scholarly journals Impact of surgical drain output monitoring on patient outcomes in hepatopancreaticobiliary surgery: A systematic review

2021 ◽  
pp. 145749692110301
Author(s):  
Mikolaj Kowal ◽  
William Bolton ◽  
Bernard Van Duren ◽  
Joshua Burke ◽  
David Jayne
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Patient Outcomes ◽  
Bile Leak ◽  
Fistula Formation ◽  
Cochrane Library ◽  
Drain Removal ◽  
Hepatopancreaticobiliary Surgery ◽  
Drain Amylase ◽  
Surgical Drain

Background and objective: Surgical drains are widely utilized in hepatopancreaticobiliary surgery to prevent intra-abdominal collections and identify postoperative complications. Surgical drain monitoring ranges from simple-output measurements to specific analysis for constituents such as amylase. This systematic review aimed to determine whether surgical drain monitoring can detect postoperative complications and impact on patient outcomes. Methods: A systematic review was performed, and the following databases searched between 02/03/20 and 26/04/20: MEDLINE, EMBASE, The Cochrane Library, and Clinicaltrials.gov. All studies describing surgical drain monitoring of output and content in adult patients undergoing hepatopancreaticobiliary surgery were considered. Other invasive methods of intra-abdominal sampling were excluded. Results: The search returned 403 articles. Following abstract review, 390 were excluded and 13 articles were included for full review. The studies were classified according to speciality and featured 11 pancreatic surgery and 2 hepatobiliary surgery studies with a total sample of 3262 patients. Postoperative monitoring of drain amylase detected pancreatic fistula formation and drain bilirubin testing facilitated bile leak detection. Both methods enabled early drain removal. Improved patient outcomes were observed through decreased incidence of postoperative complications (pancreatic fistulas, intra-abdominal infections, and surgical-site infections), length of stay, and mortality rate. Isolated monitoring of drain output did not confer any clinical benefits. Conclusions: Surgical drain monitoring has advantages in the postoperative care for selected patients undergoing hepatopancreaticobiliary surgery. Enhanced surgical drain monitoring involving the testing of drain amylase and bilirubin improves the detection of complications in the immediate postoperative period.

scholarly journals 389 Impact of Surgical Drain Output Monitoring on Patient Outcomes in Gastrointestinal Surgery: A Systematic Review

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Kowal ◽  
W Bolton ◽  
B Van Duren ◽  
J Burke ◽  
D Jayne
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Gastrointestinal Surgery ◽  
Cochrane Library ◽  
Emergency General Surgery ◽  
Operative Care ◽  
Operative Complications ◽  
Output Monitoring ◽  
Surgical Drain ◽  
Post Operative Complications

Abstract Aim Surgical drains are widely utilised in Gastrointestinal Surgery to prevent intra-abdominal collections and identify post-operative complications. Surgical drain monitoring ranges from simple output measurements through to specific analysis for constituents such as amylase. This systematic review aimed to determine whether surgical drain monitoring can detect post-operative complications and impact on patient outcomes. Method A systematic review was performed, and the following databases searched between 02/03/20 and 26/04/20: MEDLINE, EMBASE, The Cochrane Library and Clinicaltrials.gov. All studies describing surgical drain monitoring of output and content in adult patients undergoing gastrointestinal surgery were considered. Other invasive methods of intra-abdominal sampling were excluded. Results The search returned 396 articles. Following abstract review, 383 were excluded and 13 articles were included for full review. The studies were classified according to speciality: Oesophagogastric (1), Pancreatic (6), Hepatobiliary (2), Colorectal (3) and Emergency General Surgery (1). Post-operative monitoring of amylase and bilirubin decreased the incidence of post-operative complications (pancreatic fistulas, intra-abdominal infections, surgical site infections), length of stay and mortality rate in Pancreatic and Hepatobiliary Surgery. Testing of drain contents following Colorectal Surgery can aid anastomotic leak and the detection of peritonitis, however this did not confer any improvement in patient outcome. Surgical drain monitoring did not improve patient outcomes in Oesophagogastric Surgery. Conclusions Surgical drain monitoring has established advantages in the post-operative care for patients undergoing Gastrointestinal Surgery. Enhanced surgical drain monitoring involving the testing of drain amylase, bilirubin, lactate, and cytokines may improve detection of complications in the immediate post-operative period.

