scholarly journals Methodological Approaches to Support Process Improvement in Emergency Departments: A Systematic Review

2020 ◽  
Vol 17 (8) ◽  
pp. 2664 ◽  
Author(s):  
Miguel Angel Ortíz-Barrios ◽  
Juan-José Alfaro-Saíz
Keyword(s):  
Process Improvement ◽  
Operations Research ◽  
Lean Manufacturing ◽  
Patient Flow ◽  
Inclusion Criteria ◽  
Left Without Being Seen ◽  
Extended Length ◽  
Methodological Approaches ◽  
Meta Analyses ◽  
Future Work

The most commonly used techniques for addressing each Emergency Department (ED) problem (overcrowding, prolonged waiting time, extended length of stay, excessive patient flow time, and high left-without-being-seen (LWBS) rates) were specified to provide healthcare managers and researchers with a useful framework for effectively solving these operational deficiencies. Finally, we identified the existing research tendencies and highlighted opportunities for future work. We implemented the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to undertake a review including scholarly articles published between April 1993 and October 2019. The selected papers were categorized considering the leading ED problems and publication year. Two hundred and three (203) papers distributed in 120 journals were found to meet the inclusion criteria. Furthermore, computer simulation and lean manufacturing were concluded to be the most prominent approaches for addressing the leading operational problems in EDs. In future interventions, ED administrators and researchers are widely advised to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for upgrading the performance of EDs. On a different tack, more interventions are required for tackling overcrowding and high left-without-being-seen rates.

Adverse Effects of Natural Products: A Brief Pre-Systematic Review

2020 ◽  
Vol 01 ◽  
Author(s):  
Carla Pires ◽  
Ana Fernandes
Keyword(s):  
Systematic Review ◽  
Adverse Event ◽  
Natural Products ◽  
Adverse Events ◽  
In Vitro Study ◽  
Google Scholar ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Meta Analyses

Background: Natural products are commonly used for treating health problems. These products may be associated with adverse events, which are defined as "noxious and unintended response to a medicinal product" by the European Medicine Agency. Objectives: To identify studies describing at least one adverse event (or with potential to promote an adverse event) related to the use of natural products, as well as to describe the involved product(s) and adverse event(s). Methods: A pre-systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Keywords: "natural product(s)" and ["adverse drug reaction(s)" or "adverse effect(s)"]. Screened databases: PubMed, SciELO, DOAJ and Google Scholar. Inclusion criteria: papers describing at least one adverse event associated with the use of natural products and published between 2017 and 2019. Exclusion criteria: Repeated studies, reviews and papers written in other languages than English, Portuguese, French or Spanish. Results: 104 studies were identified (20 PubMed; 0 SciELO; 2 DOAJ; 82 Google Scholar), but only 10 were selected (4 PubMed and 6 Google Scholar): 1 in-vitro study; 2 non-clinical studies, 1 study reporting in-vitro and clinical data and 5 studies were cases reports. Globally, 997 reports of adverse drug reactions with natural products were identified, mainly non-severe cases. Conclusion: Since a limited number of studies was found, we conclude that adverse events due to natural products may be underreported, or natural products may have a good safety profile. This review contributes for assuring the safety of natural products consumers, by evaluating the knowledge/information on the potential adverse events and interactions of these products.

Sleep and cognition

2018 ◽  
Author(s):  
Donald L. Bliwise ◽  
Michael K. Scullin
Keyword(s):  
Cognitive Function ◽  
Natural History ◽  
Population Health ◽  
Effect Sizes ◽  
Biological Plausibility ◽  
Vast Array ◽  
Neurobiological Substrates ◽  
Meta Analyses ◽  
Sleep And Cognition ◽  
Future Work

Possible associations between sleep and cognition are provocative across different domains and hold the promise of prevention or reversibility. A vast array of studies has been reported. Evidence is suggestive but hardly definitive. We provide an overview of this literature, adopting the framework of Hill’s perspective on epidemiological causation. With rare exception, formal meta-analyses have yet to appear. Apparent consistency of findings suggests relationships, but the diversity of findings involving specific components of cognitive function raises interpretative caution. Large effect sizes have been noted, but small-to-moderate effects predominate. Natural history data are similarly enticing, and studies of biological plausibility and gradient indicate likely neurobiological substrates. Perhaps the ultimate population-health criterion, demonstration of reversibility of impairment, remains elusive at best. This area offers an exciting topic for future work.

