scholarly journals A systematic review of interventions to improve acute hospital care for people with dementia

2020 ◽  
Author(s):  
Melanie Karrer ◽  
Angela Schnelli ◽  
Adelheid Zeller ◽  
Hanna Mayer
Keyword(s):  
Systematic Review ◽  
Acute Care ◽  
Systematic Reviews ◽  
Acute Care Hospitals ◽  
Risk Of Bias ◽  
Special Care ◽  
Special Care Units ◽  
People With Dementia ◽  
Educational Programmes ◽  
Delirium Management

Abstract Background People with dementia are confronted with negative consequences due to hospital stays. When developing new interventions to improve the care of people with dementia in acute care hospitals, it is crucial to have a comprehensive overview of the previous interventions tested in this field and to know the investigated outcomes and effects. Methods We conducted a systematic review of interventional studies to provide an overview of interventions targeting the care situation of patients with dementia in acute care hospitals. We included trials with interventional study designs and systematic reviews of interventional studies with no restrictions regarding the outcomes. We searched five electronic databases, conducted a hand search of journals and performed forward and backward citation tracking of the included studies. For risk of bias assessment, we used the Cochrane Collaboration’s tool for assessing risk of bias in randomised trials, ROBANS (for non-randomised controlled trials) and AMSTAR (for systematic reviews). We provide tabular and narrative summaries of the findings. Results Nineteen studies met the inclusion criteria. he findings indicated a broad range of interventions and outcomes. We categorised the interventions into nine intervention types: educational programmes, family-/person-centred programmes, use of specially trained nurses, volunteer programmes, delirium management programmes, special care units and inpatient rehabilitation interventions. Staff outcomes were primarily investigated, followed by patient outcomes. Outcomes for relatives were only reported in three of the included studies. Educational programmes were the most commonly reported intervention type and showed improvements in staff outcomes. Family-/person-centred care programmes, use of specially trained nurses and delirium management programmes were able to improve patient-related outcomes, e.g. delirium severity, functional performance and rehospitalisation rates. Rehabilitation interventions after hip fractures and special care units for people with dementia showed hardly significant effects. Conclusions Although the included interventional studies were able to show improved outcomes for staff, relatives and patients, the evidence is insufficient to declare which interventions are effective in improving care for people with dementia in acute care hospitals. Future research should focus on patient and family caregiver outcomes. Furthermore, interventions addressing relatives, interprofessional collaboration and the entire practice culture are needed.

scholarly journals A systematic review of interventions to improve acute hospital care for people with dementia

2020 ◽  
Author(s):  
Melanie Karrer ◽  
Angela Schnelli ◽  
Adelheid Zeller ◽  
Hanna Mayer
Keyword(s):  
Systematic Review ◽  
Acute Care ◽  
Systematic Reviews ◽  
Acute Care Hospitals ◽  
Risk Of Bias ◽  
Special Care ◽  
Special Care Units ◽  
People With Dementia ◽  
Educational Programmes ◽  
Delirium Management

Abstract Background: People with dementia are confronted with negative consequences due to hospital stays. When developing new interventions to improve care for people with dementia in acute care hospitals (by intervention we understand organisational strategies, programmes, and/or treatments and actions performed by healthcare professionals), it is crucial to have a comprehensive overview of previous interventions tested in this field and to know the outcomes.Methods: We conducted a systematic review to provide an overview of interventions targeting the care situation of patients with dementia in acute care hospitals. We included trials with interventional study designs and systematic reviews without restrictions regarding the outcomes. We searched five electronic databases, conducted a hand search of journals and performed forward and backward citation tracking of included studies. For risk of bias assessment, we used the Cochrane Collaboration’s tool for assessing risk of bias in randomised trials, ROBANS (for non-randomised controlled trials) and AMSTAR (for systematic reviews). We provide tabular and narrative summaries of the findings. Results: Twenty studies met the inclusion criteria. The findings indicated a broad range of interventions and outcomes. We categorised the interventions into eight intervention types: educational programmes, special non-pharmacological interventions, delirium management programmes, inpatient rehabilitation interventions, family-/person-centred programmes, use of specially trained nurses, volunteer programmes and special care units. Staff outcomes were investigated in most of the studies, followed by patient outcomes. Outcomes concerning relatives were reported in four studies. Educational programmes were the most commonly reported intervention type and resulted in improved staff outcomes. Family-/person-centred care programmes, use of specially trained nurses and delirium management programmes were effective in improving patient-related outcomes, e.g. delirium severity and functional performance. Rehabilitation interventions after hip fractures and special care units for people with dementia hardly showed any significant effects. Conclusions: Although the included interventional studies reported improved outcomes concerning patients, relatives and staff, the evidence is insufficient to declare which interventions are effective in improving care for people with dementia in acute care hospitals. Future research should focus on relevant patient and family caregiver outcomes. Thereby, it is necessary to consider the complexity of the interventions. Interventions addressing relatives, interprofessional collaboration and the entire practice culture are needed. Trial registration: PROSPERO: CRD42018111032.

