BACKGROUND: A stroke is a sudden loss of brain function caused by lack of blood supply. Stroke can lead to death or physical and cognitive impairment and can have long lasting psychological and social implications. Research shows that stroke survivors and their families are dissatisfied with the information provided and have a poor understanding of stroke and associated issues.
OBJECTIVES: The primary objective is to assess the effects of active or passive information provision for stroke survivors (people with a clinical diagnosis of stroke or transient ischaemic attack (TIA)) or their identified carers. The primary outcomes are knowledge about stroke and stroke services, and anxiety.
SEARCH METHODS: We updated our searches of the Cochrane Stroke Group Specialised Register on 28 September 2020 and for the following databases to May/June 2019: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 5) and the Cochrane Database of Systematic Reviews (CDSR; 2019, Issue 5) in the Cochrane Library (searched 31 May 2019), MEDLINE Ovid (searched 2005 to May week 4, 2019), Embase Ovid (searched 2005 to 29 May 2019), CINAHL EBSCO (searched 2005 to 6 June 2019), and five others. We searched seven study registers and checked reference lists of reviews.
SELECTION CRITERIA: Randomised trials involving stroke survivors, their identified carers or both, where an information intervention was compared with standard care, or where information and another therapy were compared with the other therapy alone, or where the comparison was between active and passive information provision without other differences in treatment.
DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial eligibility and risk of bias, and extracted data. We categorised interventions as either active information provision or passive information provision: active information provision included active participation with subsequent opportunities for clarification and reinforcement; passive information provision provided no systematic follow-up or reinforcement procedure. We stratified analyses by this categorisation. We used GRADE methods to assess the overall certainty of the evidence.
MAIN RESULTS: We have added 12 new studies in this update. This review now includes 33 studies involving 5255 stroke-survivor and 3134 carer participants. Twenty-two trials evaluated active information provision interventions and 11 trials evaluated passive information provision interventions. Most trials were at high risk of bias due to lack of blinding of participants, personnel, and outcome assessors where outcomes were self-reported. Fewer than half of studies were at low risk of bias regarding random sequence generation, concealment of allocation, incomplete outcome data or selective reporting. The following estimates have low certainty, based on the quality of evidence, unless stated otherwise. Accounting for certainty and size of effect, analyses suggested that for stroke survivors, active information provision may improve stroke-related knowledge (standardised mean difference (SMD) 0.41, 95% confidence interval (CI) 0.17 to 0.65; 3 studies, 275 participants), may reduce cases of anxiety and depression slightly (anxiety risk ratio (RR) 0.85, 95% CI 0.68 to 1.06; 5 studies, 1132 participants; depression RR 0.83, 95% CI 0.68 to 1.01; 6 studies, 1315 participants), may reduce Hospital Anxiety and Depression Scale (HADS) anxiety score slightly, (mean difference (MD) -0.73, 95% CI -1.10 to -0.36; 6 studies, 1171 participants), probably reduces HADS depression score slightly (MD (rescaled from SMD) -0.8, 95% CI -1.27 to -0.34; 8 studies, 1405 participants; moderate-certainty evidence), and may improve each domain of the World Health Organization Quality of Life assessment short-form (WHOQOL-BREF) (physical, MD 11.5, 95% CI 7.81 to 15.27; psychological, MD 11.8, 95% CI 7.29 to 16.29; social, MD 5.8, 95% CI 0.84 to 10.84; environment, MD 7.0, 95% CI 3.00 to 10.94; 1 study, 60 participants). No studies evaluated positive mental well-being. For carers, active information provision may reduce HADS anxiety and depression scores slightly (MD for anxiety -0.40, 95% CI -1.51 to 0.70; 3 studies, 921 participants; MD for depression -0.30, 95% CI -1.53 to 0.92; 3 studies, 924 participants), may result in little to no difference in positive mental well-being assessed with Bradley's well-being questionnaire (MD -0.18, 95% CI -1.34 to 0.98; 1 study, 91 participants) and may result in little to no difference in quality of life assessed with a 0 to 100 visual analogue scale (MD 1.22, 95% CI -7.65 to 10.09; 1 study, 91 participants). The evidence is very uncertain (very low certainty) for the effects of active information provision on carers' stroke-related knowledge, and cases of anxiety and depression. For stroke survivors, passive information provision may slightly increase HADS anxiety and depression scores (MD for anxiety 0.67, 95% CI -0.37 to 1.71; MD for depression 0.39, 95% CI -0.61 to 1.38; 3 studies, 227 participants) and the evidence is very uncertain for the effects on stroke-related knowledge, quality of life, and cases of anxiety and depression. For carers, the evidence is very uncertain for the effects of passive information provision on stroke-related knowledge, and HADS anxiety and depression scores. No studies of passive information provision measured carer quality of life, or stroke-survivor or carer positive mental well-being.
