At the Crossroad with Morbidity and Mortality Conferences: Lessons Learned through a Narrative Systematic Review

Objective. To determine the process and structure of Morbidity and Mortality Conference (MMC) and to provide guidelines for conducting MMC.Methods. Using a narrative systematic review methodology, literature search was performed from January 1, 1950, to October 2, 2012. Original articles in adult population were included. MMC process and structure, as well as baseline study demographics, main results, and conclusions, were collected.Results. 38 articles were included. 10/38 (26%) pertained to medical subspecialties and 25/38 (66%) to surgical subspecialties. 15/38 (40%) were prospective, 14/38 (37%) retrospective, 7/38 (18%) interventional, and 2/38 (5%) cross-sectional. The goals were quality improvement and education. Of the 10 medical articles, MMC were conducted monthly 60% of the time. Cases discussed included complications (60%), deaths (30%), educational values (30%), and system issues (40%). Recommendations for improvements were made frequently (90%). Of the 25 articles in surgery, MMCs were weekly (60% of the time). Cases covered mainly complications (72%) and death (52%), with fewer cases dedicated to education (12%). System issues and recommendations were less commonly reported.Conclusion. Fundamental differences existed in medical versus surgical departments in conducting MMC, although the goals remained similar. We provide a schematic guideline for MMC through a summary of existing literature.

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Methods of conduct and reporting of living systematic reviews: a protocol for a living methodological survey

F1000Research ◽

10.12688/f1000research.18005.2 ◽

2019 ◽

Vol 8 ◽

pp. 221 ◽

Cited By ~ 3

Author(s):

Assem M. Khamis ◽

Lara A. Kahale ◽

Hector Pardo-Hernandez ◽

Holger J. Schünemann ◽

Elie A. Akl

Keyword(s):

Systematic Review ◽

Systematic Reviews ◽

Evidence Synthesis ◽

Cochrane Library ◽

Cross Sectional Survey ◽

Systematic Review Methodology ◽

Cross Sectional ◽

Prospective Longitudinal ◽

Over Time

Background: The living systematic review (LSR) is an emerging approach for improved evidence synthesis that uses continual updating to include relevant new evidence as soon as it is published. The objectives of this study are to: 1) assess the methods of conduct and reporting of living systematic reviews using a living study approach; and 2) describe the life cycle of living systematic reviews, i.e., describe the changes over time to their methods and findings. Methods: For objective 1, we will begin by conducting a cross-sectional survey and then update its findings every 6 months by including newly published LSRs. For objective 2, we will conduct a prospective longitudinal follow-up of the cohort of included LSRs. To identify LSRs, we will continually search the following electronic databases: Medline, EMBASE and the Cochrane library. We will also contact groups conducting LSRs to identify eligible studies that we might have missed. We will follow the standard systematic review methodology for study selection and data abstraction. For each LSR update, we will abstract information on the following: 1) general characteristics, 2) systematic review methodology, 3) living approach methodology, 4) results, and 5) editorial and publication processes. We will update the findings of both the surveys and the longitudinal follow-up of included LSRs every 6 months. In addition, we will identify articles addressing LSR methods to be included in an ‘LSR methods repository’. Conclusion: The proposed living methodological survey will allow us to monitor how the methods of conduct, and reporting as well as the findings of LSRs change over time. Ultimately this should help with ensuring the quality and transparency of LSRs.

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Participants' Opinion about Conduct of Morbidity and Mortality Conferences in Surgical Practice in a Tertiary Hospital, Ethiopia

Ethiopian Journal of Health Sciences ◽

10.4314/ejhs.v30i3.6 ◽

2020 ◽

Vol 30 (3) ◽

Author(s):

Berhanetsehay Teklewold ◽

Tilahun Deresse ◽

Goytom Kinfe ◽

Henok Teshome

Keyword(s):

Patient Safety ◽

Multidisciplinary Team ◽

Addis Ababa ◽

Univariate Analysis ◽

Tertiary Hospital ◽

Morbidity And Mortality ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Morbidity And Mortality Conferences

BACKGROUND: Morbidity and mortality conference has both educational and quality improvement purposes. However clear evidences for the effectiveness of the morbidity and mortality conferences in improving patient safety is lacking.METHODS: A facility based cross sectional study was conducted at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia, to assess participants’ opinion on benefits and functioning of morbidity and mortality conferences. Univariate analysis was used to determine the influence of professional type on participants’ opinion about the morbidity and mortality conferences.RESULT: A total of 98 participants completed the survey. The majority of the participants agreed that there was a structured system of case identification (67.3%), meeting format (72.4%), the conferences were conducted every month (79.6%), it is blame free (71.4%) and system of care was focus of discussion (70%). Most (88.8%) participants agreed that the conferences were important for improvement of patient safety and quality of care, whereas 67.3% of the participants believed that there is no written term of reference and prior dissemination of agendas. Only 40% agreed that there is multidisciplinary team involvement. Fifty one percent of them disagreed that there is a follow up on the implementation of the forwarded recommendations.CONCLUSION: Even though the majority of the participants were satisfied with the mortality and morbidity conferences, most disagreed on the presence of written term of reference, earlier dissemination of agendas, multidisciplinary team involvement and follow up on the implementation of the forwarded recommendations.

