scholarly journals Patient prioritisation methods to shorten waiting times for elective surgery: A systematic review of how to improve access to surgery

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256578
Author(s):  
Dimuthu Rathnayake ◽  
Mike Clarke ◽  
Viraj Jayasinghe
Keyword(s):  
Systematic Review ◽  
Web Of Science ◽  
Elective Surgery ◽  
Waiting Times ◽  
Healthcare Management ◽  
Waiting List ◽  
Cochrane Library ◽  
Wide Range ◽  
The Impact ◽  
Patient Prioritisation

Background Concern about long waiting times for elective surgeries is not a recent phenomenon, but it has been heightened by the impact of the COVID-19 pandemic and its associated measures. One way to alleviate the problem might be to use prioritisation methods for patients on the waiting list and a wide range of research is available on such methods. However, significant variations and inconsistencies have been reported in prioritisation protocols from various specialties, institutions, and health systems. To bridge the evidence gap in existing literature, this comprehensive systematic review will synthesise global evidence on policy strategies with a unique insight to patient prioritisation methods to reduce waiting times for elective surgeries. This will provide evidence that might help with the tremendous burden of surgical disease that is now apparent in many countries because of operations that were delayed or cancelled due to the COVID-19 pandemic and inform policy for sustainable healthcare management systems. Methods We searched PubMed, EMBASE, SCOPUS, Web of Science, and the Cochrane Library, with our most recent searches in January 2020. Articles published after 2013 on major elective surgery lists of adult patients were eligible, but cancer and cancer-related surgeries were excluded. Both randomised and non-randomised studies were eligible and the quality of studies was assessed with ROBINS-I and CASP tools. We registered the review in PROSPERO (CRD42019158455) and reported it in accordance with the PRISMA statement. Results The electronic search in five bibliographic databases yielded 7543 records (PubMed, EMBASE, SCOPUS, Web of Science, and Cochrane) and 17 eligible articles were identified in the screening. There were four quasi-experimental studies, 11 observational studies and two systematic reviews. These demonstrated moderate to low risk of bias in their research methods. Three studies tested generic approaches using common prioritisation systems for all elective surgeries in common. The other studies assessed specific prioritisation approaches for re-ordering the waiting list for a particular surgical specialty. Conclusions Explicit prioritisation tools with a standardised scoring system based on clear evidence-based criteria are likely to reduce waiting times and improve equitable access to health care. Multiple attributes need to be considered in defining a fair prioritisation system to overcome limitations with local variations and discriminations. Collating evidence from a diverse body of research provides a single framework to improve the quality and efficiency of elective surgical care provision in a variety of health settings. Universal prioritisation tools with vertical and horizontal equity would help with re-ordering patients on waiting lists for elective surgery and reduce waiting times.

scholarly journals Patient prioritisation methods to shorten waiting times for elective surgery: a systematic review of how to improve access to surgery

2021 ◽  
Author(s):  
Dimuthu Rathnayake ◽  
Mike Clarke ◽  
Viraj Jayasinghe
Keyword(s):  
Systematic Review ◽  
Web Of Science ◽  
Elective Surgery ◽  
Waiting Times ◽  
Healthcare Management ◽  
Waiting List ◽  
Cochrane Library ◽  
Wide Range ◽  
The Impact ◽  
Patient Prioritisation

