scale (VAS) for pain, the Lysholm score, the Knee injury and Osteoarthritis Outcome Score (KOOS), the subjective International Knee Documentation Committee (IKDC) score, and treatment failure. Results: We identified 6 studies (2 studies with level 1 evidence; 4 studies with level 3 evidence) that met inclusion criteria, for a total of 309 patients undergoing MR with PRP (mean age, 31.9 years) and 445 patients without PRP augmentation (mean age, 29.6 years). The mean follow-up was 32.8 months (range, 12-72 months). Overall, 17.0% of PRP patients experienced MR failure compared with 22.1% of non-PRP patients. No differences in VAS, Lysholm, or subjective IKDC scores were found between groups except in 1 study, in which postoperative subjective IKDC scores were significantly better in the PRP group ( P < .01). Another study found significantly better postoperative WOMAC scores among PRP patients, and 2 studies found significantly better KOOS subscores among PRP patients. Conclusion: There are a limited number of high-quality studies comparing outcomes and healing rates between patients undergoing MR with versus without PRP augmentation. Based on the available evidence, patients undergoing MR with PRP augmentation experience similar clinical outcomes at midterm follow-up when compared with conventional MR, and additional studies are needed to determine the efficacy of MR augmented with PRP.

scholarly journals The relationships between bariatric surgery and sexual function: current evidence based medicine

BMC Urology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Shengzhuo Liu ◽  
Dehong Cao ◽  
Zhengju Ren ◽  
Jinze Li ◽  
Lei Peng ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Sexual Function ◽  
Erectile Function ◽  
Meta Analysis ◽  
Current Evidence ◽  
Cochrane Library ◽  
Male Sexual Function ◽  
The Cochrane Library ◽  
Based Medicine

Abstract Background Controversy remains despite several studies have discussed the role of bariatric surgery in improving male’s sexual function. This study aims to evaluate the efficacy of bariatric surgery in promoting male’s erectile function. Methods PubMed, EMbase, The Cochrane Library, CNKI and Clinical Trails.gov were searched from database inception to May 2019. The language of publication was limited in English. The International Index of Erectile Function (IIEF) score and Brief Male Sexual Function Inventory (BSFI) score were set as the primary outcome. Results Eleven studies with a total of 370 patients were enrolled in this meta-analysis. The results showed significant improvement in the IIEF score (erectile function: MD = 5.33, 95% CI 4.12–6.54; intercourse satisfaction: MD = 2.57, 95% CI 1.19–3.94; orgasmic function: MD = 0.50, 95%CI 0.60–0.94; overall satisfaction: MD = 1.67, 95% CI 0.78–2.56; sexual desire: MD = 1.27, 95% CI 0.61–1.93; total erectile function: MD = 7.21, 95% CI 4.33–10.10) and the BSFI score (erection: MD =2.53, 95% CI 2.39–2.67; ejaculation: MD = 1.40, 95% CI 1.28–1.51; desire: MD =1.40, 95% CI 1.32–1.49; problem assessment: MD = 2.20, 95% CI 2.06–2.34; sexual satisfaction: MD = 0.70, 95% CI 0.60–0.76) in obese individuals after bariatric surgery. Conclusions This systematic review and meta-analysis indicated that bariatric surgery could be effective in promoting males’s sexual function for obese individuals.

scholarly journals Current and Potential Roles in Sports Pharmacy: A Systematic Review

Pharmacy ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 29 ◽  
Author(s):  
Alison Hooper ◽  
Joyce Cooper ◽  
Jennifer Schneider ◽  
Therése Kairuz
Keyword(s):  
Systematic Review ◽  
Sports Medicine ◽  
Current Evidence ◽  
Cochrane Library ◽  
Original Research ◽  
Good Potential ◽  
Limited Opportunity ◽  
The Cochrane Library ◽  
And Control ◽  
Source Of Information

(1) Background: The objective of this systematic review was to evaluate current and potential roles for pharmacists in sports medicine and to identify key themes in outcomes reported in studies. (2) Methods: EMBASE, MEDLINE, CINAHL, Scopus and the Cochrane Library were searched in January 2019. Peer-reviewed, original research articles were considered for inclusion. Articles published in a language other than English were excluded. Quality appraisal was performed independently by two authors. (3) Results: Findings of 11 eligible articles (10 observational and 1 experimental study design) were grouped into three themes: (i) doping prevention and control, (ii) injury management and first aid, and (iii) educational and curricular needs. Pharmacists were perceived as a good potential source of information about doping and are enthusiastic about counseling athletes, but lack knowledge and confidence in this area. While pharmacists were frequently consulted for advice on managing sprains and strains, their advice was not always guided by current evidence. Pharmacists and pharmacy students recalled limited opportunity for education in sports pharmacy. (4) Conclusion: Pharmacists showed a willingness and an aptitude to counsel athletes. However, lack of knowledge and confidence, and limited educational opportunities, were key barriers. More research is necessary to support pharmacists in this role.