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Lessons Learned From the Surgical Morbidity and Mortality Conference

Journal of Surgical Education ◽

10.1016/j.jsurg.2018.07.002 ◽

2019 ◽

Vol 76 (1) ◽

pp. 174-181 ◽

Cited By ~ 3

Author(s):

Kaio S. Ferreira ◽

Kenneth Lynch ◽

Beth A. Ryder ◽

Michael Connolly ◽

Thomas Miner ◽

...

Keyword(s):

Lessons Learned ◽

Morbidity And Mortality ◽

Surgical Morbidity ◽

Morbidity And Mortality Conference ◽

Mortality Conference

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Adaptation of the Systematic Review Framework to the Assessment of Toxicological Test Methods: Challenges and Lessons Learned With the Zebrafish Embryotoxicity Test

Toxicological Sciences ◽

10.1093/toxsci/kfz128 ◽

2019 ◽

Vol 171 (1) ◽

pp. 56-68

Author(s):

Martin L Stephens ◽

Sevcan Gül Akgün-Ölmez ◽

Sebastian Hoffmann ◽

Rob de Vries ◽

Burkhard Flick ◽

...

Keyword(s):

Systematic Review ◽

Developmental Toxicity ◽

Test Methods ◽

Lessons Learned ◽

Hazard Identification ◽

Test Method ◽

Main Study ◽

Systematic Review Methodology ◽

Method Performance ◽

Toxicological Test

AbstractSystematic review methodology is a means of addressing specific questions through structured, consistent, and transparent examinations of the relevant scientific evidence. This methodology has been used to advantage in clinical medicine, and is being adapted for use in other disciplines. Although some applications to toxicology have been explored, especially for hazard identification, the present preparatory study is, to our knowledge, the first attempt to adapt it to the assessment of toxicological test methods. As our test case, we chose the zebrafish embryotoxicity test (ZET) for developmental toxicity and its mammalian counterpart, the standard mammalian prenatal development toxicity study, focusing the review on how well the ZET predicts the presence or absence of chemical-induced prenatal developmental toxicity observed in mammalian studies. An interdisciplinary team prepared a systematic review protocol and adjusted it throughout this piloting phase, where needed. The final protocol was registered and will guide the main study (systematic review), which will execute the protocol to comprehensively answer the review question. The goal of this preparatory study was to translate systematic review methodology to the assessment of toxicological test method performance. Consequently, it focused on the methodological issues encountered, whereas the main study will report substantive findings. These relate to numerous systematic review steps, but primarily to searching and selecting the evidence. Applying the lessons learned to these challenges can improve not only our main study, but may also be helpful to others seeking to use systematic review methodology to compare toxicological test methods. We conclude with a series of recommendations that, if adopted, would help improve the quality of the published literature, and make conducting systematic reviews of toxicological studies faster and easier over time.

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Prevalence and Determinants of Trachomatous Trichiasis towards Elimination of Trachoma in Ethiopia: A Systematic Review and Meta- Analysis

10.21203/rs.3.rs-743732/v1 ◽

2021 ◽

Author(s):

