A meta-analysis of randomized controlled trials

Purpose: The aim of this meta-analysis is to examine the efficacy and safety of intra-articular tranexamic acid (TXA) when compared to intravenous (IV) route. Methods: The literature search was conducted using PubMed, Cochrane Library, MEDLINE, EMBASE and China National Knowledge Infrastructure (CNKI). All randomized controlled trials evaluating the effectiveness of topical route and IV route of TXA administration were included. Results: Eight randomized clinical trials comprising of 857 patients were included in this analysis. We found no statistically significant difference in terms of total blood loss, drain output, transfusion requirement, thromboembolic complication, tourniquet time and surgical duration. Conclusion: Topical TXA has a similar efficacy to IV-TXA in reducing total blood loss, drain output, transfusion rate and haemoglobin drop without any increase in thromboembolic complications

The emotional labour of quality improvement work in end of life care : a qualitative study of Patient and Family Centred Care in England

Abstract: Background: There is a growing emphasis on understanding patient experience in order to inform efforts to support improvement. This paper reports findings from an implementation study of an evidence-based intervention called Patient and Family Centred Care (PFCC) designed to tap into patient experiences as a basis for improvement. In this study the PFCC intervention was spread to a new service area (end of life care) and delivered at scale in England. The findings presented here focus specifically on one key aspect of the intervention: staff shadowing of patients, and the experiences of staff carrying out shadowing for the purposes of service improvements. Methods: The study methods were ethnographic observations of key events, semi-structured interviews with members of participating teams and the programme implementation support team and managers, and a review of the documents used in the set up and running of the programme. Results: One of the key strengths of the PFCC approach is to encourage staff through shadowing to engage with patient experience of services. Many staff described the process of shadowing as a transformative experience that alerted them to immediate areas where their services could be improved. However, engaging with patient experience of end of life care services also had unintended consequences for some staff in the form of emotional labour. Furthermore, we observed difficulties encountered by staff that are not accounted for in the existing PFCC literature relating to how care service structures may unevenly distribute the amount of ‘emotional labour’ that staff members need to invest in implementing the programme. Conclusions: Connecting with patient experience is a crucial aspect of a number of quality improvement interventions that aim to help staff to engage with the lived experience of their services and reconnect their motivations for working in the health care system. However, there may be unintended consequences for health care service staff, particularly in sensitive areas of service delivery such as end of life care. The ‘emotional labour’ for staff of engaging in quality improvement work informed by patient experience should be considered in planning and supporting patient experience led quality improvement

“What Matters to You?”: A pilot project for implementing patient-centered care

This project was intended to enhance the delivery of patient-centered care by asking patients what matters to them before and after total joint replacement (TJR) surgery. In Phase I, pre-operatively, patients undergoing total joint replacement (TJR) surgery were asked, “What matters to you before surgery, during your hospital stay, and in the first 3 months following surgery?” and “What matters to you moving forward after you’ve recovered from your joint replacement?” Four weeks post-operatively they were asked, “Now that that you’ve been through the surgery and first 4 weeks of recovery, can you identify new concerns that you didn’t have before?” and “What matters to you moving forward after you’ve recovered?” In Phase 2, 49 patients were asked pre-operatively, “Thinking ahead in this process…what matters to you?” Four weeks post-operatively, they were told, “Now that you’ve gained experience from going through a joint replacement, rank the categories in terms of how important it would have been to know in your pre-operative interview what you know now.” In Phase 1, 98% of patients answered the questions the same way pre- and post-operatively. The 2% who did not reported greater than expected surgical pain. In Phase 2, patients ranked the 3 most important categories pre- and post-operatively surgical results, quality of life, and reduction in pain. The WMTY project may increase patients’ engagement in their care, show providers how to better understand what matters to their patients, and help surgeons to define outcomes more broadly

“What Matters to You?”: A pilot project for implementing patient-centered care

This project was intended to enhance the delivery of patient-centered care by asking patients what matters to them before and after total joint replacement (TJR) surgery. In Phase I, pre-operatively, patients undergoing total joint replacement (TJR) surgery were asked, “What matters to you before surgery, during your hospital stay, and in the first 3 months following surgery?” and “What matters to you moving forward after you’ve recovered from your joint replacement?” Four weeks post-operatively they were asked, “Now that that you’ve been through the surgery and first 4 weeks of recovery, can you identify new concerns that you didn’t have before?” and “What matters to you moving forward after you’ve recovered?” In Phase 2, 49 patients were asked pre-operatively, “Thinking ahead in this process…what matters to you?” Four weeks post-operatively, they were told, “Now that you’ve gained experience from going through a joint replacement, rank the categories in terms of how important it would have been to know in your pre-operative interview what you know now.” In Phase 1, 98% of patients answered the questions the same way pre- and post-operatively. The 2% who did not reported greater than expected surgical pain. In Phase 2, patients ranked the 3 most important categories pre- and post-operatively surgical results, quality of life, and reduction in pain. The WMTY project may increase patients’ engagement in their care, show providers how to better understand what matters to their patients, and help surgeons to define outcomes more broadly