MRSA management strategies in acute care hospitals: a systematic review

2002 ◽  
Vol 7 (4) ◽  
pp. 128-135 ◽  
Author(s):  
Elizabeth J. Halcomb ◽  
Ritin S. Fernandez ◽  
Rhonda D. Griffiths
Keyword(s):  
Systematic Review ◽  
Acute Care ◽  
Management Strategies ◽  
Acute Care Hospitals

scholarly journals Interventions to improve healthcare workers’ hand hygiene compliance: A systematic review of systematic reviews

2018 ◽  
Vol 39 (12) ◽  
pp. 1449-1456 ◽  
Author(s):  
Lesley Price ◽  
Jennifer MacDonald ◽  
Lucyna Gozdzielewska ◽  
Tracey Howe ◽  
Paul Flowers ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hand Hygiene ◽  
Systematic Reviews ◽  
Hand Hygiene Compliance ◽  
Educational Interventions ◽  
Risk Of Bias ◽  
Future Research ◽  
Monitoring Technology ◽  
Positive Effects ◽  
Hygiene Compliance

AbstractObjectiveTo synthesize the existing evidence base of systematic reviews of interventions to improve healthcare worker (HCW) hand hygiene compliance (HHC).MethodsPRISMA guidelines were followed, and 10 information sources were searched in September 2017, with no limits to language or date of publication, and papers were screened against inclusion criteria for relevance. Data were extracted and risk of bias was assessed.ResultsOverall, 19 systematic reviews (n=20 articles) were included. Only 1 article had a low risk of bias. Moreover, 15 systematic reviews showed positive effects of interventions on HCW HHC, whereas 3 reviews evaluating monitoring technology did not. Findings regarding whether multimodal rather than single interventions are preferable were inconclusive. Targeting social influence, attitude, self-efficacy, and intention were associated with greater effectiveness. No clear link emerged between how educational interventions were delivered and effectiveness.ConclusionsThis is the first systematic review of systematic reviews of interventions to improve HCW HHC. The evidence is sufficient to recommend the implementation of interventions to improve HCW HHC (except for monitoring technology), but it is insufficient to make specific recommendations regarding the content or how the content should be delivered. Future research should rigorously apply behavior change theory, and recommendations should be clearly described with respect to intervention content and how it is delivered. Such recommendations should be tested for longer terms using stronger study designs with clearly defined outcomes.

scholarly journals A systematic review of interventions to improve acute hospital care for people with dementia

2021 ◽  
Author(s):  
Melanie Karrer ◽  
Angela Schnelli ◽  
Adelheid Zeller ◽  
Hanna Mayer
Keyword(s):  
Systematic Review ◽  
Hospital Care ◽  
Current Evidence ◽  
Future Research ◽  
Acute Hospital Care ◽  
Hand Search ◽  
People With Dementia ◽  
Acute Hospitals ◽  
Delirium Management ◽  
Study Designs

Abstract The aim of this study was to provide an overview of interventions targeting hospital care of patients with dementia. We conducted a systematic review, including interventional study designs. We searched five electronic databases, conducted a hand search and performed citation tracking. To assess risk of bias, we used Cochrane Collaboration’s tool, ROBANS and AMSTAR. We narratively summarized the outcomes.The findings of twenty studies indicated a broad range of interventions and outcomes. We categorised the interventions into eight intervention types. Educational programmes were the most reported intervention type and resulted in improved staff outcomes. Family-/person-centred care programmes, use of specially trained nurses and delirium management programmes were effective in improving patient-related outcomes. However, current evidence is insufficient to declare which interventions are effective in improving dementia care in acute hospitals. Future research should focus on relevant patient and family caregiver outcomes and must to consider the complexity of the interventions. Trial registration: PROSPERO: CRD42018111032.

