Interprofessional education for delirium care: a systematic review

Abstract

Recent delirium prevention and treatment guidelines recommend the use of an interprofessional team trained and competent in delirium care. We conducted a systematic review to identify the evidence for the value of interprofessional delirium education programs on learning outcomes. We searched several databases and the grey literature. Studies describing an education intervention, involving two or more healthcare professions and reporting on at least one learning outcome as classified by Kirkpatrick’s evaluation framework were included in this review. Ten out of 633 abstracts reviewed met the study inclusion criteria. Several studies reported on more than one learning outcome. Two studies focused on learner reactions to interprofessional delirium education; three studies focused on learning outcomes (e.g. delirium knowledge); six studies focused on learner behavior in practice; and six studies reported on learning results (e.g. patient outcomes), mainly changes in delirium rates post-intervention. Studies reporting changes in patient outcomes following the delirium education intervention used an interprofessional practice (IPP) intervention in combination with interprofessional education (IPE). Our review of the limited evidence suggests that IPE programs may influence team and patient outcomes in delirium care. More systematic studies of the effectiveness of interprofessional delirium education interventions are needed.     

Effectiveness of pharmacist‐participated warfarin therapy management: a systematic review and meta‐analysis

Summary. Objective: Although pharmacist‐participated warfarin therapy management (PWTM) has been accepted and implemented in various parts of the world, the evidence demonstrating the effects of PWTM compared with usual care on clinical outcomes is lacking. We performed a systematic review and meta‐analysis to compare the effects of PWTM with usual care on bleeding and thromboembolic outcomes. Methods: We searched MEDLINE, SCOPUS, EMBASE, IPA, CINAHL, Cochrane CENTRAL, Thai Index Medicus and Thai Medical Index, and reference lists of studies, without language restriction. Databases were searched from their inception to July 2009. The studies using warfarin as an anticoagulant with sufficient data for compilation of 2 × 2 tables were included. Both randomized controlled trials (RCTs) and non‐RCTs were considered. Two authors independently reviewed each study, assigned quality scores and extracted data for all outcomes using a standardized form. Pooled effect estimates (risk ratio; RR) were obtained using a random effects model. Result: Of 661 articles identified, 24 studies with 728,377 patients were included. In the random‐effects meta‐analysis of RCTs, the PWTM group had statistically significant effects on the prevention of total bleeding [RR, 0.51; 95% confidence interval (CI), 0.28–0.94]. However, the effects on major bleeding (RR, 0.64; 95% CI, 0.18–2.36), thromboembolic events (RR, 0.79; 95% CI, 0.33–1.93), all‐cause mortality (RR, 0.93; 95% CI, 0.41–2.13) and warfarin‐related mortality (RR, 0.65; 95% CI, 0.18–2.42) were not significant. Conclusion: Pharmacist’s participation in the management of warfarin therapy significantly reduces total bleeding, with a non‐significant trend towards decreases in other warfarin‐related complications.     

Cadec: A corpus of adverse drug event annotations

CSIRO Adverse Drug Event Corpus (Cadec) is a new rich annotated corpus of medical forum posts on patient-reported Adverse Drug Events (ADEs). The corpus is sourced from posts on social media, and contains text that is largely written in colloquial language and often deviates from formal English grammar and punctuation rules. Annotations contain mentions of concepts such as drugs, adverse effects, symptoms, and diseases linked to their corresponding concepts in controlled vocabularies, i.e., SNOMED Clinical Terms and MedDRA. The quality of the annotations is ensured by annotation guidelines, multi-stage annotations, measuring inter-annotator agreement, and final review of the annotations by a clinical terminologist. This corpus is useful for studies in the area of information extraction, or more generally text mining, from social media to detect possible adverse drug reactions from direct patient reports. The corpus is publicly available at https://data.csiro.au.¹     

The Effect of Therapist Presence On a Desensitization Program For Test Anxiety

This study investigated the effect of varying degrees of therapist presence on outcome measures of a test anxiety program on systematic desensitization. Three treatments, which included face-to-face administration by a therapist, some therapist involvement, and fully automated administration were compared to a waiting list control group. It was found that all three treatments were effective when compared to the control group in terms of reduction of reported anxiety as measured by the STABS. It was noted that clients who used the automated program were more likely to terminate prematurely. It was concluded that, while all of the treatments may be effective in a laboratory setting, the presence of a counselor would seem to be important for the use of this type of program in a service agency.     