ABSTRACTBackgroundConcern about long waiting times for elective surgeries is not a recent phenomenon, but it has been heightened by the impact of the COVID-19 pandemic and its associated measures. One way to alleviate the problem might be to use prioritisation methods for patients on the waiting list and a wide range of research is available on such methods. However, significant variations and inconsistencies have been reported in prioritisation protocols from various specialties, institutions, and health systems. To bridge the evidence gap in existing literature, this comprehensive systematic review will synthesise global evidence on policy strategies with a unique insight to patient prioritisation methods to reduce waiting times for elective surgeries. This will provide evidence that might help with the tremendous burden of surgical disease that is now apparent in many countries because of operations that were delayed or cancelled due to the COVID-19 pandemic and inform policy for sustainable healthcare management systems.MethodsWe searched PubMed, EMBASE, SCOPUS, Web of Science, and the Cochrane Library, with our most recent searches in January 2020. Articles published after 2013 on major elective surgery lists of adult patients were eligible, but cancer and cancer-related surgeries were excluded. Both randomised and non-randomised studies were eligible and the quality of studies was assessed with ROBINS-I and CASP tools. We registered the review in PROSPERO (CRD42019158455) and reported it in accordance with the PRISMA statement.ResultsThe electronic search in five bibliographic databases yielded 7543 records (PubMed, EMBASE, SCOPUS, Web of Science, and Cochrane) and 17 eligible articles were identified in the screening. There were four quasi-experimental studies, 11 observational studies and two systematic reviews. These demonstrated moderate to low risk of bias in their research methods. Three studies tested generic approaches using common prioritisation systems for all elective surgeries in common. The other studies assessed specific prioritisation approaches for re-ordering the waiting list for a particular surgical specialty.ConclusionsExplicit prioritisation tools with a standardised scoring system based on clear evidence-based criteria are likely to reduce waiting times and improve equitable access to health care. Multiple attributes need to be considered in defining a fair prioritisation system to overcome limitations with local variations and discriminations. Collating evidence from a diverse body of research provides a single framework to improve the quality and efficiency of elective surgical care provision in a variety of health settings. Universal prioritisation tools with vertical and horizontal equity would help with re-ordering patients on waiting lists for elective surgery and reduce waiting times.

scholarly journals Efficient perioperative time-management methods for operating theatres: a systematic review showing how to reduce overall patient waiting times for elective surgery

2021 ◽  
Author(s):  
Dimuthu Rathnayake
Keyword(s):  
Systematic Review ◽  
Time Management ◽  
Elective Surgery ◽  
Waiting Times ◽  
Experimental Studies ◽  
Cochrane Library ◽  
Start Time ◽  
Randomized Controlled Studies ◽  
First Case ◽  
Patient Waiting

Abstract Introduction: The effects on long waiting times for elective surgeries from lower operating theatre (OT) performance have been reported in many studies. The timeliness of perioperative processes and adherence to scheduled times is crucial for efficient performance in OT but the perioperative workflow includes multiple tasks assigned to different work teams. Each of these needs to be completed in a timely manner. This systematic review investigates the effects of efficient preoperative systems on the timeliness of upstream and downstream processes in surgical care pathways in order to reduce overall patient waiting times for elective surgery. Methods: We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases during December 2019 and January 2020, for articles published after 1 January 2014. All studies pertaining to perioperative time-management methods, which had an intention to reduce waiting times for elective surgery were eligible for this review. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer and cancer-related surgeries. Both randomized trials and non-randomized controlled studies were considered and the quality of studies was assessed using ROBINS-I and CASP tools. The review findings are presented as a narrative synthesis due to the heterogeneity of included studies. The PROSPERO registration is CRD42019158455. Results: The electronic search yielded 7543 records and 20 articles were eligible after deduplication and full article screening. There were two experimental studies, five quasi-experimental studies and 13 observational studies. The studies varied widely in design, scope, reported outcomes and overall quality. The first-case-start-time and patient change-over-time at OT were the main time related measures considered as affecting timeliness in many studies. Conclusion: This review suggests that a significant amount of time could be saved with efficient scheduling and planning perioperative processes, which could reduce overall patient waiting time for elective surgeries. Managing perioperative time in isolation could be an enabling factor for an overall increase in both theatre utilisation and theatre efficiency. However, only a small number of good quality studies were available and further evaluation with higher quality study designs and rigour is recommended in order for firm conclusions to be reached.

scholarly journals Currently prescribed drugs in the UK that could upregulate or downregulate ACE2 in COVID-19 disease: a systematic review

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e040644
Author(s):  
Hajira Dambha-Miller ◽  
Ali Albasri ◽  
Sam Hodgson ◽  
Christopher R Wilcox ◽  
Shareen Khan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Web Of Science ◽  
Angiotensin Receptor Blockers ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Channel Blockers ◽  
Human Lungs ◽  
The Uk ◽  
The Cochrane Library ◽  
The Impact

