scholarly journals Análise da Revisão Cochrane: Alta Hospitalar Precoce para Hospitalização Domiciliária. Cochrane Database Syst Rev. 2017;6:CD000356.

2017 ◽  
Vol 30 (12) ◽  
pp. 835
Author(s):  
Mariana Alves ◽  
Miguel Bigotte Vieira ◽  
João Costa ◽  
António Vaz Carneiro
Keyword(s):  
Systematic Review ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Care Group ◽  
Cochrane Central Register ◽  
Cochrane Database ◽  
Central Register ◽  
Objective Evidence ◽  
Hospital At Home ◽  
At Home

Hospital at home is a service that provides active treatment by healthcare professionals in the patient’s home for a condition that otherwise would require acute hospital in-patient care. However, the clinical benefit of this intervention and its effect on health costs are not established. This Cochrane systematic review aimed to assess the effectiveness and costs of managing patients with hospital at home compared with inpatient hospital care. A systematic review of the literature was carried out by searching the following databases to 9 January 2017: Cochrane Effective Practice and Organization of Care Group (EPOC) register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, EconLit and clinical trials registries. Thirty-two randomized trials (2 of which unpublished), including 4746 patients, were included. The present review provides insufficient objective evidence of economic benefit (through a reduction in hospital length of stay) or improved health outcomes.

scholarly journals A Systematic Review and Jurisdictional Scan of the Evidence Characterizing and Evaluating Assisted Peritoneal Dialysis Models

2020 ◽  
Vol 15 (4) ◽  
pp. 511-520 ◽  
Author(s):  
Mark Hofmeister ◽  
Scott Klarenbach ◽  
Lesley Soril ◽  
Nairne Scott-Douglas ◽  
Fiona Clement
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Peritoneal Dialysis ◽  
Cochrane Central Register ◽  
Home Based ◽  
Cochrane Database ◽  
Central Register ◽  
Professional Assistance ◽  
Dialysis Outcomes ◽  
Assisted Peritoneal Dialysis

Background and objectivesCompared with hemodialysis, home peritoneal dialysis alleviates the burden of travel, facilitates independence, and is less costly. Physical, cognitive, or psychosocial factors may preclude peritoneal dialysis in otherwise eligible patients. Assisted peritoneal dialysis, where trained personnel assist with home peritoneal dialysis, may be an option, but the optimal model is unknown. The objective of this work is to characterize existing assisted peritoneal dialysis models and synthesize clinical outcomes.Design, setting, participants, & measurementsA systematic review of MEDLINE, Cochrane Central Register of Controlled Trails, Cochrane Database of Systematic Reviews, Embase, PsycINFO, and CINAHL was conducted (search dates: January 1995–September 2018). A focused gray literature search was also completed, limited to developed nations. Included studies focused on home-based assisted peritoneal dialysis; studies with the assist provided exclusively by unpaid family caregivers were excluded. All outcomes were narratively synthesized; quantitative outcomes were graphically depicted.ResultsWe included 34 studies, totaling 46,597 patients, with assisted peritoneal dialysis programs identified in 20 jurisdictions. Two categories emerged for models of assisted peritoneal dialysis on the basis of type of assistance: health care and non–health care professional assistance. Reported outcomes were heterogeneous, ranging from patient-level outcomes of survival, to resource use and transfer to hemodialysis; however, the comparative effect of assisted peritoneal dialysis was unclear. In two qualitative studies examining the patient experience, the maintenance of independence was identified as an important theme.ConclusionsReported outcomes and quality were heterogeneous, and relative efficacy of assisted peritoneal dialysis could not be determined from included studies. Although the patient voice was under-represented, suggestions to improve assisted peritoneal dialysis included using a person-centered model of care, ensuring continuity of nurses providing the peritoneal dialysis assist, and measures to support patient independence. Although attractive elements of assisted peritoneal dialysis are identified, further evidence is needed to connect assisted peritoneal dialysis outcomes with programmatic features and their associated funding models.

scholarly journals Evaluation of Spontaneous Swallow Frequency in Healthy People and Those With, or at Risk of Developing, Dysphagia: A Systematic Review and Meta-Analysis.

