Checklist Scores Research Articles

Associations between residential treatment length, PTSD, and outpatient healthcare utilization among veterans.

Premature discontinuation of posttraumatic stress disorder (PTSD) treatment is generally associated with poorer outcomes for veterans with PTSD. What is less clear is whether treatment benefits, as a function of treatment length, persist, as well as predict less future mental health care utilization. We sought to determine whether length of stay (LOS) in residential PTSD treatment predicted discharge PTSD symptom severity and outpatient mental health care utilization. We hypothesized discharge PTSD Checklist (PCL) scores would mediate the relations between LOS in residential treatment and outpatient mental health care utilization. The current study included 740 veterans who received residential PTSD treatment within 5 VA hospitals and completed intake and discharge assessments, including the PTSD Checklist (PCL). Information about LOS in residential treatment and outpatient mental health care utilization was obtained from the National Patient Care Database. We examined the relations between residential LOS, discharge Posttraumatic Stress Disorder Checklist (PCL), and outpatient mental health care utilization. Nonparametric bootstrapping was utilized to test for the significance of the indirect effect. Veterans who stayed in residential treatment longer had lower PCL scores at discharge (est. = -2.50, SE = .51, p < .001), and veterans with lower PCL scores at discharge sought fewer outpatient mental health visits (est. = .31, SE = .14, p = .03). A bias-corrected bootstrap confidence interval for the indirect effect (ab = -.77) based on 10,000 bootstrap samples was entirely below zero (-1.72 to -.05). This indicates discharge PCL mediated the relations between LOS and outpatient mental health care utilization, such that individuals with a longer LOS in residential PTSD treatment had lower PCL scores at discharge and thus utilized less outpatient mental health care. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Reporting quality of randomized controlled trial abstracts in the seven highest-ranking anesthesiology journals

BackgroundThe aim of this study was to assess adherence to the Consolidated Standards of Reporting Trials (CONSORT) extension for s (CONSORT-A) in the highest-impact anesthesiology journals.MethodsThis was a descriptive, cross-sectional, methodological study. We analyzed whether abstracts of randomized controlled trials (RCTs) published in the highest-impact anesthesiology journals between 2014 and 2016 adhered with CONSORT-A. RCT abstracts published in the seven first-quartile journals in the Journal Citation Reports (JCR) category Anesthesiology were analyzed. The primary outcome was adherence to the 17-item CONSORT-A checklist. Secondary outcomes were adherence to individual checklist items and adherence with the checklist across the individual journals.ResultsSearch results yielded 688 records, of which 622 abstracts were analyzed. Analysis of the total score of the CONSORT-A checklist indicated a per-article median of 41% (interquartile range 35–53%). The European Journal of Anesthesiology had the highest overall adherence rate (53%), whereas Anaesthesia had the lowest (32%). The lowest adherence was observed for the following items: Trial design (18%), Contact of the authors as an e-mail address of the corresponding author (16%), Recruitment status (9%), Number of participants analyzed (8%), Randomization (3%), and Funding (0.2%).ConclusionsRCT abstracts published in top anesthesiology journals are poorly reported, providing insufficient information to readers. Interventions are needed to increase adherence to relevant reporting checklists for writing RCT abstracts.

Infant temperament and behavioral problems: analysis of high-risk infants in child welfare

ABSTRACTResearchers have demonstrated the association between difficult temperament in infancy and early childhood behavioral problems, but to date this has not been demonstrated in the child welfare population. This study utilized the National Survey of Child and Adolescent Well-Being (NSCAW), a nationally representative, longitudinal survey of children in the child-welfare system. The sample consisted of 1084 infants 0–12 months old at baseline who were investigated for suspected child abuse. The researchers used longitudinal, multivariable logistic regression to examine the association between difficult temperament score in infants 0–12 months who had child welfare involvement and clinical-range Child Behavior Checklist (CBCL; Achenbach & Rescorla, 2000) score at 36-months-follow-up. Findings from this study suggest that among children with substantiated maltreatment, difficult temperament in infancy predicts early childhood behavioral problems. This relationship persists after adjusting for other risk factors, such as placement, caregiver depression, and family income. The study also discusses implications for child welfare practices.Abbreviations: National Survey of Child and Adolescent Wellbeing II (NSCAW-II); Child Behavior Checklist (CBCL); Early Childhood Behavioral Problems (ECBPs)

