Broad syntheses related to this topic

loading
24 References (24 articles) loading Revert Studify

Broad synthesis

Unclassified

Non-opioid medications for the relief of chronic breathlessness: current evidence.

期刊 Expert review of respiratory medicine
Year 2017
連結 Pubmed DOI

此文書包括 37 Primary studies Primary studies (37 references) 14 Systematic reviews Systematic reviews (14 references)

Loading references information
INTRODUCTION: To evaluate systematically randomised clinical trials investigating non-opioid medications for the management and treatment of chronic breathlessness. Areas covered: The evidence for the role of benzodiazepines, anxiolytics, selective serotonin re-uptake inhibitors (SSRIs), tricyclic antidepressants, antihistamines, cannabinoids, nebulized furosemide and herbal-based treatments were critically reviewed. Search of the Clinical Trials Registry (Clinicaltrial.gov) identified ongoing studies expected to generate new data in the near future in several classes of non-opioid medications for their net effect on chronic breathlessness. Expert commentary: Morphine still has the best level of evidence for the symptomatic treatment of chronic breathlessness. Non-opioid treatments for chronic breathlessness are less studied than morphine and morphine-related medications although evidence is emerging in relation to some options. Currently, there is insufficient evidence to recommend non-opioids in the routine treatment of chronic breathlessness. There is a need to find agents, new as well as re-purposed, that can be used as alternative therapies to opioids for chronic breathlessness for people who are unable to tolerate morphine.

Broad synthesis / Overview of systematic reviews

Unclassified

Does integrated care reduce hospital activity for patients with chronic diseases? An umbrella review of systematic reviews.

作者 Damery S , Flanagan S , Combes G
期刊 BMJ open
Year 2016
連結 Pubmed DOI PubMed Central

此文書包括 42 Systematic reviews Systematic reviews (42 references)

Loading references information
OBJECTIVE: To summarise the evidence regarding the effectiveness of integrated care interventions in reducing hospital activity. DESIGN: Umbrella review of systematic reviews and meta-analyses. SETTING: Interventions must have delivered care crossing the boundary between at least two health and/or social care settings. PARTICIPANTS: Adult patients with one or more chronic diseases. DATA SOURCES: MEDLINE, Embase, ASSIA, PsycINFO, HMIC, CINAHL, Cochrane Library (HTA database, DARE, Cochrane Database of Systematic Reviews), EPPI-Centre, TRIP, HEED, manual screening of references. OUTCOME MEASURES: Any measure of hospital admission or readmission, length of stay (LoS), accident and emergency use, healthcare costs. RESULTS: 50 reviews were included. Interventions focused on case management (n=8), chronic care model (CCM) (n=9), discharge management (n=15), complex interventions (n=3), multidisciplinary teams (MDT) (n=10) and self-management (n=5). 29 reviews reported statistically significant improvements in at least one outcome. 11/21 reviews reported significantly reduced emergency admissions (15-50%); 11/24 showed significant reductions in all-cause (10-30%) or condition-specific (15-50%) readmissions; 9/16 reported LoS reductions of 1-7 days and 4/9 showed significantly lower A&E use (30-40%). 10/25 reviews reported significant cost reductions but provided little robust evidence. Effective interventions included discharge management with postdischarge support, MDT care with teams that include condition-specific expertise, specialist nurses and/or pharmacists and self-management as an adjunct to broader interventions. Interventions were most effective when targeting single conditions such as heart failure, and when care was provided in patients' homes. CONCLUSIONS: Although all outcomes showed some significant reductions, and a number of potentially effective interventions were found, interventions rarely demonstrated unequivocally positive effects. Despite the centrality of integrated care to current policy, questions remain about whether the magnitude of potentially achievable gains is enough to satisfy national targets for reductions in hospital activity. TRIAL REGISTRATION NUMBER: CRD42015016458.

Broad synthesis / Living FRISBEE

Unclassified

Are prophylactic antibiotics useful in chronic obstructive pulmonary disease?

作者 Arenas A , Rada G
期刊 Medwave
Year 2015
連結 Pubmed DOI

此文書包括 5 Systematic reviews Systematic reviews (5 references) 10 Primary studies Primary studies (10 references)

Loading references information
Bacterial infections are one of the main causes of chronic obstructive pulmonary disease exacerbation, so the use of prophylactic antibiotics, especially macrolides, has been proposed in these patients. However, it is unclear whether antibiotics use is worth the risk and cost. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified five systematic reviews including eight randomized trials. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded prophylactic antibiotics probably decrease exacerbations in chronic obstructive pulmonary disease, but have no effect on hospitalizations or mortality.

Broad synthesis / Guideline

Unclassified

Prevention of Acute Exacerbations of Chronic Obstructive Pulmonary Disease: American College of Chest Physicians and Canadian Thoracic Society Guideline.