scholarly journals An analysis of equity in treatment of hip fractures for older patients with dementia in acute care hospitals: observational study using nationwide hospital claims data in Japan

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Shinichi Tomioka ◽  
Megumi Rosenberg ◽  
Kiyohide Fushimi ◽  
Shinya Matsuda
Keyword(s):  
Hip Fracture ◽  
Older People ◽  
Acute Care ◽  
Waiting Time ◽  
Older Patients ◽  
Acute Care Hospitals ◽  
Care Quality ◽  
Severe Dementia ◽  
People With Dementia ◽  
Acute Care Settings

Abstract Background Globally, and particularly in countries with rapidly ageing populations like Japan, there are growing concerns over the heavy burden of ill health borne by older people, and the capacity of the health system to ensure their access to quality care. Older people with dementia may face even greater barriers to appropriate care in acute care settings. Yet, studies about the care quality for older patients with dementia in acute care settings are still few. The objective of this study is to assess whether dementia status is associated with poorer treatment by examining the association of a patient’s dementia status with the probability of receiving surgery and the waiting time until surgery for a hip fracture in acute care hospitals in Japan. Methods All patients with closed hip fracture were extracted from the Diagnosis Procedure Combination (DPC) database between April 2014 and March 2018. After excluding complicated cases, we conducted regressions with multilevel models. We used two outcome measures: (i) whether the patient received a surgery or was treated by watchful waiting; and (ii) number of waiting days until surgery after admission. Results Two hundred fourteen thousand six hundred one patients discharged from 1328 hospitals were identified. Among them, 159,173 patients received surgery. Both 80–89 year-olds (OR 0.87; 95% CI, 0.84, 0.90) and those 90 years old and above (OR 0.67; 95% CI, 0.65, 0.70) had significantly lower odds ratios for receiving surgery compared to 65–79 year-olds. Those with severe dementia had a significantly greater likelihood of receiving surgery compared to those without dementia (OR 1.21; 95% CI, 1.16, 1.25). Patients aged 90 years old and above had shorter waiting time for surgery (Coef. -0.06; 95% CI, − 0.11, − 0.01). Mild dementia did not have a statistically significant impact on the number of waiting days until surgery (P = 0.34), whereas severe dementia was associated with shorter waiting days (Coef. -0.08; 95% CI, − 0.12, − 0.03). Conclusions These findings suggest physicians may be taking proactive measures to preserve physical function for those with severe dementia and to avoid prolonged hospitalization although there are no formal guidelines on prioritization for the aged and dementia patients.

scholarly journals Additional Search Strategies May Not Be Necessary for a Rapid Systematic Review

2015 ◽  
Vol 10 (2) ◽  
pp. 150
Author(s):  
Joanne L. Jordan
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Reference Lists ◽  
Meta Analysis ◽  
Search Strategies ◽  
Risk Of Bias ◽  
Chronic Depression ◽  
Randomized Controlled ◽  
Central Database