scholarly journals Effects of Different Components of Yoga: A Meta-Synthesis

2021 ◽  
Vol 06 (03) ◽  
pp. 1-1
Author(s):  
◽  
Holger C. Bringmann ◽  
Peter Sedlmeier ◽  
◽  
◽  
...  
Keyword(s):  
Stress Reduction ◽  
Meta Analysis ◽  
Current Evidence ◽  
Cochrane Library ◽  
Theoretical Frameworks ◽  
Breathing Techniques ◽  
Study Population ◽  
Meta Analyses ◽  
The Cochrane Library ◽  
Clinical Conditions

Traditional yoga encompasses a variety of practices, such as postures, breathing techniques, meditation, and ethical teachings. However, little is known about how different components of yoga contribute to its overall effect. In this meta-synthesis, we comprehensively summarized the current evidence on differential and incremental effects of various yoga components collected from available meta-analyses. For this meta-analysis, we searched Medline/PubMed, Scopus, PsychInfo, and the Cochrane Library in July 2021. We selected only meta-analyses that performed subgroup analyses comparing the effects of different yoga components. There were no restrictions regarding yoga type, study population, or outcome variables. Nineteen meta-analyses were identified that evaluated a multitude of variables. These meta-analyses varied greatly with regard to population, study design, and yoga components under investigation. However, combined interventions incorporating multiple components consistently outperformed simple interventions. In this regard, adding breathing and/or meditation practices to yoga interventions proved particularly beneficial. However, specific components or combinations were more effective in enhancing certain variables or clinical conditions, suggesting a need for customized programs. Comparable multi-component mind–body interventions, such as yoga and mindfulness-based stress reduction, were often equally efficient. Nevertheless, most findings are preliminary, and certain components such as the ethical part of yoga are particularly under-researched. Conclusion: Future studies should isolate and compare all components of yoga and evaluate additive effects by investigating their different combinations. The researchers should refer to theoretical frameworks, use rigorous methodology, and consider individual factors.

scholarly journals Comparison of pathologic outcomes of robotic and open resections for rectal cancer: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245154
Author(s):  
Yinyin Guo ◽  
Yichen Guo ◽  
Yanxin Luo ◽  
Xia Song ◽  
Hui Zhao ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymph Nodes ◽  
Meta Analysis ◽  
Rectal Surgery ◽  
Current Evidence ◽  
Cochrane Library ◽  
Resection Margins ◽  
Controlled Trials ◽  
Robotic Resection ◽  
The Cochrane Library

Objective The application of robotic surgery for rectal cancer is increasing steadily. The purpose of this meta-analysis is to compare pathologic outcomes among patients with rectal cancer who underwent open rectal surgery (ORS) versus robotic rectal surgery (RRS). Methods We systematically searched the literature of EMBASE, PubMed, the Cochrane Library of randomized controlled trials (RCTs) and nonrandomized controlled trials (nRCTs) comparing ORS with RRS. Results Fourteen nRCTs, including 2711 patients met the predetermined inclusion criteria and were included in the meta-analysis. Circumferential resection margin (CRM) positivity (OR: 0.58, 95% CI, 0.29 to 1.16, P = 0.13), number of harvested lymph nodes (WMD: −0.31, 95% CI, −2.16 to 1.53, P = 0.74), complete total mesorectal excision (TME) rates (OR: 0.93, 95% CI, 0.48 to 1.78, P = 0.83) and the length of distal resection margins (DRM) (WMD: −0.01, 95% CI, −0.26 to 0.25, P = 0.96) did not differ significantly between the RRS and ORS groups. Conclusion Based on the current evidence, robotic resection for rectal cancer provided equivalent pathological outcomes to ORS in terms of CRM positivity, number of harvested lymph nodes and complete TME rates and DRM.

scholarly journals Efficacy and Safety of Moxibustion for Postherpetic Neuralgia: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Qiqi Wu ◽  
Hantong Hu ◽  
Dexiong Han ◽  
Hong Gao
Keyword(s):  
Systematic Review ◽  
Herbal Medicine ◽  
Adverse Events ◽  
Postherpetic Neuralgia ◽  
Outcome Measure ◽  
Meta Analysis ◽  
Current Evidence ◽  
Cochrane Library ◽  
Efficacy Rate ◽  
Efficacy And Safety