Effect of male-specific childhood trauma on telomere length

Child maltreatment (CM) is a global issue with serious lifelong consequences. In fact, maltreatment during childhood might be an important risk factor for the development of psychiatric disorders. Furthermore, previous studies showed a strong relationship between telomere length (TL) and early life stress. Considering that only a few studies have evaluated this relationship in children and that even fewer considered the sex as a possible moderator, we investigated whether TL in the blood of both children and adolescents was associated with psychopathology and with a history of CM, and whether these associations were moderated by the sex. In this cross-sectional study, 561 individuals (ranging between 6 and 14 years of age) from a large prospective community school-based study, i.e., the Brazilian High-Risk Cohort (HRC), were evaluated. The Child Behavior Checklist (CBCL) score was used to assess psychopathology, whereas a latent variable encompassing some questions about history of adverse environment and trauma was employed to determine the CM history. TL was measured in blood cells using a multiplex quantitative polymerase chain reaction. Additionally, TL was inserted in two moderation models, in which the CBCL score/CM, TL and sex were the independent variables, the outcome, and the moderator variable, respectively. Although an association between psychiatric symptoms and TL was not observed, a relation between CM and TL moderated by the sex was seen, indicating that males with higher CM scores presented with shorter telomeres than did females. Our results suggest that child maltreatment could influence telomere length in both children and adolescents and that this effect is mediated by the sex.

Adolescents’ and Young Adults’ Use and Perceptions of Pod-Based Electronic Cigarettes

ImportanceElectronic cigarettes (e-cigarettes) are the most commonly used tobacco product among adolescents and young adults, and the new pod-based e-cigarette devices may put adolescents and young adults at increased risk for polytobacco use and nicotine dependence.ObjectiveTo build an evidence base for perceptions of risk from and use of pod-based e-cigarettes among adolescents and young adults.Design, Setting, and ParticipantsIn a survey study, a cross-sectional analysis was performed of data collected from April 6 to June 20, 2018, from 445 California adolescents and young adults as part of an ongoing prospective cohort study designed to measure the use and perceptions of tobacco products.ExposuresUse of pod-based e-cigarettes, e-cigarettes, and cigarettes.Main Outcomes and MeasuresEver use, past 7-day use, and past 30-day use and co-use of pod-based e-cigarettes, e-cigarettes, and cigarettes; use of flavors and nicotine in pod-based e-cigarettes and e-cigarettes; and associated perceptions of risks, benefits, and nicotine dependence.ResultsAmong 445 adolescents and young adults (280 females, 140 males, 6 transgender individuals, and 19 missing data; mean [SD] age, 19.3 [1.7] years) who completed wave 6 of the ongoing prospective cohort study, ever use information was provided by 437 respondents, of which 68 (15.6%) reported use of pod-based e-cigarettes, 133 (30.4%) reported use of e-cigarettes, and 106 (24.3%) reported use of cigarettes. The mean (SD) number of days that pod-based e-cigarettes were used in the past 7 days was 1.5 (2.4) and in the past 30 days was 6.7 (10.0). The mean (SD) number of days that other e-cigarettes were used in the past 7 days was 0.8 (1.8) and in the past 30 days was 3.2 (7.4). The mean (SD) number of days that cigarettes were used in the past 7 days was 0.7 (1.8) and in the past 30 days was 3.0 (7.6). Among ever users of pod-based e-cigarettes, 18 (26.5%) reported their first e-liquid was flavored menthol or mint and 19 (27.9%) reported fruit (vs 13 [9.8%] and 50 [37.6%] for other e-cigarettes). The mean perceived chance of experiencing social risks and short-term and long-term health risks from the use of either pod-based e-cigarettes or other e-cigarettes was 40% and did not differ statistically by e-cigarette type. Among 34 adolescents and young adults reporting any loss of autonomy from nicotine, there was no difference in mean (SD) Hooked On Nicotine Checklist scores between those using pod-based e-cigarettes (2.59 [3.14]) and other e-cigarettes (2.32 [2.55]).Conclusions and RelevanceUse by adolescents and young adults of newer types of e-cigarettes such as pod-based systems is increasing rapidly, and adolescents and young adults report corresponding misperceptions and lack of knowledge about these products. Rapid innovation by e-cigarette manufacturers suggests that public health and prevention efforts appear to be needed to include messages targeting components common to all current and emerging e-cigarette products to increase knowledge and decrease misperceptions, with the goal to try to ultimately reduce e-cigarette use among adolescents and young adults.