ObjectiveTo review evidence on routinely prescribed drugs in the UK that could upregulate or downregulate ACE2 and potentially affect COVID-19 disease.DesignSystematic review.Data sourceMEDLINE, EMBASE, CINAHL, the Cochrane Library and Web of Science.Study selectionAny design with animal or human models examining a currently prescribed UK drug compared with a control, placebo or sham group, and reporting an effect on ACE2 level, activity or gene expression.Data extraction and synthesisMEDLINE, EMBASE, CINAHL, the Cochrane Library, Web of Science and OpenGrey from inception to 1 April 2020. Methodological quality was assessed using the SYstematic Review Centre for Laboratory animal Experimentation (SYRCLE) risk-of-bias tool for animal studies and Cochrane risk-of-bias tool for human studies.ResultsWe screened 3360 titles and included 112 studies with 21 different drug classes identified as influencing ACE2 activity. Ten studies were in humans and one hundred and two were in animal models None examined ACE2 in human lungs. The most frequently examined drugs were angiotensin receptor blockers (ARBs) (n=55) and ACE inhibitors (ACE-I) (n=22). More studies reported upregulation than downregulation with ACE-I (n=22), ARBs (n=55), insulin (n=8), thiazolidinedione (n=7) aldosterone agonists (n=3), statins (n=5), oestrogens (n=5) calcium channel blockers (n=3) glucagon-like peptide 1 (GLP-1) agonists (n=2) and Non-steroidal anti-inflammatory drugs (NSAIDs) (n=2).ConclusionsThere is an abundance of the academic literature and media reports on the potential of drugs that could attenuate or exacerbate COVID-19 disease. This is leading to trials of repurposed drugs and uncertainty among patients and clinicians concerning continuation or cessation of prescribed medications. Our review indicates that the impact of currently prescribed drugs on ACE2 has been poorly studied in vivo, particularly in human lungs where the SARS-CoV-2 virus appears to enact its pathogenic effects. We found no convincing evidence to justify starting or stopping currently prescribed drugs to influence outcomes of COVID-19 disease.

scholarly journals Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e022202 ◽  
Author(s):  
Martin Müller ◽  
Jonas Jürgens ◽  
Marcus Redaèlli ◽  
Karsten Klingberg ◽  
Wolf E Hautz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Safety ◽  
Adverse Events ◽  
Patient Outcomes ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Communication Tool ◽  
Clinical Routine ◽  
Wide Range ◽  
The Impact

ObjectivesCommunication breakdown is one of the main causes of adverse events in clinical routine, particularly in handover situations. The communication tool SBAR (situation, background, assessment and recommendation) was developed to increase handover quality and is widely assumed to increase patient safety. The objective of this review is to summarise the impact of the implementation of SBAR on patient safety.DesignA systematic review of articles published on SBAR was performed in PUBMED, EMBASE, CINAHL, Cochrane Library and PsycINFO in January 2017. All original research articles on SBAR fulfilling the following eligibility criteria were included: (1) SBAR was implemented into clinical routine, (2) the investigation of SBAR was the primary objective and (3) at least one patient outcome was reported.SettingA wide range of settings within primary and secondary care and nursing homes.ParticipantsA variety of heath professionals including nurses and physicians.Primary and secondary outcome measuresAspects of patient safety (patient outcomes) defined as the occurrence or incidence of adverse events.ResultsEight studies with a before–after design and three controlled clinical trials performed in different clinical settings met the inclusion criteria. The objectives of the studies were to improve team communication, patient hand-offs and communication in telephone calls from nurses to physicians. The studies were heterogeneous with regard to study characteristics, especially patient outcomes. In total, 26 different patient outcomes were measured, of which eight were reported to be significantly improved. Eleven were described as improved but no further statistical tests were reported, and six outcomes did not change significantly. Only one study reported a descriptive reduction in patient outcomes.ConclusionsThis review found moderate evidence for improved patient safety through SBAR implementation, especially when used to structure communication over the phone. However, there is a lack of high-quality research on this widely used communication tool.Trial registrationnone

scholarly journals What is the impact of cinnamon supplementation on blood pressure? A systematic review and meta-analysis