scholarly journals Emotion Recognition in Adults With a History of Childhood Maltreatment: A Systematic Review

2021 ◽  
pp. 152483802110294
Author(s):  
Annie Bérubé ◽  
Jessica Turgeon ◽  
Caroline Blais ◽  
Daniel Fiset
Keyword(s):  
Systematic Review ◽  
Child Maltreatment ◽  
Emotion Recognition ◽  
Childhood Maltreatment ◽  
Mental Health Problems ◽  
Inclusion Criteria ◽  
History Of Childhood ◽  
History Of ◽  
Effects On Children ◽  
Meta Analyses

Child maltreatment has many well-documented lasting effects on children. Among its consequences, it affects children’s recognition of emotions. More and more studies are recognizing the lasting effect that a history of maltreatment can have on emotion recognition. A systematic literature review was conducted to better understand this relationship. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol was used and four databases were searched, MEDLINE/PubMed, PsycINFO, EMBASE, and FRANCIS, using three cross-referenced key words: child abuse, emotion recognition, and adults. The search process identified 23 studies that met the inclusion criteria. The review highlights the wide variety of measures used to assess child maltreatment as well as the different protocols used to measure emotion recognition. The results indicate that adults with a history of childhood maltreatment show a differentiated reaction to happiness, anger, and fear. Happiness is less detected, whereas negative emotions are recognized more rapidly and at a lower intensity compared to adults not exposed to such traumatic events. Emotion recognition is also related to greater brain activation for the maltreated group. However, the results are less consistent for adults who also have a diagnosis of mental health problems. The systematic review found that maltreatment affects the perception of emotions expressed on both adult and child faces. However, more research is needed to better understand how a history of maltreatment is related to adults’ perception of children’s emotions.

Process Improvement of Brake Lever Production Using DMAIC (+)

2011 ◽  
Author(s):  
Chittaranjan Sahay ◽  
Suhash Ghosh ◽  
Pradeep Kumar Bheemarthi
Keyword(s):  
Data Analysis ◽  
Problem Solving ◽  
Process Improvement ◽  
Six Sigma ◽  
Lean Manufacturing ◽  
Cost Effective ◽  
Poor Quality ◽  
Statistical Process ◽  
Automotive Components ◽  
The Cost

This work describes a strategy to reduce the cost associated with poor quality, by reducing the parts per million defects by Defining, Measuring, Analyzing, Implementing and Controlling (DMAIC) the production process. The method uses a combination of principles of Six Sigma applications, Lean Manufacturing and Shanin Strategy. The process has been used in analyzing the manufacturing lines of a brake lever at a Connecticut automotive components manufacturing company for reducing the cost associated with the production of nonconforming parts. The analysis was carried out with the help of the data collected on nonconformance parts and the application of phase change rules from DMAIC (+). Data analysis was carried out on statistical process control softwares, MINITAB and SPC XL 2000. Although, the problem of tight bushing existed on only one line of the brake lever assembly, this problem solving approach has solved the tight bushing problems on all assembly and alternates lines in a time- and cost-effective way.

scholarly journals Osteoarthritis, mobility-related comorbidities and mortality: an overview of meta-analyses

2020 ◽  
Vol 12 ◽  
pp. 1759720X2098121
Author(s):  
Gustavo Constantino de Campos ◽  
Raman Mundi ◽  
Craig Whittington ◽  
Marie-Josée Toutounji ◽  
Wilson Ngai ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Ischemic Attack ◽  
Meta Analyses ◽  
The Relationship ◽  
Related Mortality