scholarly journals The effects of clinical decision support system for prescribing medication on patient outcomes and physician practice performance: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sharare Taheri Moghadam ◽  
Farahnaz Sadoughi ◽  
Farnia Velayati ◽  
Seyed Jafar Ehsanzadeh ◽  
Shayan Poursharif
Keyword(s):  
Systematic Review ◽  
Decision Support ◽  
Patient Outcomes ◽  
Clinical Decision Support ◽  
Meta Analysis ◽  
Clinical Decision ◽  
Cochrane Library ◽  
Physician Practice ◽  
Positive Effects ◽  
Practice Performance

Abstract Background Clinical Decision Support Systems (CDSSs) for Prescribing are one of the innovations designed to improve physician practice performance and patient outcomes by reducing prescription errors. This study was therefore conducted to examine the effects of various CDSSs on physician practice performance and patient outcomes. Methods This systematic review was carried out by searching PubMed, Embase, Web of Science, Scopus, and Cochrane Library from 2005 to 2019. The studies were independently reviewed by two researchers. Any discrepancies in the eligibility of the studies between the two researchers were then resolved by consulting the third researcher. In the next step, we performed a meta-analysis based on medication subgroups, CDSS-type subgroups, and outcome categories. Also, we provided the narrative style of the findings. In the meantime, we used a random-effects model to estimate the effects of CDSS on patient outcomes and physician practice performance with a 95% confidence interval. Q statistics and I2 were then used to calculate heterogeneity. Results On the basis of the inclusion criteria, 45 studies were qualified for analysis in this study. CDSS for prescription drugs/COPE has been used for various diseases such as cardiovascular diseases, hypertension, diabetes, gastrointestinal and respiratory diseases, AIDS, appendicitis, kidney disease, malaria, high blood potassium, and mental diseases. In the meantime, other cases such as concurrent prescribing of multiple medications for patients and their effects on the above-mentioned results have been analyzed. The study shows that in some cases the use of CDSS has beneficial effects on patient outcomes and physician practice performance (std diff in means = 0.084, 95% CI 0.067 to 0.102). It was also statistically significant for outcome categories such as those demonstrating better results for physician practice performance and patient outcomes or both. However, there was no significant difference between some other cases and traditional approaches. We assume that this may be due to the disease type, the quantity, and the type of CDSS criteria that affected the comparison. Overall, the results of this study show positive effects on performance for all forms of CDSSs. Conclusions Our results indicate that the positive effects of the CDSS can be due to factors such as user-friendliness, compliance with clinical guidelines, patient and physician cooperation, integration of electronic health records, CDSS, and pharmaceutical systems, consideration of the views of physicians in assessing the importance of CDSS alerts, and the real-time alerts in the prescription.

scholarly journals Patient Outcomes Associated With Phenobarbital Use With or Without Benzodiazepines for Alcohol Withdrawal Syndrome: A Systematic Review

2017 ◽  
Vol 52 (9) ◽  
pp. 607-616 ◽  
Author(s):  
Drayton A. Hammond ◽  
Jordan M. Rowe ◽  
Adrian Wong ◽  
Tessa L. Wiley ◽  
Kristen C. Lee ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Observational Studies ◽  
Alcohol Withdrawal Syndrome ◽  
Hospital Length Of Stay ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Icu Admission