Exploring associations between maternal adverse childhood experiences and child behavior

Adverse childhood experiences (ACEs) are linked to many negative outcomes for adults, but scant research has examined their intergenerational effects. This study's purpose is (1) to identify whether an association exists between maternal ACEs and children's psychosocial functioning, and, if so, (2) to delineate whether such an association is linked to age in a sample of families involved with the child welfare system (N = 259). The relationship between maternal ACEs and child behavior was assessed using OLS regressions, and significant, positive associations were found linking the number of maternal ACEs and children's standardized Child Behavior Checklist scores, on both internalizing (B = 0.10, p < .001) and externalizing (B = 0.09, p < .001) subscales. Age was not significantly associated with CBCL scores. Findings suggest the need for deeper understanding of the pathways for intergenerational transmission of risk, improved identification of parental risk and its symptoms, use of interventions accounting for parental ACEs, and greater attention to the environmental and societal contexts placing families in risk.

High-Value, Cost-Conscious Communication Skills in Undergraduate Medical Education

Training in high-value, cost-conscious care (HVCCC) is increasingly being incorporated into medical school curricula, but students may have limited opportunities to engage patients in HVCCC conversations. The aim of this study was to develop two standardized patient scenarios with associated checklists, hypothesizing that resulting scores would allow for valid formative assessments of HVCCC communication skills. Scenarios were designed to generate a less-is-more conversation (in response to a patient requesting an unnecessary test) and a shared decision-making conversation (in response to a patient choosing between multiple effective treatment options). Checklists were developed by experts and informed by the existing literature. Validity evidence was collected from content, response process, internal structure, relations to other variables, and consequences of testing. Ninety-three third-year medical students participated during 2014-2015. Mean checklist scores were 79% (SD = 18, Cronbach α = 0.72) and 72% (SD = 13, Cronbach α = 0.62) for the less-is-more and shared decision-making scenarios, respectively. Checklist scores correlated with global ratings of performance (r = 0.65 and 0.54, respectively, both P < 0.001), and overall interrater reliability was good (r = 0.66). Checklist scores discriminated between higher and lower performers (discrimination indices of 0.84 and 0.65, respectively, both P < 0.001). Most students (83/90, 92%) agreed that the session improved their HVCCC communication skills. This study provides validity evidence supporting the use of scores derived from two standardized patient scenarios for formative assessment of HVCCC communication skills among third-year medical students. These scenarios can help equip students with practical, patient-centered strategies for promoting value in clinical encounters.

Simulation Model for Retroperitoneal Dissection: Can Improve Surgical Skills for Complicated Open Laparotomy

Faculty Advisor: John Fischer, MD PURPOSE: To develop a low fidelity model for retroperitoneal dissection and identification of the ureter to improve resident's confidence and competency in the operating room. BACKGROUND: Work hour restrictions and few open laparotomies have created barriers to confident resident performance of retroperitoneal dissections. While simulation training models have been developed for laparoscopy, few have been created and validated for open laparotomies. METHODS: OB/GYN residents were divided into case (PGY3) and control (PGY4). A pretest questionnaire assessed operative experience. Both groups performed a videotaped low fidelity simulated retroperitoneal dissection that included identifying the course of the ureter. An instructional video was introduced and repeat simulation was performed by PGY3 trainees only. Three expert gynecologists independently scored performances using a checklist and global rating scale of operative performance (OSAT). PGY3 pretest/posttest scores were compared to PGY4 scores using the Wilcoxon rank sum test. Paired t-test was used for comparison of cases. P&lt;.05. RESULTS: Median pretest checklist score for PGY4 was significantly increased compared to PGY3 (7.3 vs. 6.3, P=.0314) however the median pretest OSAT score was not. A statistically significant increase in average PGY3 scores between pre vs. post final checklist scores and final OSAT scores was noted. A statistically significant increase in the median scores between PGY4 pretest (control) vs. PGY3 posttest (case) final checklist scores and final global scores (7.3 vs. 9.2, P=.0052) and (24.2 vs. 28.2, P=.0042) was noted. DISCUSSION: The development of a low fidelity model for retroperitoneal dissection and use of an instructional video may complement traditional learning for this core competency.