2020 ◽  
Vol 20 ◽  
Author(s):  
Abed Ghavami ◽  
Hossein Khadem Haghighian ◽  
Neda Roshanravan ◽  
Rahele Ziaei ◽  
Ehsan Ghaedi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Web Of Science ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Cochrane Library ◽  
High Dose ◽  
Randomized Controlled ◽  
Long Duration ◽  
The Impact

Background and Aims: This study was designed to make a systematic review and meta-analysis on randomized controlled trials (RCTs) assessing the effect of cinnamon on blood pressure (BP). Methods: A systematic computerized literature search of PubMed, Scopus, Web of Science, Cochrane Library and Google Scholar databases were conducted up to August 2019. All RCTs using cinnamon supplements in adults were included in this systematic review and meta-analysis. Results: Out of 927 records, 8 trials that enrolled 582 participants included. The pooled effect size showed that SBP did not change following cinnamon supplementation. (WMD: -0.61mmHg; 95% CI: -1.36, 0.14, P= 0.111). Also cinnamon supplementation in long-duration (≥ 8weeks) had a significant effect on SBP (WMD: -1.25 mmHg; 95% CI: -2.22, -0.28, P= 0.012). Pooled analysis showed that cinnamon had a significant effect on DBP (WMD: -0.93mmHg, 95% CI: -1.55 to -0.32, P= 0.003). In addition, results from both duration subsets and high dose (>1500 mg/day) of cinnamon supplementation were significant. Conclusion: Our findings revealed that cinnamon supplementation has favorable effects on DBP although results about SBP were not the same. Nonetheless, further studies are required.

scholarly journals Currently prescribed drugs in the UK that could up or downregulate ACE2 in COVID-19 disease: A systematic review

2020 ◽  
Author(s):  
Hajira Dambha-Miller ◽  
Ali Albasri ◽  
Sam Hodgson ◽  
Christopher R Wilcox ◽  
Shareen Khan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Angiotensin Converting Enzyme ◽  
Web Of Science ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Converting Enzyme ◽  
Human Lungs ◽  
The Uk ◽  
The Cochrane Library ◽  
The Impact

Objective: To review evidence on routinely prescribed drugs in the UK that could up or downregulate Angiotensin Converting Enzyme 2 (ACE2) and potentially affect COVID-19 disease Design: Systematic review Data source: MEDLINE, EMBASE, CINAHL, the Cochrane Library and Web of Science Study selection: Any design with animal or human models examining a currently prescribed UK drug compared to a control, placebo or sham group, and reporting an effect on ACE2 level, activity or gene expression. Data extraction and synthesis: MEDLINE, EMBASE, CINAHL, the Cochrane Library, Web of Science and OpenGrey from inception to 1st April 2020. Methodological quality was assessed using the SYRCLE's risk of bias tool for animal studies and Cochrane risk of bias tool for human studies. Results: We screened 3,360 titles and included 112 studies with 21 different drug classes identified as influencing ACE2 activity. Ten studies were in humans and 102 were in animal models None examined ACE2 in human lungs. The most frequently examined drugs were Angiotensin Receptor Blockers (ARBs) (n= 55) and Angiotensin-Converting Enzyme- Inhibitors (ACE-I) (n= 22). More studies reported upregulation than downregulation with ACE-I (n=22), ARBs (n=55), insulin (n=8), thiazolidinedione (n=7) aldosterone agonists (n=3), statins (n=5), oestrogens (n=5) calcium channel-blockers (n=3) GLP-1 agonists (n=2) and NSAIDs (n=2). Conclusions: There is an abundance of academic literature and media reports on the potential of drugs that could attenuate or exacerbate COVID-19 disease. This is leading to trials of repurposed drugs and uncertainty amongst patients and clinicians concerning continuation or cessation of prescribed medications. Our review indicates that the impact of currently prescribed drugs on ACE2 has been poorly studied in-vivo, particularly in human lungs where the SARS-CoV-2 virus appears to enact its pathogenic effects. We found no convincing evidence to justify starting or stopping currently prescribed drugs to influence outcomes of COVID-19 disease.