Purpose: Benzodiazepines are the drug of choice for alcohol withdrawal syndrome (AWS); however, phenobarbital is an alternative agent used with or without concomitant benzodiazepine therapy. In this systematic review, we evaluate patient outcomes with phenobarbital for AWS. Methods: Medline, Cochrane Library, and Scopus were searched from 1950 through February 2017 for controlled trials and observational studies using [“phenobarbital” or “barbiturate”] and [“alcohol withdrawal” or “delirium tremens.”] Risk of bias was assessed using tools recommended by National Heart, Lung, and Blood Institute. Results: From 294 nonduplicative articles, 4 controlled trials and 5 observational studies (n = 720) for AWS of any severity were included. Studies were of good quality (n = 2), fair (n = 4), and poor (n = 3). In 6 studies describing phenobarbital without concomitant benzodiazepine therapy, phenobarbital decreased AWS symptoms ( P < .00001) and displayed similar rates of treatment failure versus comparator therapies (38% vs 29%). A study with 2 cohorts showed similar rates of intensive care unit (ICU) admission (phenobarbital: 16% and 9% vs benzodiazepine: 14%) and hospital length of stay (phenobarbital: 5.85 and 5.30 days vs benzodiazepine: 6.64 days). In 4 studies describing phenobarbital with concomitant benzodiazepine therapy, phenobarbital groups had similar ICU admission rates (8% vs 25%), decreased mechanical ventilation (21.9% vs 47.3%), decreased benzodiazepine requirements by 50% to 90%, and similar ICU and hospital lengths of stay and AWS symptom resolution versus comparator groups. Adverse effects with phenobarbital, including dizziness and drowsiness, rarely occurred. Conclusion: Phenobarbital, with or without concomitant benzodiazepines, may provide similar or improved outcomes when compared with alternative therapies, including benzodiazepines alone.

Antimicrobial Stewardship Programs in Inpatient Hospital Settings: A Systematic Review

2014 ◽  
Vol 35 (10) ◽  
pp. 1209-1228 ◽  
Author(s):  
Brittin Wagner ◽  
Gregory A. Filice ◽  
Dimitri Drekonja ◽  
Nancy Greer ◽  
Roderick MacDonald ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Antimicrobial Stewardship ◽  
English Language ◽  
Guideline Implementation ◽  
Hospital Setting ◽  
The United States ◽  
Prescribing Patterns ◽  
Audit And Feedback ◽  
Cochrane Library

ObjectiveEvaluate the evidence for effects of inpatient antimicrobial stewardship programs (ASPs) on patient, prescribing, and microbial outcomes.DesignSystematic review.MethodsSearch of MEDLINE (2000 through November 2013), Cochrane Library, and reference lists of relevant studies. We included English language studies with patient populations relevant to the United States (ie, infectious conditions and prescriptions required for antimicrobials) that evaluated ASP interventions and reported outcomes of interest. Study characteristics and outcomes data were extracted and reviewed by investigators and trained research personnel.ResultsFew intervention types (eg, audit and feedback, guideline implementation, and decision support) substantially impacted patient outcomes, including mortality, length of stay, readmission, or incidence of Clostridium difficile infection. However, most interventions were not powered adequately to demonstrate impacts on patient outcomes. Most interventions were associated with improved prescribing patterns as measured by decreased antimicrobial use or increased appropriate use. Where reported, ASPs were generally associated with improvements in microbial outcomes, including institutional resistance patterns or resistance in the study population. Few data were provided on harms, sustainability, or key intervention components. Studies were typically of short duration, low in methodological quality, and varied in study design, populations enrolled, hospital setting, ASP intent, intervention composition and implementation, comparison group, and outcomes assessed.ConclusionsNumerous studies suggest that ASPs can improve prescribing and microbial outcomes. Strength of evidence was low, and most studies were not designed adequately to detect improvements in mortality or other patient outcomes, but obvious adverse effects on patient outcomes were not reported.

scholarly journals Does education of primary care professionals to support patient self-management improve patient outcomes in chronic disease management? updated systematic review