AUTHORS' CONCLUSIONS: Active information provision may improve stroke-survivor knowledge and quality of life, and may reduce anxiety and depression. However, the reductions in anxiety and depression scores were small and may not be important. In contrast, providing information passively may slightly worsen stroke-survivor anxiety and depression scores, although again the importance of this is unclear. Evidence relating to carers and to other outcomes of passive information provision is generally very uncertain. Although the best way to provide information is still unclear, the evidence is better for strategies that actively involve stroke survivors and carers and include planned follow-up for clarification and reinforcement.
Los sistemas de salud necesitan ser rediseñado para ofrecer una asistencia segura, eficaz y eficiente, y cumple con las múltiples necesidades de los pacientes. Esta revisión sistemática examina cómo se aplica el factor humano y la ergonomía (HFE) para rediseñar sistemas de trabajo de la salud y los procesos y mejorar la calidad y seguridad de la atención. Se identificaron 12 proyectos que representan 23 estudios y que abordan diferentes temas HFE físico, cognitivo y de organización en una variedad de sistemas de salud y centros de atención. Existe cierta evidencia de la efectividad de la sede en HFE rediseño del sistema de atención médica en la mejora de las medidas de proceso y de resultados de calidad y seguridad de la atención. Se evaluó el riesgo de sesgo en los 16 estudios que informaron el impacto de la sede en HFE rediseño del sistema de atención médica y encontramos calidad variable entre los estudios. Las investigaciones futuras deberían evaluar más a fondo el impacto de HFE en la calidad y seguridad de la atención, y definir claramente los mecanismos por los que el rediseño del sistema basado en la HFE puede mejorar la calidad y seguridad de la atención.
ANTECEDENTES: El cuidado de transición es un servicio limitado en el tiempo para evitar que la atención discontinua y resultados adversos, como la rehospitalización.
Objetivo: describir las intervenciones de atención de transición y pruebas de beneficio o daño en los pacientes hospitalizados por infarto agudo de miocardio o accidente cerebrovascular (MI).
FUENTES DE DATOS: Índice acumulativo de Enfermería y Salud Aliada Literatura, MEDLINE, Cochrane Database of Systematic Reviews, y EMBASE, complementadas con búsquedas manuales en listas de referencias de los estudios relevantes y artículos de revisión (enero 2000 hasta marzo de 2012).
SELECCIÓN DE ESTUDIOS: 6 evaluadores seleccionados 5857 citas para identificar Inglés de habla informes de ensayos o estudios observacionales de que la atención en comparación con la atención habitual de transición entre los adultos hospitalizados por accidente cerebrovascular o infarto de miocardio y el paciente informado, el cuidador, el proceso o los resultados de los sistemas dentro de 1 año de hospital descarga.
EXTRACCIÓN DE DATOS: Los datos sobre el diseño del estudio, la calidad, la población, características de la intervención y los resultados en el paciente y nivel de sistema fueron extraídos por 3 revisores y confirmados por un revisor adicional.
SÍNTESIS: 62 artículos que representan a 44 estudios de cuidados de transición, ya sea para el accidente cerebrovascular agudo (27 estudios) o MI (17 estudios). Cuatro tipos de intervención fueron estudiados: el hospital empezó a prestar apoyo (n = 14), educación del paciente y de la familia (n = 7), basado en la comunidad de apoyo (n = 20) y control de enfermedades crónicas (n = 3). La mayoría de los estudios (68%) eran de una calidad razonable. En general, moderada resistencia pruebas mostraron que el hospital empezó a prestar apoyo reducido tiempo de estancia de los pacientes que tuvieron un accidente cerebrovascular, y de baja resistencia evidencia demostró que reducía la mortalidad en los pacientes que habían tenido un infarto de miocardio. La evidencia sobre los beneficios de otras intervenciones y los efectos nocivos de los servicios de atención de transición fue insuficiente.