scholarly journals Oral Cavity as an Extragastric Reservoir of Helicobacter pylori

2014 ◽  
Vol 2014 ◽  
pp. 1-16 ◽  
Author(s):  
Arwa Al Sayed ◽  
Pradeep S. Anand ◽  
Kavitha P. Kamath ◽  
Shankargouda Patil ◽  
R. S. Preethanath ◽  
...  
Keyword(s):  
Systematic Review ◽  
Helicobacter Pylori ◽  
Oral Cavity ◽  
Oral Hygiene ◽  
Dental Plaque ◽  
Web Of Science ◽  
Cochrane Library ◽  
H Pylori ◽  
The Impact

Background. Several studies were reported on the prevalence, and relationship between the existence of Helicobacter pylori (H. pylori) in oral cavity and in stomach of patients. The purpose of this study was to systematically review the existing literature on the presence of H. pylori in the oral cavity and its link to gastric infection, the existence of coinfection, and the impact of anti-H. pylori therapy on the dental plaque and vice versa. Method. Two authors independently searched the Medline, EMBASE, Cochrane Library, Web of Science, Google Scholar, and Scopus databases for relevant studies. The articles were analyzed critically and all qualified studies were included. The search was carried out by using a combined text and the MeSH search strategies: using the key words Helicobacter, Helicobacter pylori, and H. pylori in combination with dental plaque, periodontitis, and oral hygiene. Results. The data was presented in 8 tables and each topic separately discussed. Conclusion. Based on the systematic review of the available literature on H. pylori infection and its presence in the oral cavity, it can be concluded that dental plaque can act as a reservoir, and proper oral hygiene maintenance is essential to prevent reinfection. Due to the diversified methods and population groups involved in the available literature, no concrete evidence can be laid down. Further studies are necessary to establish the role of H. pylori in the oral cavity and its eradication on preventing the gastroduodenal infection.

scholarly journals β-(1→3,1→6)-D-glucans in disease prevention and health promotion - a systematic review of randomized controlled trials

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Marigoula Vlassopoulou ◽  
Adamantini Kyriacou ◽  
Vasiliki Pletsa ◽  
George Zervakis ◽  
Mary Yiannakoulia
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Abdominal Circumference ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Beneficial Effects ◽  
Randomized Controlled ◽  
Wide Range ◽  
Tract Infections ◽  
The Impact

AbstractIntroductionβ-Glucans comprise a heterogeneous group of polysaccharides exhibiting a wide range of biological properties. They are categorized as dietary fibers due to their ability to reach the large intestine undigested and undergo fermentation by gut microbiota, with potential beneficial effects for the host. Aim of this systematic review is to assess the effects of consumption of β-(1→3,1→6)-D-glucans, naturally found in the cell walls of fungi, on health outcomes.MethodsA comprehensive literature search was performed on PubMed, Cochrane Library and Web of Science in order to retrieve studies that investigated the impact of exclusively oral administration of β-(1→3,1→6)-D-glucans to healthy individuals and/or patients in any form, at any dosage. Only randomized controlled trials (RCTs) were considered.ResultsTwenty-five RCTs, of the 48 clinical studies retrieved in total, met the eligibility criteria and are included in the present review. The sources of β-(1→3,1→6)-D-glucans were Saccharomyces cerevisiae, Aureobasidium pullulans, Pleurotus ostreatus and Lentinula edodes and the dosage of supplementation ranged from 2.5 to 3000 mg daily for up to 6 months. The main physiological outcome for the majority of the interventions was immunomodulation, which resulted in a) strengthened immune defence that reduces the incidence and symptoms of cold, flu and upper respiratory tract infections in general and b) alleviation of allergic symptoms. However, findings on the induction of immune response alterations were inconsistent at a cellular and molecular level. Another aspect is psychological wellbeing, as the cohorts that received the polysaccharides of interest reported improvement of mood state as well as amelioration of the wellbeing overall, while co-administration with chemotherapeutic drugs enhanced cancer patients’ quality of life and prolonged their survival. Furthermore, supplements containing β-(1→3,1→6)-D-glucan induced beneficial changes in body fat mass and abdominal circumference in overweight adults. Notably, no adverse event causally related to the glucans was recorded in any of the trials.ConclusionsSupplementation with β-(1→3,1→6)-D-glucans is well-tolerated and health-promoting properties are manifested primarily through the potentiation of the immune system. More studies are required in order to confirm additional beneficial effects, establish the optimal dose and reveal the underlying molecular mechanisms.