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2020.0186
Author(s):  
Claire Collins ◽  
Gillian Doran ◽  
Patricia Patton ◽  
Roisin Fitzgerald ◽  
Andree Rochfort
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Patient Outcomes ◽  
Professional Training ◽  
Complex Interventions ◽  
Educational Interventions ◽  
Self Management ◽  
Cochrane Library ◽  
Web Searches ◽  
High Quality Research

BackgroundOur first systematic review included only two papers showing patient outcomes following health professional training for promoting patient self-management.AimTo present the updated review undertaken from September 2013 to August 2018.Design & settingA systematic review was undertaken using the PRISMA guidelines, following the methodology of the first review and is outlined in the PROSPERO registered protocol (Database registration number: CRD42013004418).MethodSix databases were searched - Cochrane Library, PubMed, ERIC, EMBASE, CINAHL and PsycINFO - in addition to Web searches, Hand searches and Bibliographies for articles published from September 1st, 2013 to August 31st 2018.ResultsOur updated systematic review showed more evidence is now available with 18 papers in the five year period from the 4,284 abstracts located. Twelve of these papers showed a difference between intervention and control groups. Of the 18 papers identified, 11 were assessed as having a low risk of bias and five overall were rated of weak quality. The educational interventions with health professionals spanned a range of techniques and modalities and many incorporated multiple interventions including patient components. There may be lack of adoption due to several challenges, including that complex interventions may not be delivered as planned and are difficult to assess, and due to patient engagement and the need for ongoing follow-up.DiscussionMore high quality research is needed on what methods work best and for which patients and what clinical conditions in the primary care setting. The practical implications of training healthcare professionals require specific attention.

scholarly journals What Is the Clinical Evidence Supporting Trauma Team Training (TTT): A Systematic Review and Meta-Analysis

Medicina ◽  
2019 ◽  
Vol 55 (9) ◽  
pp. 551
Author(s):  
Noonan ◽  
Olaussen ◽  
Mathew ◽  
Mitra ◽  
Smit ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Patient Outcomes ◽  
Meta Analysis ◽  
Ct Scanning ◽  
Trauma Team ◽  
Team Training ◽  
Cochrane Library ◽  
Medical Subject Headings ◽  
Mesh Terms

Background and Objectives: Major trauma centres manage severely injured patients using multi-disciplinary teams but the evidence-base that targeted Trauma Team Training (TTT) improves patients’ outcomes is unclear. This systematic review aimed to identify the association between the implementation of TTT programs and patient outcomes. Methods: We searched OVID Medline, PubMed and The Cochrane Library (CENTRAL) from the date of the database commencement until 10 of April 2019 for a combination of Medical Subject Headings (MeSH) terms and keywords relating to TTT and clinical outcomes. Reference lists of appraised studies were also screened for relevant articles. We extracted data on the study setting, type and details about the learners, as well as clinical outcomes of mortality and/or time to critical interventions. A meta-analysis of the association between TTT and mortality was conducted using a random effects model. Results: The search yielded 1136 unique records and abstracts, of which 18 full texts were reviewed. Nine studies met final inclusion, of which seven were included in a meta-analysis of the primary outcome. There were no randomised controlled trials. TTT was not associated with mortality (Pooled overall odds ratio (OR) 0.83; 95% Confidence Interval; 0.64–1.09). TTT was associated with improvements in time to operating theatre and time to first computerized tomography (CT) scanning. Conclusions: Despite few publications related to TTT, its introduction was associated with improvements in time to critical interventions. Whether such improvements can translate to improvements in patient outcomes remains unknown. Further research focusing on the translation of standardised trauma team reception “actions” into TTT is required to assess the association between TTT and patient outcome.

scholarly journals Risk factors for postoperative stroke in adults patients with moyamoya disease: a systematic review with meta-analysis