6.59 Efficacy of Stimulant Medications for Patients With Disruptive Behavior Disorders: A Prospective Cohort Study

The extent to which stimulant medications impact the core symptoms of disruptive behavioral disorders (DBD) other than symptoms of ADHD is of scientific debate. Most previous studies have either not clearly provided defined outcomes or have only evaluated DBD in the context of an existing comorbid ADHD diagnosis. The goal of the current study was to determine whether patients (especially younger individuals ages 6–10 years) on stimulants have significantly better Child Behavior Checklist (CBCL) scores on questions related to conduct disorder (CD), ODD, and irritability after behavioral modification program intervention compared with those who have not received stimulant medications.

Vasectomy Simulation Curriculum and Trainer with Enhanced Face, Content, and Construct Validity

IntroductionThe primary objective is to assess the face, content, and construct validity of a newly created vasectomy simulation module. MethodsPre- and post-simulation surveys quantifying simulation effectiveness, impact on confidence level, and critiques of the overall design were obtained in July 2015 to assess face and content validity. Residents were subdivided based on year of residency and construct validity was ascertained via a 20-objective checklist and individual Likert score as graded by a single attending physician in a blinded fashion. ResultsA total of 2 medical students and 8 residents (2 Pre-urology, 2 Uro-1, 2 Uro-2, and 2 Uro-3) were included in the analysis. The response rate was 100% (10/10) for the simulation exercise, and all residents (100%, 8/8) were used in the metric data analysis. Simulation increased the confidence to perform a vasectomy independently on average of 1.58 points based on pre- and post-questionnaire analysis (95% CI 1.09—2.89, P=.02). Training year had a significantly positive association (overall P<.01) with number of objectives completed. ConclusionsOur enhanced vasectomy simulation module demonstrated excellent face, content, and construct validity.

Postnatal development of organ systems: a species comparison

To evaluate obstetrics and gynecology resident physicians' performance following a simulation curriculum on dilation and evacuation (D&E) procedures.This study included two phases: simulation curriculum development and resident physician performance evaluation following training on a D&E simulator. Trainees participated in two evaluations. Simulation training evaluated participants performing six cases on a D&E simulator, measuring procedural time and a 26-step checklist of D&E steps. The operative training portion evaluated residents' performance after training on the simulator using mastery learning techniques. Intra-operative evaluation was based on a 21-step checklist score, Objective Structured Assessment of Technical Skills (OSATS), and percentage of cases completed.Twenty-two residents participated in simulation training, demonstrating improved performance from cases one and two to cases five and six, as measured by checklist score and procedural time (p < .001 and p = .001, respectively). Of 10 participants in the operative training, all performed at least three D&Es, while seven performed at least six cases. While checklist scores did not change significantly from the first to sixth case (mean for first case: 18.3; for sixth case: 19.6; p = .593), OSATS ratings improved from case one (19.7) to case three (23.5; p = .001) and to case six (26.8; p = .005). Trainees completed approximately 71.6% of their first case (range: 21.4–100%). By case six, the six participants performed 81.2% of the case (range: 14.3–100%).D&E simulation using a newly-developed uterine model and simulation curriculum improves resident technical skills. Simulation training with mastery learning techniques transferred to high level of performance in OR using checklist. The OSATS measured skills and showed improvement in performance with subsequent cases.Implementation of a D&E simulation curriculum offers potential for improved surgical training and abortion provision.

Pediatric-Oncology Simulation Training for Resident Education.