LIMITACIONES: Son pocos los estudios tenían diseños de alta calidad de la investigación. El comparador de atención habitual fue a menudo mal definido. Aplicabilidad a la práctica clínica EE.UU. fue limitado; sólo 6 estudios se realizaron en los Estados Unidos.
Conclusión: La evidencia disponible muestra que el hospital inició cuidado de transición puede mejorar algunos resultados en adultos hospitalizados por accidente cerebrovascular o infarto de miocardio. Encontrar intervenciones adicionales del cuidado de transición que mejoran los resultados funcionales y prevenir rehospitalizaciones y los eventos adversos es de alta prioridad para la creciente población de pacientes con un infarto de miocardio o un accidente cerebrovascular.
Principal fuente de financiación: Agencia para la Investigación y Calidad.
OBJETIVO: Evaluar la eficacia de las estrategias de suministro de información para mejorar el resultado para los pacientes con accidente cerebrovascular o sus cuidadores identificados.
FUENTES DE INFORMACIÓN: Se realizaron búsquedas en: Cochrane de Ensayos Stroke Group Register, el Registro Cochrane Central de Ensayos Controlados, bases de datos electrónicas MEDLINE, EMBASE, CINAHL, PsycINFO, Science Citation Index y Social Science Citation Index, Assia, Reino Unido Índice de tesis; Dissertation Abstracts; los ensayos en curso y registros de investigación, bibliografías de los artículos recuperados, artículos relevantes y libros; el Journal of Advanced Nursing. También se contactó con los investigadores para obtener información adicional.
Métodos de revisión: Dos revisores evaluaron de forma independiente la elegibilidad del ensayo, extrajeron los datos y evaluaron la calidad metodológica. Los resultados primarios fueron el conocimiento sobre el accidente cerebrovascular y su impacto en el estado de ánimo. Los meta-análisis se llevaron a cabo para los dominios de conocimiento, el estado de ánimo, la satisfacción y la mortalidad.
RESULTADOS: Diecisiete ensayos fueron identificados y 11 aportaron los datos para los metanálisis. Hubo efectos significativos a favor de la intervención sobre el conocimiento del paciente (diferencia de medias estandarizada (DME) 0,29, 95% intervalo de confianza (IC) 0,12 a 0,46), el conocimiento médico (DME 0,74 IC 95%: 0,06 a 1,43), las puntuaciones de depresión del paciente ( diferencia de medias ponderada (DMP) -0,52, IC del 95% -0,93 a -0,10), y un aspecto de la satisfacción del paciente (odds ratio (OR) 2,07, IC 95%: 1,33 a 3,23). Los análisis post hoc de subgrupos mostró que las estrategias que participan activamente los pacientes y los cuidadores tuvo un efecto significativamente mayor en la ansiedad del paciente (P <0,05) y depresión (p <0,02) que las estrategias pasivas.
CONCLUSIÓN: Hay una cierta evidencia para apoyar la provisión regular de información a los pacientes con ictus y sus familias. Aunque la mejor manera de proporcionar la información todavía no está claro, los resultados de esta revisión indican que las estrategias que involucren activamente a los pacientes y los cuidadores deben ser utilizados en la práctica habitual.
A stroke is a sudden loss of brain function caused by lack of blood supply. Stroke can lead to death or physical and cognitive impairment and can have long lasting psychological and social implications. Research shows that stroke survivors and their families are dissatisfied with the information provided and have a poor understanding of stroke and associated issues.
OBJECTIVES:
The primary objective is to assess the effects of active or passive information provision for stroke survivors (people with a clinical diagnosis of stroke or transient ischaemic attack (TIA)) or their identified carers. The primary outcomes are knowledge about stroke and stroke services, and anxiety.
SEARCH METHODS:
We updated our searches of the Cochrane Stroke Group Specialised Register on 28 September 2020 and for the following databases to May/June 2019: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 5) and the Cochrane Database of Systematic Reviews (CDSR; 2019, Issue 5) in the Cochrane Library (searched 31 May 2019), MEDLINE Ovid (searched 2005 to May week 4, 2019), Embase Ovid (searched 2005 to 29 May 2019), CINAHL EBSCO (searched 2005 to 6 June 2019), and five others. We searched seven study registers and checked reference lists of reviews.