2019 ◽  
Author(s):  
Wei Wei ◽  
Xin Chen ◽  
Yu Jun ◽  
Xuqin Li
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Postoperative Complications ◽  
Moyamoya Disease ◽  
Meta Analysis ◽  
Age At Onset ◽  
Adult Patients ◽  
Cochrane Library ◽  
Postoperative Stroke ◽  
Increased Risk

Abstract Background This systematic review and meta-analysis aimed to clarify the risk factors for postoperative stroke in adult patients with moyamoya disease (MMD). Methods We comprehensively searched MEDLINE/PubMed, Web of Science, and Cochrane Library for eligible published literature with regard to the risk factors and postoperative complications in adult patients with MMD. Statistical analysis was conducted using Stata version 12.0. Pooled odds ratio (OR) with 95% confidence interval (CI) were assessed for each risk factor. Results There were 8 studies encompassing 1649 patients who underwent surgery with MMD were selected for analysis. Preoperative ischemic event significantly increase the risk of postoperative stroke events (OR=1.40; 95%CI=1.02–1.92; P=0.039). PCA involvement correlate with an increased risk of post-infarction (OR=4.60; 95%CI=2.61–8.11; P=0.000). Compared to direct bypass, patients who underwent indirect bypass or combined bypass could significantly increase the risk of postoperative stroke events. (OR=1.17; 95%CI=1.03–1.33; p=0.017). MMD patients with diabetes were associated with an increased risk of postoperative stroke events (OR=4.02, 95% CI=1.59-10.16; p=0.003). MMD patients with hypertension, age at onset and male sex were not associated with an increased risk of postoperative stroke events (P>0.05). Conclusions This systematic review and meta-analysis indicated that preoperative ischemic events, PCA involvement and diabetes were independent risk factors for postoperative stroke in MMD patients. Therefore, in order to ensure the curative effect of patients with MMD, it is very necessary to detect these risk factors and prevent postoperative complications in time.

scholarly journals Spine Surgery and Preoperative Hemoglobin, Hematocrit, and Hemoglobin A1c: A Systematic Review

2021 ◽  
pp. 219256822097982
Author(s):  
Krishna V. Suresh ◽  
Kevin Wang ◽  
Ishaan Sethi ◽  
Bo Zhang ◽  
Adam Margalit ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Spine Surgery ◽  
Postoperative Infection ◽  
Lumbar Fusion ◽  
Adult Patients ◽  
Cochrane Library ◽  
Cardiac Events ◽  
Level Of Evidence ◽  
Increased Risk

Study Design: Systematic review. Objectives: Synthesize previous studies evaluating clinical utility of preoperative Hb/Hct and HbA1c in patients undergoing common spinal procedures: anterior cervical discectomy and fusion (ACDF), posterior cervical fusion (PCF), posterior lumbar fusion (PLF), and lumbar decompression (LD). Methods: We queried PubMed, Embase, Cochrane Library, and Web of Science for literature on preoperative Hb/Hct and HbA1c and post-operative outcomes in adult patients undergoing ACDF, PCF, PLF, or LD surgeries. Results: Total of 4,307 publications were assessed. Twenty-one articles met inclusion criteria. PCF and ACDF: Decreased preoperative Hb/Hct were significant predictors of increased postoperative morbidity, including return to operating room, pulmonary complications, transfusions, and increased length of stay (LOS). For increased HbA1c, there was significant increase in risk of postoperative infection and cost of hospital stay. PLF: Decreased Hb/Hct was reported to be associated with increased risk of postoperative cardiac events, blood transfusion, and increased LOS. Elevated HbA1c was associated with increased risk of infection as well as higher visual analogue scores (VAS) and Oswestry disability index (ODI) scores. LD: LOS and total episode of care cost were increased in patients with preoperative HbA1c elevation. Conclusion: In adult patients undergoing spine surgery, preoperative Hb/Hct are clinically useful predictors for postoperative complications, transfusion rates, and LOS, and HbA1c is predictive for postoperative infection and functional outcomes. Using Hct values <35-38% and HbA1c >6.5%-6.9% for identifying patients at higher risk of postoperative complications is most supported by the literature. We recommend obtaining these labs as part of routine pre-operative risk stratification. Level of Evidence: III

scholarly journals Nurse practitioners and physician assistants working in ambulance care: A systematic review