Background: Postherpetic neuralgia (PHN) is one of the most common complications of herpes zoster (HZ), and there is still a lack of effective therapies. An increasing number of studies have found that compared to traditional therapy, moxibustion treatment is beneficial for the treatment of PHN, although current evidence remains inconclusive. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of moxibustion for PHN.Methods: We conducted a broad literature review of a range of databases from inception to December 2020, including the Cochrane Library, PubMed, EMBASE, Web of Science, Clinical Trails, China National Knowledge Infrastructure (CNKI), VIP Database for Chinese Technical Periodicals (VIP), China Biomedical Network Information, and Wanfang databases. We included RCTs that compared moxibustion to pharmacological therapies, herbal medicine, or no treatment for treating PHN. The main outcome measure was efficacy rate and Visual Analog Scale (VAS); the secondary outcome measure was adverse events. Data accumulation and synthesis included meta-analysis, publication bias, sensitivity analysis, risk-of-bias assessment, and adverse events.Results: We included 13 RCTs involving 798 patients. Compared with the controls (pharmacological therapies, herbal medicine, or no treatment), moxibustion achieved a significantly higher efficacy rate (odds ratio [OR]: 3.65; 95% [confidence interval]: [2.32, 5.72]; P &lt; 0.00001). Subgroup analysis of the distinct moxibustion modalities showed that both Zhuang medicine medicated thread and thunder-fire moxibustions obtained higher clinical efficacy than the control group. Compared with the controls, moxibustion resulted in significantly lower scores on the VAS (Weighted Mean Difference (MD) = −1.79; 95% CI: [−2.26, −1.33]; P &lt; 0.00001). However, there was no significant difference in terms of safety between moxibustion and the controls (OR = 0.33; 95% CI [0.06, 1.77]; P = 0.19).Conclusion: Due to the lack of methodological quality as well as the significant heterogeneity of the included studies, it remains difficult to draw a firm conclusion on the efficacy and safety of moxibustion for the treatment of PHN. Future high-quality studies are urgently needed.

scholarly journals Systematic Review of Questionnaires Measuring Patient Satisfaction in Ambulatory Anesthesia

2009 ◽  
Vol 110 (5) ◽  
pp. 1061-1067 ◽  
Author(s):  
Pratamaporn Chanthong ◽  
Amir Abrishami ◽  
Jean Wong ◽  
Francisco Herrera ◽  
Frances Chung
Keyword(s):  
Systematic Review ◽  
Patient Satisfaction ◽  
Literature Search ◽  
Search Strategy ◽  
Cochrane Library ◽  
Anesthesia Care ◽  
Ambulatory Anesthesia ◽  
Multiple Item ◽  
The Cochrane Library ◽  
Questionnaire Construction

Background Patient satisfaction has become an important component of quality improvement in ambulatory anesthesia services. However, it is difficult to measure due to its subjective and complex psychological construct. Psychometric methodology has been successfully used to evaluate this outcome. The authors conducted a systematic review to evaluate questionnaires to measure patient satisfaction with ambulatory anesthesia. Methods A systematic literature search of The Cochrane Library, MEDLINE, EMBASE, CINAHL, HAPI, PsycINFO, and Dissertation Abstracts was performed to identify studies on questionnaires evaluating patient satisfaction after ambulatory anesthesia. The authors included the articles that used multiple-item questionnaires, and the questionnaires were assessed with the strategy of psychometric questionnaire construction, validity, reliability, and acceptability. Results The authors scanned 131 articles yielded by our search strategy. Eleven articles were included in the study. Two questionnaires, IOWA Satisfaction with Anesthesia Scale and Evaluation du Vecu de I'Anesthesie Generale, fulfilled the criteria, but the latter was not developed specifically for ambulatory anesthesia, whereas Iowa Satisfaction with Anesthesia Scale was designed only for monitored anesthesia patients. Conclusions In a large number of trials, patient satisfaction has been evaluated using overall satisfaction or nonvalidated questionnaires. Only a few studies have developed questionnaires with rigorous psychometric methods to measure patient satisfaction with anesthesia care. At this time, there is still no valid or reliable questionnaire for measuring patient satisfaction in ambulatory anesthesia. Further study should be conducted to develop standardized instruments to measure this outcome.

scholarly journals Wrist Arthroscopy in Juvenile Idiopathic Arthritis: A Review of Current Literature and Future Implications

2018 ◽  
Vol 07 (03) ◽  
pp. 186-190
Author(s):  
P. Vermaak ◽  
T. Southwood ◽  
T. Lindau ◽  
A. Jester ◽  
K. Oestreich
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Early Identification ◽  
Joint Destruction ◽  
Current Evidence ◽  
Cochrane Library ◽  
Wrist Arthroscopy ◽  
Clinical Knowledge ◽  
Arthroscopic Synovectomy ◽  
Nice Guidance ◽  
The Cochrane Library

Introduction Juvenile Idiopathic Arthritis (JIA) is the most common rheumatological condition in children and frequently affects the wrist. The roles for wrist arthroscopy and arthroscopic synovectomy (AS) in JIA are unclear. Our aim was to find the current evidence supporting its use. Methods Systematic literature review of relevant publications from 1990 to present in the Cochrane Library, Clinical Knowledge Summaries, DynaMed, PEMSoft, NICE Guidance, MEDLINE, EMBASE, and PubMed. Results We found no publications detailing the use of arthroscopy or AS specifically in patients with JIA involving the wrist. There is evidence that AS reduces pain, improves function, and induces remission in patients with rheumatoid arthritis resistant to medical management. Discussion and Conclusion Although there is paucity in evidence for the use of AS in the wrists of patients with JIA, studies suggest it to be safe and effective, and could be applied to patients with refractive JIA. It is possible that early identification of patients suffering from JIA with extensive joint destruction and little symptoms could benefit from AS, delaying joint destruction and preserving function.

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