Aims: The objective of this review was to examine the relationship between osteoarthritis (OA) and mobility-related comorbidities, specifically diabetes mellitus (DM) and cardiovascular disease (CVD). It also investigated the relationship between OA and mortality. Methods: An overview of meta-analyses was conducted by performing two targeted searches from inception to June 2020. The association between OA and (i) DM or CVD ( via PubMed and Embase); and (ii) mortality ( via PubMed) was investigated. Meta-analyses were selected if they included studies that examined adults with OA at any site and reported associations between OA and DM, CVD, or mortality. Evidence was synthesized qualitatively. Results: Six meta-analyses met inclusion criteria. One meta-analysis of 20 studies demonstrated a statistically significant association between OA and DM, with pooled odds ratio of 1.41 (95% confidence interval: 1.21, 1.65; n = 1,040,175 patients). One meta-analysis of 15 studies demonstrated significantly increased risk of CVD among OA patients, with a pooled risk ratio of 1.24 (1.12, 1.37, n = 358,944 patients). Stratified by type of CVD, OA was shown to be associated with increased heart failure (HF) and ischemic heart disease (IHD) and reduced transient ischemic attack (TIA). There was no association reported for stroke or myocardial infarction (MI). Three meta-analyses did not find a significant association between OA (any site) and all-cause mortality. However, OA was found to be significantly associated with cardiovascular-related death across two meta-analyses. Conclusion: The identified meta-analyses reported significantly increased risk of both DM and CVD (particularly, HF and IHD) among OA patients. It was not possible to confirm consistent directional or causal relationships. OA was found to be associated with increased mortality, but mostly in relation to CVD-related mortality, suggesting that further study is warranted in this area.

The use of chatbots as supportive agents for people seeking help for drug and alcohol addiction: A systematic review. (Preprint)

2021 ◽  
Author(s):  
Lisa Ogilvie ◽  
Jerome Carson ◽  
Julie Prescott
Keyword(s):  
Mixed Methods ◽  
Healthcare Setting ◽  
The Body ◽  
Alcohol Addiction ◽  
Bibliographic Databases ◽  
Ethical Implications ◽  
Qualitative Work ◽  
Meta Analyses ◽  
Future Work ◽  
Drug And Alcohol

BACKGROUND The use of chatbots in healthcare is an area of study receiving increased academic interest. As the knowledge base grows, the granularity in the level of research is being refined, seeing more targeted work in specific areas of healthcare, for example, chatbots for anxiety and depression, cancer care, and pregnancy support. This paper focuses on the targeted application of chatbots in drug and alcohol addiction. OBJECTIVE The aim of this paper is to systematically review and summarise the research conducted on the use of chatbots in the field of addiction, specifically the use of chatbots as supportive agents for those who suffer from drug and alcohol addiction. METHODS A systematic search of bibliographic databases using the broad search criteria of “chatbot and addiction,” identified papers for screening. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Mixed Methods Appraisal Tool were used, which resulted in the quality assessment and review of 5 papers. RESULTS Although the body of research in this field is limited, what has been published shows promising results. A combination of quantitative, qualitative, and mixed methods studies were reviewed, among which statistically significant findings were reported on the efficacy of chatbots targeted at drug and alcohol addiction. These findings were also substantiated in the qualitative work reviewed. A strong message of caution was conveyed however on the ethical implications of using chatbots to afford support to addicted individuals. CONCLUSIONS The literature reviewed shows that more work is needed to appreciate solutions that leverage existing data, such as big data available from social media, or that which is accessed by prevalent market leading chatbots. It also highlighted ethical concerns over the use of a non-human agent to afford support to those with drug and alcohol addiction. It was reported however, that statistically significant results were returned for ‘bespoke’ chatbots in this area of healthcare, setting a promising foundation for future work.

scholarly journals The impact on patient flow after the integration of nurse practitioners and physician assistants in 6 Ontario emergency departments

CJEM ◽  
2009 ◽  
Vol 11 (05) ◽  
pp. 455-461 ◽  
Author(s):  
James Ducharme ◽  
Robert J. Alder ◽  
Cindy Pelletier ◽  
Don Murray ◽  
Joshua Tepper
Keyword(s):  
Health Care ◽  
Nurse Practitioners ◽  
Emergency Departments ◽  
Patient Flow ◽  
Physician Assistants ◽  
Wait Times ◽  
Care Providers ◽  
Lengths Of Stay ◽  
Left Without Being Seen ◽  
The Impact