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1182
Author(s):  
Risco van Vliet ◽  
Remco Ebben ◽  
Nicolette Diets ◽  
Thomas Pelgrim ◽  
Jorik Loef ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Outcomes ◽  
Nurse Practitioners ◽  
Resource Use ◽  
Selection Process ◽  
Physician Assistants ◽  
Referral And Consultation ◽  
Cochrane Library ◽  
Process Of Care

Background: This review aims to describe the activities of nurse practitioners (NPs) and physician assistants (PAs) working in ambulance care, and the effect of these activities on patient outcomes, process of care, provider outcomes, and costs. Methods: PubMed, MEDLINE (EBSCO), EMBASE (OVID), Web of Science, the Cochrane Library (Cochrane Database of Systematic Review), CINAHL Plus, and the reference lists of the included articles were systematically searched in November 2019. All types of peer-reviewed designs on the three topics were included. Pairs of independent reviewers performed the selection process, the quality assessment, and the data extraction. Results: Four studies of moderate to poor quality were included. Activities in medical, communication and collaboration skills were found. The effects of these activities were found in process of care and resource use outcomes, focusing on non-conveyance rates, referral and consultation, on-scene time, or follow-up contact Conclusions: This review shows that there is limited evidence on activities of NPs and PAs in ambulance care. Results show that NPs and PAs in ambulance care perform activities that can be categorized into the Canadian Medical Education Directives for Specialists (CanMED) roles of Medical Expert, Communicator, and Collaborator. The effects of NPs and PAs are minimally reported in relation to process of care and resource use, focusing on non-conveyance rates, referral and consultation, on-scene time, or follow-up contact. No evidence on patient outcomes of the substitution of NPs and PAs in ambulance care exists. PROSPERO registration: CRD42017067505 (07/07/2017)

scholarly journals Comparison of complications of early and delayed open reduction and internal fixation for treating pilon fracture: A protocol of systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0258962
Author(s):  
Yang Chen ◽  
Xiaoyu Huang ◽  
Yili Chen ◽  
Changlong Shi ◽  
Hao Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Internal Fixation ◽  
Open Reduction ◽  
Meta Analysis ◽  
Assessment Tools ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Statistical Heterogeneity ◽  
Pilon Fractures

Background Tibial Pilon fractures are severe fractures accompanied by soft tissue injury. Although open reduction and internal fixation (ORIF) are effective in treating Pilon fractures, there is a controversy over time to surgery due to reported postoperative complications. However, there is no systematic review evaluating the difference of postoperative complications between early and delayed ORIF for treating pilon fractures. Methods Relevant literature written in English will be searched through PubMed, Cochrane Library, Embase, MEDLINE, and Web of Science. The study aims to compare the effects and complications of early and delayed ORIF for treating fresh pilon fractures in adult patients. The primary outcome will be infection rate, fracture union time, nonunion and malunion rate. And the secondary outcome will be metalwork removal, amputation, and ankle function grade. Two reviewers will independently assess the eligibility of the studies according to the pre-defined inclusion and exclusion criteria. A meta-analysis for the available data will be conducted using Revman 5.3. To measure effect size, odds ratios (ORs) and mean difference will be used for dichotomous and continuous data, respectively. Statistical heterogeneity will be explored. And a random-effects model or a fixed-effects will be used in pooled data on the basis of the existence or absence of heterogeneity. Subgroup analysis will be conducted to identify sources of heterogeneity and sensitivity analysis to test the results’ robustness. We will assess the risk of bias by four different quality assessment tools according to the study design. Publication bias will be evaluated by funnel plot. The study data will be stored in the Open Science Framework website. PROSPERO registration number CRD42020207465

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