2021 ◽  
Author(s):  
Joseph M Bulmer ◽  
Caroline Ewers ◽  
Michael J Drinnan ◽  
Victoria C Ewan
Keyword(s):  
Systematic Review ◽  
At Risk ◽  
Meta Analysis ◽  
Quality Criteria ◽  
Clinical Variable ◽  
Normative Values ◽  
Healthy Population ◽  
Cochrane Central Register ◽  
Cochrane Database ◽  
Central Register

Abstract BackgroundDysphagia is a common, and frequently undetected, complication of many neurological disorders and of sarcopoenia in ageing persons. However it is difficult to detect dysphagia clinically until the point of visible aspiration, and there are relatively few trained speech and language therapists, whose time and remit are limited to those with obvious disorders. Reduction in spontaneous swallowing frequency (SSF) has been mooted as a possible proxy for dysphagia. We therefore conducted a systematic review of the literature to describe SSF in both the healthy population, and in disease specific populations, in order to assess its utility as a screening tool to identify dysphagia.MethodsWe searched Medline, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials databases. Metadata were extracted, collated, and analysed via a random effects model to give quantitative insight.ResultsThree hundred and twelve articles were retrieved, with 19 meeting inclusion and quality criteria. Heterogeneity between studies was high (I2 = 98%), in part, due to the variety of methods for swallow identification reported. The mean SSF in Healthy younger groups was 0.98/min [CI: 0.78; 1.23]. In the Parkinson’s groups mean SSF was 0.59/min [0.41; 0.85]. Mean SSF in Healthy older, Higher risk and Dysphagic populations were similar (0.21/min [0.12; 0.37], 0.26/min [0.14; 0.85]), (0.27/min [0.17; 0.43] respectively).ConclusionsSSF is a novel, non-invasive clinical variable which warrants further explorations as to its potential to identify persons at risk of dysphagia. Larger, well-conducted studies are needed to develop objective, standardised methods for detecting SSF, and develop normative values in healthy populations.

scholarly journals Poststroke depression and risk of stroke recurrence and mortality: protocol of a meta-analysis and systematic review

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e026316 ◽  
Author(s):  
Wa Cai ◽  
Robert Stewart ◽  
Christoph Mueller ◽  
Yi-Jing Li ◽  
Wei-Dong Shen
Keyword(s):  
Systematic Review ◽  
Observational Studies ◽  
Meta Analysis ◽  
Stroke Recurrence ◽  
Cochrane Central Register ◽  
Poststroke Depression ◽  
Stroke Outcomes ◽  
Cochrane Database ◽  
Central Register ◽  
Registration Number

IntroductionA number of observational studies have indicated that poststroke depression could increase the risk of stroke outcomes. There is a meta-analysis indicating that poststroke depression is a risk factor of all-cause mortality. This paper reports the protocol for a systematic review and meta-analysis to clarify the associations of poststroke depression with stroke recurrence and mortality in order to determine whether poststroke depression is a predictor of stroke outcomes according to data extracted from relevant observational studies.Methods and analysisMEDLINE, Web of Science databases, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews will be used to conduct the search. Published studies written in English will be included. The risk of bias for the studies included in the systematic review or meta-analysis will be assessed by the Newcastle–Ottawa Quality Assessment Scale. HRs for stroke recurrence and mortality with 95% CIs will be included as primary outcomes. Subgroup analyses and meta-regression will be performed.Ethics and disseminationEthics approval will not be needed because the data used in this systematic review will be extracted from published studies. The results of the systematic review focusing on whether depression after stroke is a predictor for stroke recurrence and mortality will be disseminated by publication in a peer-reviewed journal.PROSPERO registration numberCRD42018107944.

scholarly journals Statins Reduce Mortality After Non-severe but Not After Severe Pneumonia: A Systematic Review and Meta-Analysis

2015 ◽  
Vol 18 (3) ◽  
pp. 286 ◽  
Author(s):  
Mingwang Jia ◽  
Wenjie Huang ◽  
Li Li ◽  
Zhong Xu ◽  
Lichan Wu
Keyword(s):  
Systematic Review ◽  
Protective Effect ◽  
Meta Analysis ◽  
Severe Pneumonia ◽  
Cochrane Central Register ◽  
Eligibility Criteria ◽  
Pneumonia Severity ◽  
Cochrane Database ◽  
Central Register ◽  
Statin Use

