scholarly journals What is the effect of electronic clinical handovers on patient outcomes? A systematic review

2020 ◽  
Vol 26 (4) ◽  
pp. 2422-2434
Author(s):  
Belinda Delardes ◽  
Lisa McLeod ◽  
Samantha Chakraborty ◽  
Kelly-Ann Bowles
Keyword(s):  
Systematic Review ◽  
Adverse Event ◽  
High Risk ◽  
Patient Care ◽  
Patient Outcomes ◽  
Healthcare Personnel ◽  
Risk Event ◽  
Event Rates ◽  
Communication Errors

Handover between physicians is a high-risk event for communication errors. Using electronic handover platforms has potential to improve the quality of informational transfer and therefore minimise this risk. This systematic review sought to compare the effectiveness of electronic handover methods on patient outcomes. Articles were identified by searching MEDLINE, EMbase, Scopus and CINAHL databases. Studies involving electronic handover between two healthcare personnel or teams, and which described patientspecific outcomes, were included. This search yielded 390 articles, with a total of nine publications included in the analysis. Outcomes reported in studies included length of stay, adverse event rates, time to procedure and handover completeness. This review suggests that e-handover may improve the handover completeness; however, it is unclear at this time if that translates to an improvement in patient care. The lack of reliable evidence highlights the need for further research exploring the effect of e-handovers on patient care.

scholarly journals The efficacy of remdesivir in coronavirus disease 2019 (COVID-19): a systematic review

2020 ◽  
Author(s):  
Amirhossein Roshanshad ◽  
Alireza Kamalipour ◽  
Mohammad Ali Ashraf ◽  
Romina Roshanshad ◽  
Sirous Jafari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Event ◽  
Cohort Studies ◽  
Clinical Improvement ◽  
Day Treatment ◽  
Mortality Rates ◽  
Severe Adverse Event ◽  
Adverse Event Rate ◽  
Significant Difference ◽  
Event Rates

Background and Objectives: Researchers all around the world are working hard to find an effective treatment for the new coronavirus 2019. We performed a comprehensive systematic review to investigate the latest clinical evidence on the efficacy and safety of treatment with Remdesivir in hospitalized patients with COVID-19. Materials and Methods: We performed a systematic search in Pubmed, Embase, Web of Science, Google scholar and MedRxiv for relevant observational and interventional studies. The outcomes measures were mortality rates, improvement rates, time to clinical improvement, all adverse event rates and severe adverse event rates. Results: Three randomized controlled trials and 2 cohort studies were included in our study. In the 2 cohort studies, patients received Remdesivir for 10 days. 2 RCTs evaluated 10-day efficacy of treatment with Remdesivir versus placebo group and the other RCT compared its 5-day regimen versus 10-day regimen. Visual inspection of the forest plots revealed that the efficacy of Remdesivir was not much different in reducing 28-day mortality versus 14-day mortality rates. Besides, 10-day treatment regimen overpowered 5-day treatment and placebo in decreasing time to clinical improvement. All adverse event rates did not have a significant difference; however, severe adverse event rate was lower in the 5-day Remdesivir group compared to the 10-day and placebo groups. Conclusion: 5-day course of Remdesivir therapy in COVID-19 patients is probably efficacious and safe, and patients without invasive mechanical ventilation benefit the most. Treatment can be extended to 10 days if satisfactory improvement is not seen by day 5. Most benefits from Remdesivir therapy take place in the first 14 days of the start of the treatment.

scholarly journals A novel application of the lotus petal flap in high-risk perineal urethrostomy: principles and outcomes

2018 ◽  
Vol 1 (1) ◽  
pp. 135-139
Author(s):  
Daniel J Reilly ◽  
Eric K Sham ◽  
Justin BL Chee ◽  
Ajay Chauhan
Keyword(s):  
High Risk ◽  
Patient Outcomes ◽  
Ileal Conduit ◽  
Soft Tissue Coverage ◽  
Skin Flaps ◽  
Flexible Cystoscopy ◽  
Urethral Strictures ◽  
Lotus Petal Flap

Introduction: Perineal urethrostomy is a valuable technique in the management of complex anterior urethral strictures, as well as following penectomy or urethrectomy. Traditional techniques that employ perineal or scrotal skin flaps have documented failure rates of up to 30%. Current techniques for salvage have only modest success, leaving patients few options other than permanent suprapubic catheter or cystectomy and ileal conduit formation.Results: We present a new method of perineal urethrostomy using perforator-based lotus petal flaps in cases which were high risk or unsuitable for traditional perineal urethrostomy techniques, or where traditional strategies had failed. All patients demonstrated continent voiding at a minimum of 22 months follow-up, with patency confirmed by flexible cystoscopy. No complications were encountered.Conclusion: Utilisation of lotus petal flaps in high-risk cases of perineal urethrostomy will lead to significant improvements in patient outcomes. The availability of larger amounts of soft tissue coverage will obviate the need for compromise on either resection of involved urethra, or calibre and inset of urethrostomy. This will subsequently minimise the rates of failure, reduce the requirement for urinary diversion procedures and lead to improved quality of life.