Daniel Geleta ◽

Netsanet Workneh

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Adult Population ◽

Comprehensive Overview ◽

Cross Sectional ◽

Pooled Prevalence ◽

The Status ◽

The Individual ◽

Study Participants ◽

Trachomatous Trichiasis

Abstract Background: Trachomatous Trichiasis is a preventable and treatable late stage of trachoma infection, mainly exacerbating the condition of poor and marginalized people. Given the hurtful nature of the infection, many countries, including Ethiopia, lack coherent data on the status of the problem toward its targeted time of elimination. Hence, this systematic review and meta-analysis aimed to provide a comprehensive overview of the prevalence and determinants of trachomatous trichiasis towards the elimination of trachoma in Ethiopia.Methods: Based on the predefined criteria, electronic database searches on the peer-reviewed journal papers of an English version were reviewed on the prevalence and determinants of trachomatous trichiasis among the adult population in Ethiopia from January 2015 to December 2020. After reviewing the quality of the individual sources of evidence by three reviewers, the data items were extracted using a locally devised charting form. Data were synthesized qualitatively and quantitatively in terms of publication year, design, study participants, and outcome of interest. Finally, quantitative results were pooled, explored for sources of variation, tested for a potential source of influence of prevalence estimates and publication bias in the statistical meta-analysis using STATA version-16 software.Result: After the exclusion of 121 duplicates, 108 extraneous titles & abstracts, and removal of three articles for the reasons detected on full-text screening, ten eligible studies were included for analysis. All the included studies were cross-sectional studies that took prevalence as the main outcome of interest. Accordingly, the overall pooled prevalence of Trachomatous trichiasis was 1.80 % (95%CI=1.15, 2.44) while an individual prevalence estimate of the studies ranged from 0.5% (95%CI= 0.42, 0.60) to 3.9 % (95%CI=3.82, 3.98). On subgroup analysis, the highest [3.76% (95% CI = 3.20, 4.41)] and the lowest [0.5% (95%CI= 0.42, 0.60)] prevalence were respectively reported in Gambella and Somalia. The trend of the prevalence has demonstrated unstable pattern, while there were no published studies on the determinants of trachoma trichiasis among adult over the specified period of the review.Conclusion: The prevalence of TT was significantly higher than the elimination threshold in all regions of Ethiopia, needing further implementation to facilitate roads toward the elimination.Trail registration: CRD42021260802

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Implementation status of morbidity and mortality conferences in Austrian hospitals-A cross-sectional national survey study

PLoS ONE ◽

10.1371/journal.pone.0248692 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248692

Author(s):

Alexandru-Cristian Tuca ◽

Johanna Münch ◽

David L. B. Schwappach ◽

Andrea Borenich ◽

Chiara Banfi ◽

...

Keyword(s):

Hierarchical Structures ◽

Cross Sectional Study ◽

Morbidity And Mortality ◽

Survey Study ◽

Limiting Factor ◽

Cross Sectional ◽

The Status ◽

Blame Culture ◽

Morbidity And Mortality Conferences ◽

Implementation Status

Introduction Morbidity and mortality conferences (M&MCs) are an instrument for learning from past complications, unexpected follow-ups and deaths in hospitals and are important for improving patient safety. However, there are currently no quantitative data on the implementation of M&MCs in Austria. The aim of the study was to determine the status quo of the M&MCs in Austria. Materials and methods A national cross-sectional study was conducted by means of a survey of 982 chief physicians of surgical disciplines, internal medicine, anesthesiology, intensive care, gynecology/obstetrics and pediatrics. The questionnaire focused on overall goals, structure and procedures of hospital M&MCs. Results Of the 982 contacted chief physicians, 314 (32.0%) completed the survey. Almost two thirds of the respondents, i.e. 203 (64.7%), had already implemented M&MCs. Of the 111 chief physicians who had not yet introduced M&MCs, 62 (55.9%) were interested in introducing such conferences in the future. Of the 203 respondents that had implemented M&MCs, 100 stated that their M&MC could be improved. They reported issues with "shame and blame" culture, hierarchical structures, too little knowledge about the capability of M&MC and, in particular, time constraints. Overall, the participating chief physicians showed that they are striving to improve their existing M&MCs. Discussion/Conclusion While we found a relatively high number of already implemented M&MCs we also identified a large heterogeneity in the format of the M&MCs. A highly structured M&MC including guidelines, checklists or templates does not only considerably improve its outcome but can also alleviate the main limiting factor which is the lack of time.

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Barriers to access dental care services among adult population: A systematic review

Journal of Global Oral Health ◽

10.25259/jgoh_1_2020 ◽

2020 ◽

Vol 3 ◽

pp. 54-62

Author(s):

Lakshmi Krishnan ◽

Aarthy C. S. ◽

Parangimalai Diwakar Madan Kumar

Keyword(s):