PURPOSE: The objective of this study was to perform a systematic review and meta-analysis of the effects of statins on mortality for patients with non-severe pneumonia or severe pneumonia. METHODS: PubMed, EMBASE, Cochrane Database of Systematic Reviews, Cochrane central register of controlled trials and Clinicaltrials.gov were searched for the association between statins and non-severe/severe pneumonia. Eligible articles were analyzed in Stata 12.0. RESULTS: The database search yielded a total of 566 potential publications, 24 studies involving 312,309 patients met the eligibility criteria. Pooled unadjusted data showed that statin use was associated with lower mortality after non-severe pneumonia (odds ratio [OR] 0.70, 95% confidence interval [CI], 0.66-0.73), but not severe pneumonia (OR 1.05; 95% CI, 0.86-1.28). However, this protective effect of statins was weakened using adjusted estimates (OR 0.78, 95% CI, 0.75-0.82). Besides, protective effect of statins was attenuated by confounders in a subgroup analysis, especially when accounting for pneumonia severity indicators (OR 0.88; 95% CI, 0.80-0.96). CONCLUSIONS: Statin use was associated with reduced mortality after non-severe pneumonia but not severe pneumonia and this protective effect was weakened in subgroups. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

scholarly journals Effects of enteral glutamine supplementation on intestinal permeability in acute pancreatitis: A literature review

2021 ◽  
Vol 4 (2) ◽  
pp. 46-56
Author(s):  
Evania Astella Setiawan ◽  
Diana Sunardi
Keyword(s):  
Acute Pancreatitis ◽  
Intestinal Permeability ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Glutamine Supplementation ◽  
Mucosal Barrier ◽  
Cochrane Central Register ◽  
University Of Oxford ◽  
Central Register ◽  
Gut Mucosal Barrier

Background. Glutamine has been shown to improve the gut mucosal barrier. However, the evidence for benefit of enteral glutamine on intestinal permeability in acute pancreatitis (AP) is limited. Objective. To identify the effect of enteral glutamine supplementation on intestinal permeability in patients with AP. Method. A systematic search was conducted by extracting evidence from published studies on enteral glutamine supplementation in three databases (PubMed, Cochrane Central Register of Controlled Trials, and SciElo) relevant to AP from 1 January 2010 till 31 December 2020. Outcomes assessed were intestinal permeability, infectious complication, hospital length of stay, and mortality rate. Results. A total of 6 studies found by search, in which 2 human RCTs with 7 days duration of intervention with 1b-1c quality based on Criteria by Center of Evidence-Based Medicine, University of Oxford. Both studies showed the benefit of early enteral glutamine supplementation on intestinal permeability in patients with AP. Conclusions. Enteral glutamine supplementation has been shown to improve the gut mucosal barrier in AP. Despite its significant improvement in intestinal permeability, glutamine supplementation did not display a consistently positive effect on clinical outcomes.

Functional cortical changes associated with shoulder instability – a systematic review

2021 ◽  
pp. 175857322110190
Author(s):  
Morissa F Livett ◽  
Deborah Williams ◽  
Hayley Potter ◽  
Melinda Cairns
Keyword(s):  
Systematic Review ◽  
Joint Instability ◽  
Glenohumeral Joint ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Cortical Function ◽  
High Quality Research ◽  
Central Register ◽  
Rehabilitative Measures ◽  
Randomised Controlled

Background Glenohumeral joint instability is associated with structural deficits and/or alterations in sensory and motor processing; however, a proportion of patients with glenohumeral joint instability fail to respond to surgical and rehabilitative measures. This systematic review aimed to establish if functional cortical changes occur in patients with glenohumeral joint instability. Methods AMED, CINAHL, Cochrane Central Register of Controlled Trials, Embase, Medline, PEDro, Pubmed, PsychINFO and Scopus were searched from inception to 17 March 2021. Randomised controlled trials and non-randomised trials were included and quality was appraised using the Downs and Black tool. Results One thousand two hundred seventy-nine records were identified of which five were included in the review. All studies showed altered cortical function when comparing instability patients with healthy controls and included areas associated with higher cortical functions. Discussion The findings of this systematic review offer some insight as to why interventions addressing peripheral pathoanatomical factors in patients with glenohumeral joint instability may fail in some cases due to functional cortical changes. However, data are of moderate to high risk of bias. Further high-quality research is required to ascertain the degree of functional cortical changes associated with the type and duration of glenohumeral joint instability.