scholarly journals Rapid diagnostic test for antenatal syphilis screening in low-income and middle-income countries: a systematic review and meta-analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018132 ◽  
Author(s):  
Carmen Phang Romero Casas ◽  
Marrissa Martyn-St James ◽  
Jean Hamilton ◽  
Daniel S Marinho ◽  
Rodolfo Castro ◽  
...  
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Diagnostic Accuracy ◽  
Pregnant Women ◽  
Sensitivity And Specificity ◽  
Methodological Quality ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Antenatal Clinics

ObjectivesTo undertake a systematic review and meta-analysis to evaluate the test performance including sensitivity and specificity of rapid immunochromatographic syphilis (ICS) point-of-care (POC) tests at antenatal clinics compared with reference standard tests (non-treponemal (TP) and TP tests) for active syphilis in pregnant women.MethodsFive electronic databases were searched (PubMed, EMBASE, CRD, Cochrane Library and LILACS) to March 2016 for diagnostic accuracy studies of ICS test and standard reference tests for syphilis in pregnant women. Methodological quality was assessed using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies). A bivariate meta-analysis was undertaken to generate pooled estimates of diagnostic parameters. Results were presented using a coupled forest plot of sensitivity and specificity and a scatter plot.ResultsThe methodological quality of the five included studies with regards to risk of bias and applicability concern judgements was either low or unclear. One study was judged as high risk of bias for patient selection due to exclusion of pregnant women with a previous history of syphilis, and one study was judged at high risk of bias for study flow and timing as not all patients were included in the analysis. Five studies contributed to the meta-analysis, providing a pooled sensitivity and specificity for ICS of 0.85 (95% CrI: 0.73 to 0.92) and 0.98 (95% CrI: 0.95 to 0.99), respectively.ConclusionsThis review and meta-analysis observed that rapid ICS POC tests have a high sensitivity and specificity when performed in pregnant women at antenatal clinics. However, the methodological quality of the existing evidence base should be taken into consideration when interpreting these results.PROSPERO registration numberCRD42016036335.

scholarly journals Pharmacists as Care Providers for Stroke Patients: A Systematic Review

2017 ◽  
Vol 45 (1) ◽  
pp. 49-55 ◽  
Author(s):  
Jade E. Basaraba ◽  
Michelle Picard ◽  
Kirsten George-Phillips ◽  
Tania Mysak
Keyword(s):  
Systematic Review ◽  
Risk Factor ◽  
Acute Stroke ◽  
Patient Care ◽  
Patient Outcomes ◽  
Stroke Patient ◽  
Full Text ◽  
Stroke Patients ◽  
Pharmacist Interventions ◽  
The Impact

AbstractBackground:Pharmacists have become an integral member of the multidisciplinary team providing clinical patient care in various healthcare settings. Although evidence supporting their role in the care of patients with other disease states is well-established, minimal literature has been published evaluating pharmacist interventions in stroke patients. The purpose of this systematic review is to summarize the evidence evaluating the impact of pharmacist interventions on stroke patient outcomes.Methods: Study abstracts and full-text articles evaluating the impact of a pharmacist intervention on outcomes in patients with an acute stroke/transient ischemic attack (TIA) or a history of an acute stroke/TIA were identified and a qualitative analysis performed.Results: A total of 20 abstracts and full-text studies were included. The included studies provided evidence supporting pharmacist interventions in multiple settings, including emergency departments, inpatient, outpatient, and community pharmacy settings. In a significant proportion of the studies, pharmacist care was collaborative with other healthcare professionals. Some of the pharmacist interventions included participation in a stroke response team, assessment for thrombolytic use, medication reconciliation, participation in patient rounds, identification and resolution of drug therapy problems, risk-factor reduction, and patient education. Pharmacist involvement was associated with increased use of evidence-based therapies, medication adherence, risk-factor target achievement, and maintenance of health-related quality of life.Conclusions: Available evidence suggests that a variety of pharmacist interventions can have a positive impact on stroke patient outcomes. Pharmacists should be considered an integral member of the stroke patient care team.

scholarly journals Systematic Review on the Effect of Training Interventions to Improve the Skills of Health Professionals in Promoting Health Behaviour Change, with Meta-Analysis of Behavioural Outcomes.