Systematic Review ◽

Dental Care ◽

Access To Health Care ◽

Adult Population ◽

Final Analysis ◽

Health Care Facilities ◽

Google Scholar ◽

Cross Sectional ◽

Care Services ◽

Meta Analyses

Objective: This systematic review was done with the aim of assessing the barriers faced in utilizing dental care services by general population in age group between 20 and 60 years in India as these findings would provide evidence for making appropriate decisions in our National Oral Health Policy which could further improve access to dental care services for people across India. This was a systematic review. Materials and Methods: For this review, PubMed, TRIP database, Cochrane, and Google Scholar were the electronic databases searched based on the PICO. Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines were followed for the final inclusion of articles. Results: The search generated a total of 91 articles from four different electronic bases: PubMed, TRIP database, Cochrane, and Google Scholar. Based on the inclusion criteria, 14 articles made it to the final analysis. All 14 studies reported a lack of time and nonavailability of dentists as major barriers in accessing dental care services. Conclusion: The cross-sectional studies of this review were assessed for quality using a modified Newcastle- Ottawa Scale, proposed by Egger et al. in 2003. Even though the available literature forms a lower standard of evidence, further evaluation of barriers using a standardized questionnaire is recommended using better-designed studies to substantiate the unequal access to health-care facilities to Indian Population.

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Do we still need to assess nurses' attitudes towards pressure ulcer prevention? A systematic review

Journal of Wound Care ◽

10.12968/jowc.2019.28.12.795 ◽

2019 ◽

Vol 28 (12) ◽

pp. 795-806 ◽

Cited By ~ 2

Author(s):

Pinar Avsar ◽

Declan Patton ◽

Tom O'Connor ◽

Zena Moore

Keyword(s):

Systematic Review ◽

Pressure Ulcer ◽

Positive Attitude ◽

Attitude Scale ◽

Research Literature ◽

Attitude Score ◽

Systematic Review Methodology ◽

Cross Sectional ◽

Pressure Ulcer Prevention ◽

Ulcer Prevention

Objective: To critically appraise and synthesise existing research literature pertaining to nurses' attitudes towards pressure ulcer (PU) prevention. Method: Using systematic review methodology, published quantitative studies focusing on nurses' attitudes towards PU prevention measured by psychometric tests were included. The search was conducted in May 2019 using PubMed, CINAHL, Scopus, Cochrane and EMBASE databases, and returned 442 records, of which 21 met the inclusion criteria. Data were extracted using a pre-designed extraction tool and all included studies were quality appraised using the checklist. Results: Of the included studies, 20 employed a cross-sectional design and one author employed a validation study. In measuring nurses' attitudes toward PU prevention two distinct instruments were used: the ‘Moore and Price Attitude Scale’ and the ‘Attitude towards Pressure Ulcer Prevention Instrument’. The mean attitude score within the studies was 73% (standard deviation=9.2%). The lowest attitude score was 51%, while the highest score was 89%. The results obtained from the studies indicated that 86% (n=18) yielded positive attitude results. Conclusion: The findings suggest that, overall, nurses are positively disposed towards PU prevention. However, it is important to highlight that the nurses have difficulties translating this positive attitude into actual PU prevention strategies.

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The use of teledermoscopy in the accurate identification of cancerous skin lesions in the adult population: A systematic review

Journal of Telemedicine and Telecare ◽

10.1177/1357633x16686770 ◽

2017 ◽

Vol 24 (2) ◽

pp. 75-83 ◽

Cited By ~ 18

Author(s):

Amy F Bruce ◽

Jennifer A Mallow ◽

Laurie A Theeke

Keyword(s):

Systematic Review ◽

Rural Communities ◽

Web Applications ◽

Adult Population ◽

Skin Lesions ◽

Telecommunication Networks ◽

Future Research ◽

Measurement Tool ◽

Accurate Identification ◽

Cross Sectional

Background The use of teledermoscopy in the diagnostic management of pre-cancerous and cancerous skin lesions involves digital dermoscopic images transmitted over telecommunication networks via email or web applications. Teledermoscopy may improve the accuracy in clinical diagnoses of melanoma skin cancer if integrated into electronic medical records and made available to rural communities, potentially leading to decreased morbidity and mortality. Objective and method The purpose of this paper is to present a systematic review of evidence on the use of teledermoscopy to improve the accuracy of skin lesion identification in adult populations. The PRISMA method guided the development of this systematic review. A total of seven scholarly databases were searched for articles published between the years of 2000 and 2015. All studies were critically appraised using the Rosswurm and Larrabee critique worksheet, placed in a matrix for comparison evaluating internal and external validity and inspected for homogeneity of findings. Results Sixteen articles met inclusion criteria for this review. A majority of the studies were cross-sectional and non-experimental. Ten of the 16 focused on interobserver concordance and diagnostic agreement between teledermoscopy and another comparator. Instrumentation in conducting the studies showed inconsistency with reported results. Discussion Higher level evidence is needed to support clinical application of teledermoscopy for accuracy of diagnostic measurement in the treatment of pre-cancerous and cancerous skin lesions in adults. Future research is needed to develop a standardized, reliable and valid measurement tool for implementation in clinical practice.

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