Stress, anxiety, depression and burnout in frontline health care workers during COVID-19 pandemic: a brief systematic review and new data from Russia

2021 ◽  
Author(s):  
Ekaterina Mosolova ◽  
Dmitry Sosin ◽  
Sergey Mosolov
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Female Gender ◽  
Assessment Tools ◽  
Care Workers ◽  
Younger Age ◽  
Wide Range ◽  
Associated Risk Factors ◽  
Anxiety Depression ◽  
The Impact

During the COVID-19 pandemic, healthcare workers (HCWs) have been subject to increased workload while also exposed to many psychosocial stressors. In a systematic review we analyze the impact that the pandemic has had on HCWs mental state and associated risk factors. Most studies reported high levels of depression and anxiety among HCWs worldwide, however, due to a wide range of assessment tools, cut-off scores, and number of frontline participants in the studies, results were difficult to compare. Our study is based on two online surveys of 2195 HCWs from different regions of Russia during spring and autumn epidemic outbreaks revealed the rates of anxiety, stress, depression, emotional exhaustion and depersonalization and perceived stress as 32.3%, 31.1%, 45.5%, 74.2%, 37.7% ,67.8%, respectively. Moreover, 2.4% of HCWs reported suicidal thoughts. The most common risk factors include: female gender, nurse as an occupation, younger age, working for over 6 months, chronic diseases, smoking, high working demands, lack of personal protective equipment, low salary, lack of social support, isolation from families, the fear of relatives getting infected. These results demonstrate the need for urgent supportive programs for HCWs fighting COVID-19 that fall into higher risk factors groups.

scholarly journals Impact of Vibration on the Levels of Biomarkers: A Systematic Review

2021 ◽  
pp. 030157422110195
Author(s):  
Ashish Agrawal ◽  
TM Chou
Keyword(s):  
Systematic Review ◽  
Web Of Science ◽  
Tooth Movement ◽  
Orthodontic Tooth Movement ◽  
Cochrane Collaboration ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Electronic Search ◽  
Proquest Dissertation

Introduction: The objective of this systematic review is to assess the effect of vibrational force on biomarkers for orthodontic tooth movement. Methods: An electronic search was conducted for relevant studies (up to December 31, 2020) on the following databases: Pubmed, Google scholar, Web of Science, Cochrane Library, Wiley Library, and ProQuest Dissertation Abstracts and Thesis database. Hand searching of selected orthodontic journals was also undertaken. The selected studies were assessed for the risk of bias in Cochrane collaboration risk of bias tool. The “traffic plot” and “weighted plot” risk of bias distribution are designed in the RoB 2 tool. The 2 authors extracted the data and analyzed it. Results: Six studies fulfilled the inclusion criteria. The risks of biases were high for 4, low and some concern for other 2 studies. The biomarkers, medium, device, frequency and duration of device, as well as other data were extracted. The outcomes of the studies were found to be heterogenous. Conclusion: One study showed highly statistically significant levels of IL-1 beta with <.001. Rate of tooth movement was correlated with levels of released biomarkers under the influence of vibrational force in 3 studies, but it was found to be significant only in 1 study. It was further observed that vibration does not have any significant reduction in pain and discomfort.

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