2020 ◽  
Author(s):  
Tom G Hatfield ◽  
Thomas Michael Withers ◽  
Colin J Greaves
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Healthcare Professional ◽  
Behaviour Change ◽  
Health Behaviour ◽  
Meta Analysis ◽  
Health Behaviours ◽  
Health Behaviour Change ◽  
Patient Health

Abstract Background We aimed to identify, synthesise and evaluate randomised control trial evidence on the effects of healthcare professional training on the delivery quality of health behaviour change interventions and, subsequently, on patient health behaviours.Methods Systematic review with narrative synthesis of effects on delivery quality and meta-analysis of health behaviour outcomes. We searched: Medline, EMBASE, PsychInfo, AMED, CINAHL Plus and the Cochrane Central Register of Control Trials up to March 2019. Studies were included if they were in English and included intervention delivery quality as an outcome. The systematic review was registered on PROSPERO (registration: CRD42019124502).Results Twelve-studies were identified as suitable for inclusion. All studies were judged as being high risk of bias with respect to training quality outcomes. However with respect to behavioural outcomes, only two of the six studies included in the meta-analysis had a high risk and four had some concerns. Educational elements (e.g. presentations) were used in all studies and nine included additional practical learning tasks. In eight studies reporting delivery quality, 54% of healthcare professional communication outcomes and 55% of content delivery outcomes improved in the intervention arm compared to controls. Training that included both educational and practical elements tended to be more effective. Meta-analysis of patient health behavioural outcomes in six-studies found significant improvements (Standardised mean difference (SMD): 0.20, 95% confidence interval: 0.11 to 0.28, P<0.0001, I 2 = 0%). No significant difference was found between short (≤6-months) and long-term (>6-months) outcomes (SMD: 0.25 vs 0.15; P=0.31).Conclusions Delivery quality of health behaviour change interventions appears to improve following training and consequently to improve health behaviours. Future studies should develop more concise /integrated measures of delivery quality and develop optimal methods of training delivery.

scholarly journals Remdesivir Efficacy in Coronavirus Disease 2019 (COVID-19): A Systematic Review

2020 ◽  
Author(s):  
Amirhossein Roshanshad ◽  
Alireza Kamalipour ◽  
Mohammad Ali Ashraf ◽  
Romina Roshanshad ◽  
Mohammad Reza Akbari
Keyword(s):  
Systematic Review ◽  
Adverse Event ◽  
Clinical Improvement ◽  
Day Treatment ◽  
Invasive Mechanical Ventilation ◽  
Mortality Rates ◽  
Severe Adverse Event ◽  
Adverse Event Rate ◽  
Significant Difference ◽  
Event Rates

AbstractBackgroundResearchers are working hard to find an effective treatment for the new coronavirus 2019. We performed a comprehensive systematic review to investigate the latest clinical evidence on the treatment efficacy and safety of Remdesivir in hospitalized patients with COVID-19.MethodsWe performed a systematic search of the Pubmed, Embase, Web of Science, Google scholar, and MedRxiv for relevant observational and interventional studies. Measured outcomes were mortality rates, improvement rates, time to clinical improvement, all adverse event rates and severe adverse event rates.Results3 RCTs and 2 cohorts were included in our study. In 2 cohort studies, patients received Remdesivir for 10 days. 2 RCTs evaluated 10-day treatment of Remdesivir efficacy versus placebo group and the other RCT compared its 5-day regimen versus 10-day regimen. Visual inspection of the forest plots revealed that Remdesivir efficacy was not much different in reducing 28-day mortality versus 14-day mortality rates. Besides, 10-day treatment regimen overpowers 5-day treatment and placebo in decreasing time to clinical improvement. All adverse event rates did not have significant difference; however, severe adverse event rate was lower in 5-day Remdesivir group compared to 10-day and placebo groups.Conclusion5-day course of Remdesivir therapy in COVID-19 patients is probably efficacious and safe and patients without invasive mechanical ventilation benefit the most. Treatment can be extended to 10 days if satisfactory improvement is not seen by day 5. Most benefits from Remdesivir therapy take place in the first 14 days of the start of the treatment.