SELECTION CRITERIA:
Randomised trials involving stroke survivors, their identified carers or both, where an information intervention was compared with standard care, or where information and another therapy were compared with the other therapy alone, or where the comparison was between active and passive information provision without other differences in treatment.
DATA COLLECTION AND ANALYSIS:
Two review authors independently assessed trial eligibility and risk of bias, and extracted data. We categorised interventions as either active information provision or passive information provision: active information provision included active participation with subsequent opportunities for clarification and reinforcement; passive information provision provided no systematic follow-up or reinforcement procedure. We stratified analyses by this categorisation. We used GRADE methods to assess the overall certainty of the evidence.
MAIN RESULTS:
We have added 12 new studies in this update. This review now includes 33 studies involving 5255 stroke-survivor and 3134 carer participants. Twenty-two trials evaluated active information provision interventions and 11 trials evaluated passive information provision interventions. Most trials were at high risk of bias due to lack of blinding of participants, personnel, and outcome assessors where outcomes were self-reported. Fewer than half of studies were at low risk of bias regarding random sequence generation, concealment of allocation, incomplete outcome data or selective reporting. The following estimates have low certainty, based on the quality of evidence, unless stated otherwise. Accounting for certainty and size of effect, analyses suggested that for stroke survivors, active information provision may improve stroke-related knowledge (standardised mean difference (SMD) 0.41, 95% confidence interval (CI) 0.17 to 0.65; 3 studies, 275 participants), may reduce cases of anxiety and depression slightly (anxiety risk ratio (RR) 0.85, 95% CI 0.68 to 1.06; 5 studies, 1132 participants; depression RR 0.83, 95% CI 0.68 to 1.01; 6 studies, 1315 participants), may reduce Hospital Anxiety and Depression Scale (HADS) anxiety score slightly, (mean difference (MD) -0.73, 95% CI -1.10 to -0.36; 6 studies, 1171 participants), probably reduces HADS depression score slightly (MD (rescaled from SMD) -0.8, 95% CI -1.27 to -0.34; 8 studies, 1405 participants; moderate-certainty evidence), and may improve each domain of the World Health Organization Quality of Life assessment short-form (WHOQOL-BREF) (physical, MD 11.5, 95% CI 7.81 to 15.27; psychological, MD 11.8, 95% CI 7.29 to 16.29; social, MD 5.8, 95% CI 0.84 to 10.84; environment, MD 7.0, 95% CI 3.00 to 10.94; 1 study, 60 participants). No studies evaluated positive mental well-being. For carers, active information provision may reduce HADS anxiety and depression scores slightly (MD for anxiety -0.40, 95% CI -1.51 to 0.70; 3 studies, 921 participants; MD for depression -0.30, 95% CI -1.53 to 0.92; 3 studies, 924 participants), may result in little to no difference in positive mental well-being assessed with Bradley's well-being questionnaire (MD -0.18, 95% CI -1.34 to 0.98; 1 study, 91 participants) and may result in little to no difference in quality of life assessed with a 0 to 100 visual analogue scale (MD 1.22, 95% CI -7.65 to 10.09; 1 study, 91 participants). The evidence is very uncertain (very low certainty) for the effects of active information provision on carers' stroke-related knowledge, and cases of anxiety and depression. For stroke survivors, passive information provision may slightly increase HADS anxiety and depression scores (MD for anxiety 0.67, 95% CI -0.37 to 1.71; MD for depression 0.39, 95% CI -0.61 to 1.38; 3 studies, 227 participants) and the evidence is very uncertain for the effects on stroke-related knowledge, quality of life, and cases of anxiety and depression. For carers, the evidence is very uncertain for the effects of passive information provision on stroke-related knowledge, and HADS anxiety and depression scores. No studies of passive information provision measured carer quality of life, or stroke-survivor or carer positive mental well-being.
AUTHORS' CONCLUSIONS:
Active information provision may improve stroke-survivor knowledge and quality of life, and may reduce anxiety and depression. However, the reductions in anxiety and depression scores were small and may not be important. In contrast, providing information passively may slightly worsen stroke-survivor anxiety and depression scores, although again the importance of this is unclear. Evidence relating to carers and to other outcomes of passive information provision is generally very uncertain. Although the best way to provide information is still unclear, the evidence is better for strategies that actively involve stroke survivors and carers and include planned follow-up for clarification and reinforcement.
