Systematic Review Of Patient Outcomes Research Articles

A systematic review of patient outcomes for primary pediatric flexor tendon repairs

BackgroundLiterature on pediatric flexor tendon repairs remains sparse. Given the various repair techniques and rehabilitation protocols available, the aim of this systematic review is to investigate outcomes of primary pediatric flexor tendon repairs. MethodsMEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases were searched from inception to June 2022 in concordance with PRISMA guidelines. Studies were included if patients were under the age of 18, sustained a flexor tendon injury repaired primarily, and had documented functional outcomes. Quality assessment was completed using the Newcastle-Ottawa Scale. The study was registered with PROSPERO (CRD42018089089). ResultsThis study includes 20 articles representing 577 patients with 748 injured digits, most frequently injured by a laceration from glass. The number of tendon injuries in zones I, II, III, IV, and V were 78, 431, 62, 2, and 19, respectively. In total, 594 FDP, 374 FDS, and 77 FPL tendons were lacerated. Concurrent digital nerve injuries occurred in 251 digits. Time of repair was 15 ​h–187 days post-injury, most commonly via the modified Kessler (n ​= ​266 digits) and Kessler (n ​= ​162 digits). Post-operatively, 170 patients were immobilized and 261 patients underwent early active (n ​= ​96) or passive (n ​= ​165) protocols. Functional outcomes were reported in 466 digits (excellent ​= ​306, good ​= ​132, fair ​= ​19, and poor ​= ​9, per the respective assessment tool used). There were 15 tendon ruptures. ConclusionsDespite heterogeneity in both operative and post-operative protocols, there is low level evidence that low complication rates and good outcomes are expected following primary repair of pediatric flexor tendons.

P115: Autologous Fat Grafting as a Treatment for Head and Neck Radiation-Induced Fibrosis: A Systematic Review of Patient Outcomes

Abstract Background Radiation-induced fibrosis (RIF) is a chronic, progressive complication of radiotherapy in head and neck cancer with no effective treatment. It has significant impact on quality of life, including pain, poor cosmesis and head and neck contracture. Autologous fat grafting (AFG) is an emerging treatment for RIF. We systematically review the evidence for AFG as a treatment for Head and Neck RIF. Methods A systematic search strategy was designed a priori to established PRISMA guidelines. MEDLINE, Embase, Cochrane Library, and clinical trial registries were searched from inception. Eligibility criteria included any study investigating AFG as an intervention for RIF following head and neck cancer. Results Fourteen studies met the inclusion criteria, all of which reported physician-assessed aesthetic improvement. No study reported objective measurements of skin biomechanics. Functional outcomes were assessed in eight studies, using the UW-QOL V4, FOIS, VAS and penetration-aspiration scale. Psychological and quality of life outcomes were assessed in four studies via the UW-QOL V4, POS head/neck, SWOL-QOL, DAS24, SF-36 and VAS. Complication rates were low. Conclusions Clinical studies demonstrate that AFG may be an effective treatment for RIF in head and neck cancer patients. Outcome measures used varied between studies; development of a core outcomes set including PROMs and objective biomechanical measures of fibrosis would improve the quality of future research and a candidate list of outcomes is proposed.

Systematic Review of Patient Outcomes and Associated Predictors After Microfracture in the Patellofemoral Joint.

Background:We summarized the clinical outcomes and predictors of clinical outcomes after microfracture for chondral lesions in the patellofemoral joint (PFJ).Methods:Embase, PubMed, CENTRAL, BIOSIS, and CINAHL databases were searched between January 1, 1980, and January 1, 2019, to identify all articles that examined outcomes or predictors of outcomes of microfracture in patients with patellofemoral chondral lesions. Studies of full-thickness chondral lesions in the PFJ were included, whereas those involving adolescents, partial-thickness chondral lesions, and underlying patellar instability were excluded.Results:We found a total of 257 articles, of which 8 articles (174 patients) met our inclusion criteria. All studies found improvement in clinical outcomes after microfracture in the PFJ. Younger patients showed greater improvement in clinical outcomes than older patients. However, the effect of size, severity (grade), or location of chondral lesions on clinical outcomes after microfracture is unclear.Conclusion:We found improvement in clinical outcomes after microfracture in the PFJ at midterm follow-up. Age may be a predictor of successful outcomes and longevity of the repair; however, there is insufficient evidence regarding the influence of defect size, severity, and location on clinical outcomes.

Impact of SLCO1B1 Pharmacogenetic Testing on Patient and Healthcare Outcomes: A Systematic Review.

Demonstrated improvements in patient outcomes will facilitate the clinical implementation of pharmacogenetic testing. Using the association between solute carrier organic anion transporter family member 1B1 (SLCO1B1) and statin-associated muscle symptoms (SAMSs) as a model, we conducted a systematic review of patient outcomes after delivery of SLCO1B1 results. Using PubMed and Embase searches through December 19, 2017, we identified 37 eligible records reporting preliminary or final outcomes, including six studies delivering only SLCO1B1 results and five large healthcare system-based implementation projects of multipharmacogene panels. Two small trials have demonstrated at least short-term improvements in low-density lipoprotein cholesterol after SLCO1B1 testing among previously statin intolerant patients. Evidence from large implementation projects suggests that SLCO1B1 results may change prescribing patterns for some high-risk patients. No study has reported improvements in SAMSs or cardiovascular events or tracked the economic outcomes of SLCO1B1 testing. Ongoing studies should collect and report outcomes relevant to pharmacogenetics stakeholders.

Point-of-care lactate testing for sepsis at presentation to health care: a systematic review of patient outcomes.