Additional bedtime H2‐receptor antagonist for the control of nocturnal gastric acid breakthrough: A Cochrane systematic review

OBJECTIVES: To assess the effectiveness and safety of additional bedtime H₂‐receptor antagonists (H₂RAs) in suppressing nocturnal gastric acid breakthrough (NAB) via a systematic review. METHODS: Eligible trials were identified by searching the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library Issue 2, 2004), MEDLINE (January 1966–June 2004), EMBASE (January 1980–June 2004) and CINAHL (January 1982–June 2004). Additional hand‐searching was conducted on the proceedings of correlated conferences, eight important Chinese journals and references of all included trials. All randomized controlled trials evaluating H₂RAs for the control of NAB were eligible for inclusion. The systematic review was conducted using methods recommended by The Cochrane Collaboration. RESULTS: Only two randomized crossover studies, comprising 32 participants, met the inclusion criteria. Because the design, dosage and duration of the treatments were different between the studies, it was not possible to conduct meta‐analysis. There were no consistent conclusions found between the two included studies in evaluating H₂RAs for the control of NAB. CONCLUSIONS: No implications for practice at this stage can be concluded. Appropriately designed large‐scale randomized controlled trials with long‐term follow up are needed to determine the effects of additional bedtime H₂RAs in suppressing NAB.     

系统疗养管理对高血压患者血压、精神状态及疾病认知的影响

目的探讨系统疗养管理对高血压患者血压、精神状态及疾病认知的影响。方法将2008年2月至2009年1月某疗养院91例高血压患者按随机数字表法分为实验组（n=47）与对照组（n=44）。在原有药物治疗基础上,实验组患者采用系统疗养管理,对照组患者进行常规疗养管理。疗养结束和疗养结束半年后,分别对两组高血压患者的血压控制情况、精神状态以及对高血压的疾病认知情况进行对比分析。结果疗养结束时,两组患者的降压效果的差异无统计学意义（P〉0.05）;疗养结束半年后实验组患者的血压控制效果明显优于对照组,差异有统计学意义（P〈0.05）。疗养前两组患者精神状态的差异无统计学意义（P〉0.05）;疗养结束时及疗养结束半年后,实验组患者的焦虑自评量表（self-rating anxiety scale,SAS）与抑郁自评量表（self-rating depressive scale,SDS）评分均优于对照组,差异有统计学意义（P〈0.05）。疗养结束时,实验组患者在心理调节和生活习惯及运动上的评分优于对照组,差异有统计学意义（P〈0.05）;疗养结束半年后,两组患者在高血压知识掌握和行为改善情况各项上的差异均有统计学意义（均P〈0.05）。结论疗养院护士采用系统疗养管理对于高血压患者控制血压和坚持健康行为有效,有利于促进高血压患者的康复。     

Neurolinguistic programming: a systematic review of the effects on health outcomes

Background

Neurolinguistic programming (NLP) in health care has captured the interest of doctors, healthcare professionals, and managers.

Aim

To evaluate the effects of NLP on health-related outcomes.

Design and setting

Systematic review of experimental studies.

Method

The following data sources were searched: MEDLINE®, PsycINFO, ASSIA, AMED, CINAHL®, Web of Knowledge, CENTRAL, NLP specialist databases, reference lists, review articles, and NLP professional associations, training providers, and research groups.