A Review of: Westphal, A., Kriston, L., Hölzel, L.P., Härter, M., & von Wolff, A. (2014). Efficiency and contribution of strategies for finding randomized controlled trials: a case study from a systematic review on therapeutic interventions of chronic depression. Journal of Public Health Research, 3(2), 177. doi: 10.4081/jphr.2014.177 Abstract Objective – To evaluate the efficiency and contribution of additional searching strategies for finding randomized controlled trials (RCTs) in a systematic review. Design – A methodological case study. Setting – Biomedical literature. Methods – A sensitive search (defined as “the ratio of the number of relevant reports identified to the total number of relevant reports in existence”) was conducted of electronic databases, Cochrane CENTRAL database, MEDLINE, EMBASE, PsycInfo, CINAHL, BIOSIS, and Web of Science databases (Science and Social Science Citation Indexes). The following additional searching strategies were conducted: hand-searching contents of relevant journals (Archives of General Psychiatry, Journal of Consulting and Clinical Psychology, and Journal of Affective Disorders), citation tracking (forwards tracking using Social Science and Science Citation Index and backwards tracking by looking through reference lists of included studies), screening reference lists of relevant systematic reviews, searching clinical trials registers (ClinicalTrials.gov and ICTRP registers), and contacting first authors of included studies to find any similar unpublished studies. The number of articles identified by each of these methods was recorded and screened for inclusion in the systematic review. The authors calculated what they labelled as the ‘efficiency’ of each searching strategy (the number of included studies identified by the search method as a proportion of the full text articles screened) and the ‘contribution’ of the search strategies (the ratio of included studies identified by that method to the final number of included studies in the systematic review). The methodological quality of each included study was assessed using the Cochrane Risk of Bias Tool, which is a critical appraisal checklist used to judge the study’s value in the systematic review. The meta-analysis in the systematic review was conducted with and without the studies identified by the additional searching strategies to assess their impact on the review’s findings. Main Results – In total 50 studies were identified, 42 from electronic database searches and 8 from additional search strategies. As illustrated by the results in Table 1, the most useful additional search strategy was screening reference lists of relevant systematic reviews. Journal hand-searching and contacting authors also contributed to the review. Of the eight studies identified by the additional search strategies none were judged to have a low risk of bias (four had high risk of bias and four were unclear). Of the 42 included studies from electronic searches only 11 were judged to have a low risk of bias, whereas 9 studies had a high risk of bias and 22 were unclear. Excluding the eight studies retrieved from additional search strategies in the systematic review meta-analysis did not influence the results on the effectiveness of the different interventions for chronic depression. These studies were found to be indexed correctly on the electronic databases, but were not identified in the initial search. Conclusion – Additional search strategies, especially screening reference lists of systematic reviews and hand-searching relevant journals, retrieved a substantial number of relevant studies for a systematic review of interventions for treating chronic depression. However, results of the review’s meta-analysis did not differ when these additional studies (rated as either high or unclear risk of bias) were not included and search methods were time consuming. It might be reasonable to rely on electronic searching strategies when resources for conducting a systematic review are limited or when doing a “rapid review.” The benefits and limitations of additional search strategies should be considered particularly when resources or time for conducting a systematic review are limited. If the electronic database search is sensitive and includes the Cochrane CENTRAL database additional search strategies may not be necessary, but these findings should be tested in other research areas.

scholarly journals Clostridium DifficileInfection in Acute Care Hospitals: Systematic Review and Best Practices for Prevention

2017 ◽  
Vol 38 (4) ◽  
pp. 476-482 ◽  
Author(s):  
Irene K. Louh ◽  
William G. Greendyke ◽  
Emilia A. Hermann ◽  
Karina W. Davidson ◽  
Louise Falzon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hand Hygiene ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Grey Literature ◽  
Quality Criteria ◽  
Acute Care Hospitals ◽  
Cochrane Library ◽  
Chlorhexidine Bathing ◽  
The Impact

OBJECTIVEPrevention ofClostridium difficileinfection (CDI) in acute-care hospitals is a priority for hospitals and clinicians. We performed a qualitative systematic review to update the evidence on interventions to prevent CDI published since 2009.DESIGNWe searched Ovid, MEDLINE, EMBASE, The Cochrane Library, CINAHL, the ISI Web of Knowledge, and grey literature databases from January 1, 2009 to August 1, 2015.SETTINGWe included studies performed in acute-care hospitals.PATIENTS OR PARTICIPANTSWe included studies conducted on hospitalized patients that investigated the impact of specific interventions on CDI rates.INTERVENTIONSWe used the QI-Minimum Quality Criteria Set (QI-MQCS) to assess the quality of included studies. Interventions were grouped thematically: environmental disinfection, antimicrobial stewardship, hand hygiene, chlorhexidine bathing, probiotics, bundled approaches, and others. A meta-analysis was performed when possible.RESULTSOf 3,236 articles screened, 261 met the criteria for full-text review and 46 studies were ultimately included. The average quality rating was 82% according to the QI-MQCS. The most effective interventions, resulting in a 45% to 85% reduction in CDI, included daily to twice daily disinfection of high-touch surfaces (including bed rails) and terminal cleaning of patient rooms with chlorine-based products. Bundled interventions and antimicrobial stewardship showed promise for reducing CDI rates. Chlorhexidine bathing and intensified hand-hygiene practices were not effective for reducing CDI rates.CONCLUSIONSDaily and terminal cleaning of patient rooms using chlorine-based products were most effective in reducing CDI rates in hospitals. Further studies are needed to identify the components of bundled interventions that reduce CDI rates.Infect Control Hosp Epidemiol2017;38:476–482

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