Lactate is measured in hospital settings to identify patients with sepsis and severe infections, and to guide initiation of early treatment. Point-of-care technology could facilitate measurement of lactate by clinicians in the community. However, there has been little research into its utility in these environments. To investigate the effect of using point-of-care lactate at presentation to health care on mortality and other clinical outcomes, in patients presenting with acute infections. Studies comparing the use of point-of-care lactate to usual care in initial patient assessment at presentation to health care were identified using a maximally sensitive search strategy of six electronic databases. Two independent authors screened 3063 records for eligibility, and extracted data from eligible studies. Quality assessment for observational studies was performed using the ROBINS-I tool. Eight studies were eligible for inclusion (3063 patients). Seven studies were recruited from emergency departments, and one from a pre-hospital aeromedical setting. Five studies demonstrated a trend towards reduced mortality with point-of-care lactate; three studies achieved statistical significance. One study demonstrated a significant reduction in length of hospital stay, although another did not find any significant difference. Two studies demonstrated a significant reduction in time to treatment for antibiotics and intravenous fluids. This review identifies an evidence gap - there is no high-quality evidence to support the use of point-of-care lactate in community settings. There are no randomised controlled trials (RCTs) and no studies in primary care. RCT evidence from community settings is needed to evaluate this potentially beneficial diagnostic technology.

Clinical effectiveness and cost-effectiveness of depth of anaesthesia monitoring (E-Entropy, Bispectral Index and Narcotrend): a systematic review and economic evaluation

It is important that the level of general anaesthesia (GA) is appropriate for the individual patient undergoing surgery. If anaesthesia is deeper than required to keep a patient unconscious, there might be increased risk of anaesthetic-related morbidity, such as postoperative nausea, vomiting and cognitive dysfunction. This may also prolong recovery times, potentially increasing health-care costs. If anaesthesia is too light, patients may not be fully unconscious and could be at risk of intraoperative awareness. The objective of this report is to assess the clinical effectiveness and cost-effectiveness of Bispectral Index (BIS), E-Entropy and Narcotrend technologies, each compared with standard clinical monitoring, to monitor the depth of anaesthesia in surgical patients undergoing GA. A search strategy was developed and run on a number of bibliographic electronic databases including MEDLINE, EMBASE, The Cochrane Library and the Health Technology Assessment (HTA) database. For the systematic review of patient outcomes, databases were searched from the beginning of 2009 to November 2011 for studies of BIS (and then updated in February 2012), and from 1995 to November 2011 (and then updated in February 2012) for studies of E-Entropy and Narcotrend. For the systematic review of cost-effectiveness, searches were from database inception to November 2011 (an update search was performed in February 2012). The systematic review of patient outcomes followed standard methodology for evidence synthesis. A decision-analytic model was developed to assess the cost-effectiveness of depth of anaesthesia monitoring compared with standard clinical observation. A simple decision tree was developed, which accounted for patients' risk of experiencing short-term anaesthetic-related complications in addition to risk of experiencing intraoperative awareness. Twenty-two randomised controlled trials comparing BIS, E-Entropy and Narcotrend with standard clinical monitoring were included in the systematic review of patient outcomes, alongside evidence from a recent Cochrane review. Six trials of patients classified with risk factors for intraoperative awareness were combined in a fixed-effect meta-analysis. The overall pooled Peto's odds ratio was 0.45 (95% confidence interval 0.25 to 0.81) in favour of BIS. However, there was statistically significant heterogeneity. The base-case cost per quality-adjusted life-year (QALY) for BIS compared with standard clinical monitoring ranged from £22,339 to £44,198 depending on patient subgroups (type of GA received; level of risk for awareness). For E-Entropy, base-case estimates ranged from £14,421 to £31,430. For Narcotrend, estimates varied from a cost per QALY of £8033 to Narcotrend dominating standard clinical monitoring. The analysis was limited by lack of clinical effectiveness data, particularly for E-Entropy and Narcotrend. The available evidence on the impact of the technologies on reducing the likelihood of intraoperative awareness is limited. However, there were reductions in general anaesthetic consumption and anaesthetic recovery times. The cost-effectiveness of depth of anaesthesia monitoring appears to be highly dependent on a number of factors, including probability of awareness. PROSPERO registration number CRD42011001834. The National Institute for Health Research Health Technology Assessment programme.

Personalised support delivered by support workers for people with severe and persistent mental illness: a systematic review of patient outcomes

Personalised support services assist patients with severe and persistent mental illness (SPMI) to live with functional deficits by providing living skills, emotional support, community access and advocacy. This paper aims to systematically review the evidence for personalised support. Systematic searches of Medline, PsycINFO and Google Scholar (inception to March 2011) identified studies investigating patient outcomes for personalised support services. The quality of the selected studies was assessed. The strength of evidence for the three categories of patient outcomes (illness acuity, personal functioning and patient satisfaction) was graded. Fifteen studies met inclusion criteria with most rated as having moderate or weak study designs. The selected studies evaluated programs for outpatients with SPMI. There was moderate strength of evidence for reducing illness acuity and improving patient satisfaction with services, and weak strength of evidence for improving personal functioning in studies published to date. Most programs delivered multiple service types, and no clear pattern of service types leading to specific patient outcomes could be discerned. Although evidence published to date for personalised support is of variable quality, it suggests that services may be effective. More research on the effects of personalised support subtypes on patient outcomes is required.

For-profit versus not-for-profit delivery of long-term care

Public funds can be used to pay for health care services that are delivered either by for-profit or not-for profit agencies. A systematic review of patient outcomes in US hospitals by ownership status showed that not-for-profit hospitals tended to produce better results.[1][1] Although there are no