We sought to evaluate pediatric oncology simulations intended to improve pediatric residents' skills and comfort in caring for children with cancer. In a non-randomized trial, controls (the first three rotations) received a standard set of lectures, and the intervention arm received these lectures plus five simulation-training scenarios-fever/neutropenia, a new leukemia diagnosis, end-of-life care discussion, tumor lysis syndrome, and a mediastinal mass. All residents were tested after the rotation on the first three scenarios; management skills were evaluated independently by two raters. Before and after training, all residents completed an emotional-appraisal questionnaire evaluating each scenario as a perceived challenge or threat. Analysis of variance (ANOVA) measured differences by study arm in skills-checklist assessments and appraisals; repeated-measures ANOVA measured changes in emotional-appraisal scores. Forty-two residents (9 control, 33 intervention) participated. Inter-rater agreement for skills-checklist scores using average-measures intraclass correlation was high (0.847), and overall mean scores were significantly higher for the intervention than control group across both raters (P = 0.005). For all residents, perceived challenge increased in the end-of-life simulation, and perceived threat decreased in all three test scenarios. The intervention group, regardless of training year, evaluated the teaching scenarios favorably and felt that challenging oncology situations were addressed, skills were enhanced, and the simulations should be offered to other residents. It was feasible to introduce residents to difficult pediatric oncology scenarios using simulation. The intervention group performed more skills than controls when tested, and perceive threat declined in all residents after their pediatric oncology rotation.

Development of a technical checklist for the assessment of suturing in robotic surgery.

With the increased use of simulation for surgical training, there is a need for objective forms of assessment to evaluate trainees. The Global Evaluative Assessment of Robotic Skills (GEARS) is widely used for assessing skills in robotic surgery, but there are no recognised checklist scoring systems. This study aimed to develop a checklist for suturing in robotic surgery. A suturing checklist for needle driving and knot tying was constructed following evaluation of participants performing urethrovesical anastomoses. Key procedural steps were identified from expert videos, while assessing novice videos allowed identification of common technical errors. 22 novice and 13 expert videos were marked on needle driving, while 18 novices and 10 experts were assessed on knot tying. Validation of the finalised checklist was performed with the assessment of 39 separate novices by an expert surgeon and compared to GEARS scoring. The internal consistency of the preliminary checklist was high (Cronbach's alpha = 0.870 for needle driving items; 0.736 for knot tying items), and after removal of poorly correlating items, the final checklist contained 23 steps. Both the needle driving and knot tying categories discriminated between novices and experts, p < 0.005. While the GEARS score demonstrated construct validity for needle driving, it could not significantly differentiate between novices and experts for knot tying, p = 0.286. The needle driving category significantly correlated with the corresponding GEARS scores (rs = 0.613, p < 0.005), but the correlation for knot tying was insignificant (rs = 0.296, p = 0.127). The pilot data indicates the checklist significantly correlated with the GEARS score (p < 0.005). This study reports the development of a valid assessment tool for suturing in robotic surgery. Given that checklists are simple to use, there is significant scope for this checklist to be used in surgical training.

Home Safety of Individuals with Neurological Disorders: A Turkish Sample

The aim of this study is to determine the home safety status and associated risks of individuals with neurological disorders. Material and Methods: Eighty-three individuals with neurological disorders living in Denizli constitute the sample group of the study. The Home Safety Checklist was employed in order to evaluate the home safety status of the participants. Results: While 93% of the participants (n=77) were considered to be living in ‘dangerous’ homes, 7% (n=6) had ‘good’ homes according to the Home Safety Checklist scores. In this study’s sample, no participant was considered to be living in a ‘perfect’ home. Conclusion: The results are indicative of the fact that the home safety scores of participants with neurological disorders are very low. In light of this, the environment and living area of the affected individuals should be adapted according to their limitations in such a way so as to enable them to live a barrier-free and easier life.