Results

Searches revealed 1459 titles from which 10 experimental studies were included. Five studies were randomised controlled trials (RCTs) and five were pre-post studies. Targeted health conditions were anxiety disorders, weight maintenance, morning sickness, substance misuse, and claustrophobia during MRI scanning. NLP interventions were mainly delivered across 4–20 sessions although three were single session. Eighteen outcomes were reported and the RCT sample sizes ranged from 22 to 106. Four RCTs reported no significant between group differences with the fifth finding in favour of the NLP arm (F = 8.114, P<0.001). Three RCTs and five pre-post studies reported within group improvements. Risk of bias across all studies was high or uncertain.

Conclusion

There is little evidence that NLP interventions improve health-related outcomes. This conclusion reflects the limited quantity and quality of NLP research, rather than robust evidence of no effect. There is currently insufficient evidence to support the allocation of NHS resources to NLP activities outside of research purposes.     

Short-term treatment of gastroesophageal reflux disease

OBJECTIVE: To investigate the efficacy of acid suppressant drugs in the empirical treatment of gastroesophageal reflux disease (GERD) and in the treatment of endoscopy-negative reflux disease (ENRD). DESIGN: medline, embase, and the Cochrane Controlled Trials Register were searched. Bibliographies were reviewed. SETTING: Studies were eligible that compared the short-term use of proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) with each other or with placebo in adults with GERD who were enrolled irrespective of endoscopic findings (empirical cases) or in whom endoscopy showed no signs of esophagitis (endoscopy-negative cases). MEASUREMENTS: Of 1,408 studies, only 13 could be included for meta-analysis. Data on 3,433 patients empirically treated for GERD and 2,520 patients treated for ENRD were extracted. The primary endpoint was relief of heartburn. MAIN RESULTS: In the empirical treatment of GERD, the summary relative risk (sRR) for symptom relief from H2RAs versus placebo was 0.77 (95% confidence interval [95% CI], 0.60 to 0.99). RR in the only placebo-controlled PPI trial was 0.35 (95% CI, 0.26 to 0.46). The sRR for standard dose PPIs versus H2RAs was 0.55 (95% CI, 0.44 to 0.68). In treatment of ENRD, both PPIs (sRR, 0.64; 95% CI, 0.52 to 0.79) and H2RAs (sRR, 0.78; 95% CI, 0.62 to 0.97) were superior to placebo, and PPIs were superior to H2RAs (sRR, 0.81; 95% CI, 0.70 to 0.95). CONCLUSIONS: Acid suppressant therapy (with a PPI or an H2RA) is more effective than placebo for short-term relief of heartburn in patients with persistent symptoms who are treated empirically for GERD and in those in whom esophagitis was excluded after endoscopy. The benefit of PPIs compared with H2RAs is more pronounced in patients treated empirically.     

清热解毒类中药治疗癌性发热的Meta分析

目的 评价清热解毒类中药治疗癌性发热的疗效和安全性.方法 按照循证医学的要求,全面检索至2012年7月清热解毒类中药治疗癌性发热的临床对照研究文献.运用改良后Jadad量表评价纳入文献的方法学质量,并提取有效数据进行Meta分析,用RevMan5.0软件完成统计和系统评价.结果 共14篇文献包含908例患者符合纳入标准.Meta分析表明,清热解毒类中药治疗癌性发热的疗效优于对照组（RR 1.40,95％ CI：1.29 ～1.52）,其中对比消炎痛片（RR 1.36,95％ CI：1.22～ 1.51）、消炎痛栓剂（RR1.53,95％ CI：1.28～1.82）,差异均有统计学意义.清热解毒类中药复发率较对照组低,其中1周复发综合率差为-0.35（-0.23～0.55）、2周复发综合率差为-0.37（-0.24～0.57）.7篇文献报道了不良事件的结局,未见严重不良反应的报道.结论 清热解毒类中药治疗癌性发热的疗效较好,且复发率低.