scholarly journals Music intervention to relieve anxiety and pain in adults undergoing cardiac surgery: a systematic review and meta-analysis

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001474
Author(s):  
Ellaha Kakar ◽  
Ryan J Billar ◽  
Joost van Rosmalen ◽  
Markus Klimek ◽  
Johanna J M Takkenberg ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Rating Scale ◽  
Meta Analysis ◽  
Numeric Rating Scale ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Music Intervention ◽  
Opioid Use ◽  
Beneficial Effects

ObjectivesPrevious studies have reported beneficial effects of perioperative music on patients’ anxiety and pain. We performed a systematic review and meta-analysis of randomised controlled trials investigating music interventions in cardiac surgery.MethodsFive electronic databases were systematically searched. Primary outcomes were patients’ postoperative anxiety and pain. Secondary outcomes were hospital length of stay, opioid use, vital parameters and time on mechanical ventilation. PRISMA guidelines were followed and PROSPERO database registration was completed (CRD42020149733). A meta-analysis was performed using random effects models and pooled standardised mean differences (SMD) with 95% confidence intervals were calculated.ResultsTwenty studies were included for qualitative analysis (1169 patients) and 16 (987 patients) for meta-analysis. The first postoperative music session was associated with significantly reduced postoperative anxiety (SMD = –0.50 (95% CI –0.67 to –0.32), p<0.01) and pain (SMD = –0.51 (95% CI –0.84 to –0.19), p<0.01). This is equal to a reduction of 4.00 points (95% CI 2.56 to 5.36) and 1.05 points (95% CI 0.67 to 1.41) on the State-Trait Anxiety Inventory and Visual Analogue Scale (VAS)/Numeric Rating Scale (NRS), respectively, for anxiety, and 1.26 points (95% CI 0.47 to 2.07) on the VAS/NRS for pain. Multiple days of music intervention reduced anxiety until 8 days postoperatively (SMD = –0.39 (95% CI –0.64 to –0.15), p<0.01).ConclusionsOffering recorded music is associated with a significant reduction in postoperative anxiety and pain in cardiac surgery. Unlike pharmacological interventions, music is without side effects so is promising in this population.

Use of opioids in patients with cancer with hepatic impairment—a systematic review

2021 ◽  
pp. bmjspcare-2021-003065
Author(s):  
Lewis Thomas Hughes ◽  
David Raftery ◽  
Paul Coulter ◽  
Barry Laird ◽  
Marie Fallon
Keyword(s):  
Systematic Review ◽  
Cancer Pain ◽  
Hepatic Impairment ◽  
Evaluation System ◽  
Meta Analysis ◽  
Hepatic Function ◽  
Cochrane Central Register ◽  
Assessment Development ◽  
Patients With Cancer ◽  
Central Register

PurposeOpioids are recommended for moderate-to-severe cancer pain; however, in patients with cancer, impaired hepatic function can affect opioid metabolism. The aim of this systematic review was to evaluate the evidence for the use of opioids in patients with cancer with hepatic impairment.MethodsA systematic review was conducted and the following databases searched: AMED (−2021), MEDLINE (−2021), EMBASECLASSIC + EMBASE (−2021) and Cochrane Central Register of Controlled Trials (−2021). Eligible studies met the following criteria: patients with cancer-related pain, taking an opioid (as defined by the WHO Guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents); >18 years of age; patients with hepatic impairment defined using recognised or study-defined definitions; clinical outcome hepatic impairment related; and primary studies. All eligible studies were appraised using the Grading of Recommendations Assessment, Development and Evaluation system.ResultsThree studies (n=95) were eligible but heterogeneity meant meta-analysis was not possible. Each individual study focused on only one each of oxycodone±hydrocotarnine, oxycodone/naloxone and morphine. No recommendations could be formulated on the preferred opioid in patients with hepatic impairment.ConclusionsMorphine is the preferred opioid in hepatic impairment owing to clinical experience and pharmacokinetics. This review, however, found little clinical evidence to support this. Dose adjustments of morphine and the oxycodone formulations reviewed remain necessary in the absence of quality evidence. Overall, the quality of existing evidence on opioid treatments in cancer pain and hepatic impairment is low and there remains a need for high-quality clinical studies examining this.