A Protocol for the Use of Amorphous Hydrogel to Support Wound Healing in Neonatal Patients: An Adjunct to Nursing Skin Care

2006 ◽  
Vol 25 (4) ◽  
pp. 267-273 ◽  
Author(s):  
Lorna Cisler-Cahill
Keyword(s):  
Patient Care ◽  
Registered Nurses ◽  
Quality Indicators ◽  
Patient Outcomes ◽  
Critical Difference ◽  
Skin Breakdown ◽  
Quality Of Patient Care ◽  
Skin Integrity ◽  
Primary Nurse

The care registered nurses offer makes a critical difference in the quality and cost-effectiveness of patient outcomes. The prevention and treatment of alterations in skin integrity remain primary nurse-sensitive quality indicators. Although wound prevention is a primary goal for nurses, iatrogenic wounds do occur. Neonatal patients are at greater risk for alterations in skin integrity because of the fragile nature of their skin. When skin breakdown occurs, nurses must have knowledge of effective treatment alternatives. The purpose of this article is to describe the use of a collaborative practice protocol to introduce and document patient outcomes with the use of amorphous hydrogel as a treatment modality for iatrogenic neonatal wounds. All hospitals collect data on the quality of patient care, and it has been known for some time that registered nurses can make a critical difference in the quality of patient care and the effectiveness of patient outcomes. The American Nurses Association has identified ten specific quality measures that are impacted by nursing care. Referred to as nurse-sensitive quality indicators, these measures include the maintenance of skin integrity.1

Bisphosphonate treatment in the bone disorders in children: a systematic review

MedAlliance ◽  
2021 ◽  
Vol 9 (3) ◽  
pp. 59-70
Keyword(s):  
Bone Mineral Density ◽  
Systematic Review ◽  
Adverse Event ◽  
Bone Mineral ◽  
Bone Pain ◽  
Dose Effect ◽  
Age Group ◽  
Bisphosphonate Treatment ◽  
Mineral Density

Summary Background: bisphosphonates use over three decades in a variety conditions in children. However, the evi-dence of its use is limited. Aims:systematic analysis of publications regarding the effectiveness and safety of bisphosphonates (BPs) in children. Methods. PubMed and eLIBRARY were searched for eligible articles of Rus-sian and foreign authors up to February 2021. According the PRISMA strategies, 35 studies (data of 2545 patients) were included into the analysis. Results. More than 80% patients suffered from nonbacterial osteomyelitis (NBO) and osteogenesis imperfecta (OI). BPs in children are effective for increasing the bone mineral density for decreased fracture incidence, to reduce bone pain, to re-lieve inflammation and to improve the quality of patients’ life. The most frequently adverse event was the first-dose effect, such as flu-like syndrome. In the age group under study, no severe adverse events characteristic of adults have been seen (mandibular necrosis). Conclusions. BPs are efficient and safe in children with OI, NBO and cere-bral palsy in order to restore the bone mineral density. Further research is required to strengthen the recom-mendations made, while the wider use of BPs require revision of current registration documents in accordance with global guidelines.

scholarly journals QUALITY OF SAMPLE SIZE ESTIMATION IN TRIALS OF MEDICAL DEVICES: HIGH-RISK DEVICES FOR NEUROLOGICAL CONDITIONS AS EXAMPLE

2017 ◽  
Vol 33 (1) ◽  
pp. 103-110 ◽  
Author(s):  
Britta Olberg ◽  
Matthias Perleth ◽  
Katja Felgentraeger ◽  
Sandra Schulz ◽  
Reinhard Busse
Keyword(s):  
Systematic Review ◽  
High Risk ◽  
Sample Size ◽  
Medical Devices ◽  
Sample Size Calculation ◽  
Data Availability ◽  
Principal Investigators ◽  
Research Protocols ◽  
Neurological Conditions

Background: The aim of this study was to assess the quality of reporting sample size calculation and underlying design assumptions in pivotal trials of high-risk medical devices (MDs) for neurological conditions.Methods: Systematic review of research protocols for publicly registered randomized controlled trials (RCTs). In the absence of a published protocol, principal investigators were contacted for additional data. To be included, trials had to investigate a high-risk MD, registered between 2005 and 2015, with indications stroke, headache disorders, and epilepsy as case samples within central nervous system diseases. Extraction of key methodological parameters for sample size calculation was performed independently and peer-reviewed.Results: In a final sample of seventy-one eligible trials, we collected data from thirty-one trials. Eighteen protocols were obtained from the public domain or principal investigators. Data availability decreased during the extraction process, with almost all data available for stroke-related trials. Of the thirty-one trials with sample size information available, twenty-six reported a predefined calculation and underlying assumptions. Justification was given in twenty and evidence for parameter estimation in sixteen trials. Estimates were most often based on previous research, including RCTs and observational data. Observational data were predominantly represented by retrospective designs. Other references for parameter estimation indicated a lower level of evidence.Conclusions: Our systematic review of trials on high-risk MDs confirms previous research, which has documented deficiencies regarding data availability and a lack of reporting on sample size calculation. More effort is needed to ensure both relevant sources, that is, original research protocols, to be publicly available and reporting requirements to be standardized.

Sign in / Sign up

Export Citation Format

Share Document