Neonatal Intubation Competency Assessment Tool: Development and Validation

BackgroundNeonatal tracheal intubation (NTI) is an important clinical skill. Suboptimal performance is associated with patient harm. Simulation training can improve NTI performance. Improving performance requires an objective assessment of competency. Competency assessment tools need strong evidence of validity. We hypothesized that an NTI competency assessment tool with multisource validity evidence could be developed and be used for formative and summative assessment during simulation-based training. MethodsAn NTI assessment tool was developed based on a literature review. The tool was refined through 2 rounds of a modified Delphi process involving 12 subject-matter experts. The final tool included a 22-item checklist, a global skills assessment, and an entrustable professional activity (EPA) level. The validity of the checklist was assessed by having 4 blinded reviewers score 23 videos of health care providers intubating a neonatal simulator. ResultsThe checklist items had good internal consistency (overall α = 0.79). Checklist scores were greater for providers at greater training levels and with more NTI experience. Checklist scores correlated with global skills assessment (ρ = 0.85; P < .05), EPA levels (ρ = 0.87; P < .05), percent glottic exposure (r = 0.59; P < .05), and Cormack-Lehane scores (ρ = 0.95; P < .05). Checklist scores reliably predicted EPA levels. ConclusionsWe developed an NTI competency assessment tool with multisource validity evidence. The tool was able to discriminate NTI performance based on experience. The tool can be used during simulation-based NTI training to provide formative and summative assessment and can aid with entrustment decisions.

Preventive Effect of Suvorexant for Postoperative Delirium after Coronary Artery Bypass Grafting.

Objective: Suvorexant is an orexin receptor antagonist and is effective in inducing sleep. We hypothesized that Suvorexant would reduce the incidence of postoperative delirium (POD) after coronary artery bypass grafting (CABG).Methods: We reviewed 88 patients (12 women, mean age: 69.3 ± 2.5 years) who were undergone CABG alone. Patients were divided into two groups; patients received Suvorexant (S group, n = 36), patients not received Suvorexant (N group, n = 52), and the following data were analyzed and compared between two groups.Results: Intensive Care Unit Delirium Screening Checklist Score was significantly lower in S group compared with N group (N:S = 2.0 ± 1.7:0.8 ± 1.0, p = 0.0003). Although POD was present in 11 of 52 patients (21.2%) in N group, one patient (2.8%) developed in S group (p = 0.008). In S group, both intensive care unit stay (N:S = median 6:5 days, p = 0.001) and hospital stay (N:S = median 23:20 days, p = 0.035) were significantly shorter than in N group.Conclusions: Suvorexant might reduce incidence of POD in patients undergone CABG.

Incidence of Phlebitis Among Adult Patients with Peripheral Intravenous Catheter in an East Coast Hospital Malaysia

Objective: This study aims to determine the incidence rate of phlebitis among patients with a peripheral intravenous catheter. Methods: An observational study was conducted in one of the hospitals in East Coast Malaysia. There were 321 data collected from patients who had a peripheral intravenous catheter in medical, gynaecology and orthopaedic wards. The incidence of phlebitis was evaluated using a modified Visual Infusion Phlebitis score checklist. Results: The incidence of phlebitis, was found out to be 36.1% (n=116/321). Most patients who developed phlebitis had visual infusion phlebitis, with a score of two (34.9%) and the rest developed phlebitis with a score of three (1.2%). Conclusion: This high incidence of phlebitis indicated a worrying outcome. Therefore, the study findings suggested that a specific guideline on post insertion management of peripheral intravenous catheter should be revised which may help in reducing more incidence of phlebitis, subsequently reduce infection in an award, and provide more safety environment in hospital and reducing cost in managing infection control.

The Effect of Empowering Mothers of Infants Hospitalized at the Neonatal Intensive Care Unit on Their Participation in Neonatal Care

Abstract Introduction: Mothers’ participation in the Neonatal Intensive Care Unit is important in promoting neonatal care and good outcomes for neonates and their mothers. The present study was conducted with the aim of assessing the effect of empowering mothers of hospitalized neonates on the level of their participation in neonatal care. Methods: This quasi-experimental single-group study with before-after design recruited 59 mothers of neonates hospitalized at the NICU, selected according to the study inclusion criteria. Data were collected using educational needs questionnaire and the maternal participation checklist. The questionnaire was completed by mothers and the participation checklist by the researcher before the intervention. The empowerment program was then implemented over 2 to 4 days. Results: Comparison of participants› checklist scores before and after the implementation of the empowerment program in 3 domains of care needs, information needs, and bonding, and attachment needs, showed significant increases in the level of mothers› participation. The comparison of checklist participation scores showed that the Mean (M) and Standard Deviation (SD) of scores before and after performing the mothers› empowerment were respectively 7.61 ± 3.66 and 12.38 ± 1.31 in the care area, 1.47 ± 0.99 and 3.13 ± 0.66 in the information area, and 4.77 ± 1.42 and 5.70 ± 0.59 in the area of attachment and dependency. Conclusions: Implementation of the empowerment program for mothers based on their educational needs significantly increased mothers› participation in neonatal care. This empowerment program could be applied for a broad range of population of mothers at the intensive care units of neonates.