ABSTRACT Objective: We sought to assess the impact of the integration of the new roles of primary health care nurse practitioners (NPs) and physician assistants (PAs) on patient flow, wait times and proportions of patients who left without being seen in 6 Ontario emergency departments (EDs). Methods: We performed a retrospective review of health records data on patient arrival time, time of initial assessment by a physician, time of discharge from the ED and discharge status. Results: Whether a PA or NP was directly involved in the care of patients or indirectly involved by being on duty, the wait times, lengths of stay and proportion of patients who left without being seen were significantly reduced. When a PA or NP were directly involved in patients' care, patients were 1.6 (95% confidence interval [CI] 1.3–2.1, p < 0.05) and 2.1 (95% CI 1.6–2.8, p < 0.05) times more likely to be seen within the wait time benchmarks, respectively. Lengths of stay were 30.3% (95% CI 21.6%–39.0%, p < 0.01) and 48.8% (95% CI 35.0%–62.7%, p < 0.01) lower when PAs and NPs, respectively, were involved. When PAs and NPs were not on duty, the proportion of patients who left without being seen were 44% (95% CI 31%–63%, p < 0.01) and 71% (95% CI 53%–96%, p < 0.05), respectively. Conclusion: The addition of PAs or NPs to the ED team can improve patient flow in medium-sized community hospital EDs. Given the ongoing shortage of physicians, use of alternative health care providers should be considered. These results require validation, as their generalizability to other locations or types of EDs is not known.

How Can Social Mentality Theory Help Us Understand Eating Disorder Presentations? A Scoping Review

2018 ◽  
Vol 9 ◽  
Author(s):  
Georgina Mullen ◽  
Gary O'Reilly
Keyword(s):  
Eating Disorder ◽  
Attachment Style ◽  
Systematic Reviews ◽  
Scoping Review ◽  
Social Rank ◽  
Inclusion Criteria ◽  
Self Compassion ◽  
Social Difficulties ◽  
Caregiver Experiences ◽  
Meta Analyses

AbstractThis scoping review used social mentality theory (SMT) as a framework to identify and integrate relevant eating disorder systematic reviews and meta-analyses. A systematic search of the PsycINFO database was conducted, using terms from SMT and eating disorder literature. Eighteen systematic reviews met the inclusion criteria. Findings suggest that those with eating disorders also experience a number of relationship difficulties, in childhood and/or adulthood, related to attachment style, caregiver experiences, family functioning, social rank, social cognition, and self-compassion. The identification of these social difficulties is established in the eating disorder literature. SMT can provide a theoretical framework to understand how evolved motives to relate to others may contribute to these difficulties.

scholarly journals Effectivity of Psychotherapy Interventions for Anxiety in Medical Students: A Systematic Review

2021 ◽  
Vol 9 (F) ◽  
pp. 453-463
Author(s):  
Andrian Fajar Kusumadewi ◽  
Carla Raymondalexas Marchira ◽  
Widyandana Widyandana ◽  
Ronny Tri Wirasto
Keyword(s):  
Systematic Review ◽  
Medical Students ◽  
Systematic Reviews ◽  
Depression And Anxiety ◽  
Inclusion Criteria ◽  
Meta Analyses ◽  
And Behavior ◽  
Anxiety Depression ◽  
Suicidal Ideas ◽  
Psychotherapy Interventions

BACKGROUND: The mental health of medical students has long been a topic of concern in many countries. Much research in Europe reported that around 30% of medical students suffered from anxiety. Anxiety disorders have significant physical and emotional consequences. Various studies show that excessive, unmanaged stress related to poor academic performance in medical students leads to cynical personalities, lack of empathy, and suicidal ideas. AIM: This study aimed to identify studies for psychotherapy interventions carried out in medical students and analyze each impact on anxiety level in medical students. METHODS: This systematic review was conducted with evidence sourced from 2000 to 2020. The review process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study was registered with the Prospective Registering of Systematic Reviews database (Protocol ID: CRD42020180650). RESULTS: Twenty-three studies meet the inclusion criteria, and there are various psychotherapy interventions to deal with anxiety. Most studies reported that students who received mindfulness-based interventions reported lower anxiety, depression, and stress. CONCLUSION: There are various interventions carried out to decrease stress levels, depression, and anxiety in medical students. The most effective psychotherapy was found in cognitive and behavior intervention and mindfulness intervention.

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