scholarly journals Dynamic compared to rigid fixation in lumbar spine: a systematic review

2014 ◽  
Vol 60 (2) ◽  
pp. 151-155 ◽  
Author(s):  
Ricardo Vieira Botelho ◽  
Rafael Bastianello Junior ◽  
Luciana DiniGianini de Albuquerque ◽  
Wanderley Marques Bernardo
Keyword(s):  
Systematic Review ◽  
Lumbar Spine ◽  
Randomized Trials ◽  
Published Data ◽  
Rigid Fixation ◽  
Cochrane Central Register ◽  
Pedicle Fixation ◽  
Central Register ◽  
Spine Fixation

Objective: The objective of this review is to reveal the quality of published data and the effect size of DPFs compared to rigid fixation in lumbar spine. Summary of background data: since 2002, several dynamic pedicle fixation (DPF) systems have been developed with the aim to stabilize the spine without the undesirable effects of rigid lumbar spine fixation. Nearly ten years later, there are several studies on these dynamic systems. Methods: A systematic review was done in MEDLINE/PubMED, Embase, Cochrane Central Register of Randomized Trials and Google Scholar to assess the quality of published literature and the available studied outcomes in randomized controlled trials of DPF. Results: Only three papers described randomized trials studying DPF. One of them focused on protection of adjacent level disease provided by DPF. Conclusion: It was not possible to reveal any evidence for benefits using DPF compared to rigid fixation in surgery for lumbar spine.

scholarly journals Connected care for endocarditis and heart failure patients: a hospital-at-home programme

2021 ◽  
Author(s):  
J. van Ramshorst ◽  
M. Duffels ◽  
S. P. M de Boer ◽  
A. Bos-Schaap ◽  
O. Drexhage ◽  
...  
Keyword(s):  
Heart Failure ◽  
Home Care ◽  
Nurse Practitioners ◽  
Care Group ◽  
Proof Of Concept ◽  
Home Setting ◽  
Curative Care ◽  
Care At Home ◽  
Hospital At Home ◽  
At Home

Abstract Background Healthcare expenditure in the Netherlands is increasing at such a rate that currently 1 in 7 employees are working in healthcare/curative care. Future increases in healthcare spending will be restricted, given that 10% of the country’s gross domestic product is spent on healthcare and the fact that there is a workforce shortage. Dutch healthcare consists of a curative sector (mostly hospitals) and nursing care at home. The two entities have separate national budgets (€25 bn + €20 bn respectively) Aim In a proof of concept, we explored a new hospital-at-home model combining hospital cure and nursing home care budgets. This study tests the feasibility of (1) providing hospital care at home, (2) combining financial budgets, (3) increasing workforces by combining teams and (4) improving perspectives and increasing patient and staff satisfaction. Results We tested the feasibility of combining the budgets of a teaching hospital and home care group for cardiology. The budgets were sufficient to hire three nurse practitioners who were trained to work together with 12 home care cardiovascular nurses to provide care in a hospital-at-home setting, including intravenous treatment. Subsequently, the hospital-at-home programme for endocarditis and heart failure treatment was developed and a virtual ward was built within the e‑patient record. Conclusion The current model demonstrates a proof of concept for a hospital-at-home programme providing hospital-level curative care at home by merging hospital and home care nursing staff and budgets. From the clinical perspective, ambulatory intravenous antibiotic and diuretic treatment at home was effective in safely achieving a reduced length of stay of 847 days in endocarditis patients and 201 days in heart-failure-at-home patients. We call for further studies to facilitate combined home care and hospital cure budgets in cardiology to confirm this concept.

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