Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-analysis

The use of palliative care programs and the number of trials assessing their effectiveness have increased

Interventions to Improve Patient Comprehension in Informed Consent for Medical and Surgical Procedures: An Updated Systematic Review.

Background. Patient comprehension is fundamental to valid informed consent. Current practices often result in inadequate patient comprehension. Purpose. An updated review to evaluate the characteristics and outcomes of interventions to improve patient comprehension in clinical informed consent. Data Sources. Systematic searches of MEDLINE and EMBASE (2008-2018). Study Selection. We included randomized and nonrandomized controlled trials evaluating interventions to improve patient comprehension in clinical informed consent. Data Extraction. Reviewers independently abstracted data using a standardized form, comparing all results and resolving disagreements by consensus. Data Synthesis. Fifty-two studies of 60 interventions met inclusion criteria. Compared with standard informed consent, a statistically significant improvement in patient comprehension was seen with 43% (6/14) of written interventions, 56% (15/27) of audiovisual interventions, 67% (2/3) of multicomponent interventions, 85% (11/13) of interactive digital interventions, and 100% (3/3) of verbal discussion with test/feedback or teach-back interventions. Eighty-five percent of studies (44/52) evaluated patients' understanding of risks, 69% (41/52) general knowledge about the procedure, 35% (18/52) understanding of benefits, and 31% (16/52) understanding of alternatives. Participants' education level was reported heterogeneously, and only 8% (4/52) of studies examined effects according to health literacy. Most studies (79%, 41/52) did not specify participants' race/ethnicity. Limitations. Variation in interventions and outcome measures precluded conduct of a meta-analysis or calculation of mean effect size. Control group processes were variable and inconsistently characterized. Nearly half of studies (44%, 23/52) had a high risk of bias for the patient comprehension outcome. Conclusions. Interventions to improve patient comprehension in informed consent are heterogeneous. Interactive interventions, particularly with test/feedback or teach-back components, appear superior. Future research should emphasize all key elements of informed consent and explore effects among vulnerable populations

Dexmedetomidine for facilitating mechanical ventilation extubation in difficult-to-wean ICU patients: systematic review and meta-analysis of clinical trials

Background: Agitation and delirium are common in mechanically ventilated adult intensive care unit (ICU) patients and may contribute to delayed extubation times. Difficult-to-wean ICU patients have been associated with an increased risk of longer ICU length of stays and mortality. The purpose of this systematic review and meta-analysis is to evaluate the evidence of dexmedetomidine facilitating successful mechanical ventilation extubation in difficult-to-wean ICU patients and clinical outcomes. Methods: A literature search was conducted using MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Global Health, Cochrane Central Register of Controlled Trials, Clinical Trial Registries, and the Health Technology Assessment Database from inception to December 5, 2019. Randomized controlled trials evaluating dexmedetomidine with the intended purpose to facilitate mechanical ventilation liberation in adult ICU patients (≥18 years) experiencing extubation failure were included. The primary outcome of time to extubation was evaluated using the weighted mean difference (WMD), with a random effects model. Secondary analyses included hospital and ICU length of stay, in-hospital mortality, hypotension, and bradycardia. Results: A total of 6 trials (n = 306 patients) were included. Dexmedetomidine significantly reduced the time to extubation (WMD: −11.61 hours, 95% CI: −16.5 to −6.7, P =.005) and ICU length of stay (WMD: −3.04 days; 95% CI: −4.66 to −1.43). Hypotension risk was increased with dexmedetomidine (risk ratio [RR]: 1.62, 95% CI: 1.05-2.51), but there was no difference in bradycardia risk (RR: 3.98, 95% CI: 0.70-22.78). No differences were observed in mortality rates (RR: 1.30, 95% CI: 0.45-3.75) or hospital length of stay (WMD: −2.67 days; 95% CI: −7.73 to 2.39). Conclusions: Dexmedetomidine was associated with a significant reduction in the time to extubation and shorter ICU stay in difficult-to-wean ICU patients. Although hypotension risk was increased with dexmedetomidine, no differences in other clinical outcomes were observed

A Systematic Review of Global Health Assessment for Education in Healthcare Professions

Objective: Emphasis on global health education is growing, with schools/colleges developing relevant courses, areas of concentration, and other didactic content. Organizations such as the Consortium of Universities for Global Health (CUGH) provide guidance for competencies in global health, but evaluation strategies are lacking. Accordingly, the purpose of this study was to identify methods and tools utilized to assess knowledge, skills, and attitudes in global health courses for health science students. Methods: A systematic review was conducted according to the PRISMA guidelines. The initial search was conducted using controlled vocabularies to screen PubMed, EMBASE, Global Health using Ovid, CINAHL, and ERIC from January 1997 to March 2020. Included articles detailed students in health professions, described a didactic educational intervention related to global health, and described assessment strategies and results. Results: A total of 12,113 titles/abstracts were identified. Based on the study inclusion criteria, 545 full texts were reviewed, and 79 full-text articles were selected for qualitative synthesis. Findings of the research revealed that cultural competence (70.9%) was evaluated most often, followed by health disparities (26.6%) and global health itself (12.7%). Most articles used quantitative assessment methods (86.1%), with surveys being the predominant method. A total of 91.1% of studies assessed perceptions, attitudes, and beliefs, while fewer evaluated knowledge (43.0%) and skills (19.0%). The most common validated tool employed was the Inventory for Assessing the Process of Cultural Competence (IAPCC). Conclusions: Based of the results of this study, the majority of the assessment tools utilized for global health education focused on cultural competence. One of the important findings of this research is the lack of validated instruments to assess students\u27 skills in health disparities and global health. Given the recent global pandemic, these skills are essential for educating health care professionals to enhance global health