Effect of hyperbaric oxygenation therapy on post-concussion syndrome.

The present review evaluated the effect of hyperbaric oxygenation (HBO) therapy on post-concussion syndrome (PCS). Searches for publications from the earliest date possible up until the first week of 2016 were conducted using the electronic databases Cochrane, EBSCOhost, Embase, Ovid MEDLINE, PubMed and Web of Science. Additional trials were identified through reference list scanning. Randomized controlled trials assessing the effectiveness of HBO therapy in PCS were selected and tested for eligibility for inclusion in the present review. Two independent reviewers conducted data extraction and the Cochrane Collaboration's recommended method was used to assess the risk of bias in each study included. Review Manager 5.3 software was used for data synthesis and analysis and the standardized mean difference (SMD) or mean difference (MD) was estimated with a fixed or random effects model using a 95% confidence interval (CI). A total of 127 articles were identified, 4 of which were eligible for final analysis. The meta-analysis identified no difference in the Rivermead Post-Concussion Symptoms Questionnaire (MD=1.23; 95% CI, −3.47-5.94; P>0.05; I2=35%) or Post-Traumatic Stress Disorder Checklist (PCL) scores (SMD=0.12; 95% CI, −0.31-0.54; P>0.05; I2=0%) scores between groups receiving different oxygen doses. The differences in PCL scores (SMD=−0.13, 95% CI, −0.80-0.53; P>0.05; I2=63%) and neurobehavioral symptoms (SMD=−1.00, 95% CI, −2.58-0.58; P>0.05; I2=92%) between the HBO and sham groups were not significant. The current study demonstrated that HBO therapy has no significant effect on PCS compared with the sham group. Therefore, it was determined that effective design and execution of a large clinical trial, which includes treatment, control and sham groups is required in the future.

A hospital-wide evaluation of delirium prevalence and outcomes in acute care patients - a cohort study

BackgroundDelirium is a well-known complication in cardiac surgery and intensive care unit (ICU) patients. However, in many other settings its prevalence and clinical consequences are understudied. The aims of this study were: (1) To assess delirium prevalence in a large, diverse cohort of acute care patients classified as either at risk or not at risk for delirium; (2) To compare these two groups according to defined indicators; and (3) To compare delirious with non-delirious patients regarding hospital mortality, ICU and hospital length of stay, nursing hours and cost per case.MethodsThis cohort study was performed in a Swiss university hospital following implementation of a delirium management guideline. After excluding patients aged < 18 years or with a length of stay (LOS) < 1 day, 29′278 patients hospitalized in the study hospital in 2014 were included.Delirium period prevalence was calculated based on a Delirium Observation Scale (DOS) score ≥ 3 and / or Intensive Care Delirium Screening Checklist (ICDSC) scores ≥4.ResultsOf 10′906 patients admitted, DOS / ICDSC scores indicated delirium in 28.4%. Delirium was most prevalent (36.2–40.5%) in cardiac surgery, neurosurgery, trauma, radiotherapy and neurology patients. It was also common in geriatrics, internal medicine, visceral surgery, reconstructive plastic surgery and cranio-maxillo-facial surgery patients (prevalence 21.6–28.6%). In the unadjusted and adjusted models, delirious patients had a significantly higher risk of inpatient mortality, stayed significantly longer in the ICU and hospital, needed significantly more nursing hours and generated significantly higher costs per case. For the seven most common ICD-10 diagnoses, each diagnostic group’s delirious patients had worse outcomes compared to those with no delirium.ConclusionsThe results indicate a high number of patients at risk for delirium, with high delirium prevalence across all patient groups. Delirious patients showed significantly worse clinical outcomes and generated higher costs. Subgroup analyses highlighted striking variations in delirium period-prevalence across patient groups. Due to the high prevalence of delirium in patients treated in care centers for radiotherapy, visceral surgery, reconstructive plastic surgery, cranio-maxillofacial surgery and oral surgery, it is recommended to expand the current focus of delirium management to these patient groups.