期刊 Chest
Year 2015
連結 Pubmed DOI PubMed Central

此文書包括 21 Systematic reviews Systematic reviews (21 references) 30 Primary studies Primary studies (30 references)

Loading references information
BACKGROUND: COPD is a major cause of morbidity and mortality in the United States as well as throughout the rest of the world. An exacerbation of COPD (periodic escalations of symptoms of cough, dyspnea, and sputum production) is a major contributor to worsening lung function, impairment in quality of life, need for urgent care or hospitalization, and cost of care in COPD. Research conducted over the past decade has contributed much to our current understanding of the pathogenesis and treatment of COPD. Additionally, an evolving literature has accumulated about the prevention of acute exacerbations. METHODS: In recognition of the importance of preventing exacerbations in patients with COPD, the American College of Chest Physicians (CHEST) and Canadian Thoracic Society (CTS) joint evidence-based guideline (AECOPD Guideline) was developed to provide a practical, clinically useful document to describe the current state of knowledge regarding the prevention of acute exacerbations according to major categories of prevention therapies. Three key clinical questions developed using the PICO (population, intervention, comparator, and outcome) format addressed the prevention of acute exacerbations of COPD: nonpharmacologic therapies, inhaled therapies, and oral therapies. We used recognized document evaluation tools to assess and choose the most appropriate studies and to extract meaningful data and grade the level of evidence to support the recommendations in each PICO question in a balanced and unbiased fashion. RESULTS: The AECOPD Guideline is unique not only for its topic, the prevention of acute exacerbations of COPD, but also for the first-in-kind partnership between two of the largest thoracic societies in North America. The CHEST Guidelines Oversight Committee in partnership with the CTS COPD Clinical Assembly launched this project with the objective that a systematic review and critical evaluation of the published literature by clinical experts and researchers in the field of COPD would lead to a series of recommendations to assist clinicians in their management of the patient with COPD. CONCLUSIONS: This guideline is unique because it provides an up-to-date, rigorous, evidence-based analysis of current randomized controlled trial data regarding the prevention of COPD exacerbations.

Broad synthesis / Scoping review

Unclassified

自我管理的干预对慢性疾病：有系统的审查范围界定。

automatic
期刊 Clinical rehabilitation
Year 2014
連結 Pubmed DOI

此文書包括 50 Primary studies Primary studies (50 references)

Loading references information
无

Broad synthesis

Unclassified

药物治疗的成​​本效益COPD的日间护理：检讨。

automatic
作者 Simoens S
期刊 Journal of evaluation in clinical practice
Year 2013
連結 Pubmed DOI

此文書包括 33 Primary studies Primary studies (33 references) 3 Systematic reviews Systematic reviews (3 references)

Loading references information
基本原理，宗旨和目标：本文进行有关药物治疗慢性阻塞性肺疾病（COPD）的日间护理的成本效益的文献综述。 方法：相关的经济评估进行鉴定通过搜索MEDLINE（考研）和国家卫生服务体系（NHS）经济评价数据库。搜索策略侧重于文学评论和主要经济评估。经济评价都包括在内，这比起药物治疗慢性阻塞性肺病，慢性支气管炎或肺气肿，在成本和健康结果方面的替代。 结果：大多数经济评估表明，药物对慢性阻塞性肺病门诊护理是划算的。成本效益来源于肺功能的改善和在急性发作的数量，换算成从更少住院节约成本的降低。药物也往往是更符合成本效益的患者更严重慢性阻塞性肺病。当将这些结果与特定国家或设置，药物治疗的成​​本有效性将取决于COPD严重的患者中的分布，替代与药物疗法相比，药物治疗上加重，成本和加重的治疗模式的影响，和药物的价格。经济的评价往往从短期的时间范围，包括成本，并利用各种健康结果的措施限制范围之苦。 结论：有利于从社会角度是基于一个决策分析模型，以允许外插以外的临床试验的持续时间，并且使用通用健康后果的措施，如质量调整生命经济评估来作出的情况下年。

Broad synthesis / Overview of systematic reviews

Unclassified

临床干预措施的效果再住院率的Meta检讨发表的荟萃分析。

automatic
作者 Benbassat J , Taragin MI
期刊 Israel journal of health policy research
Year 2013
連結 Pubmed DOI PubMed Central

此文書包括 97 Systematic reviews Systematic reviews (97 references)

Loading references information
背景：对经济的影响，便于测量各种原因的再入院率（HRR），目前的辩论，无论他们是还原，以及他们是否应作为一个公开报告的质量指标医疗保健目标：预防慢性疾病的方法，患者HRR广泛的临床干预疗效评估：A元之间的患者的预后interest.Main findingsMeta的HRR的临床干预措施，包括审查的系统评价，随机对照试验（RCT）的一直分析的随机对照试验发现，在社会上，疾病管理计划的显着降低HRR心脏衰竭，冠状动脉心脏疾病和支气管哮喘患者，但不脑卒中患者，在未选中的慢性疾病患者。院内的干预措施，如在慢性阻塞性肺疾病患者的出院计划，药理协商和多学科医疗，社区干预HRR.Main研究limitationDespite经济的影响，便于测量不一致的影响，HRR不是最重要的成果病人护理，并在其减排努力可能会危及患者的健康，也减少合理的再度入院结论：院内干预措施在减少HRR的疗效需要进一步研究。在与心脏疾病和支气管哮喘的患者，HRR可能被视为一个公开报告的质量指标，社区护理，提供未来的研究证实，努力降低HRR不会产生不利影响患者的预后，如死亡率，功能能力和质量的生活。未来的研究应集中在较高的疗效比那些患有其他慢性疾病与心脏疾病和支气管哮喘患者社区干预的原因。

Broad synthesis

Unclassified

一个系统的快速证据评价的晚期诊断

automatic
報告 EPPI-Centre, Social Science Research Unit, Institute of Education, University of London
Year 2012
連結 EppiCentre Fulltext link

此文書包括 37 Systematic reviews Systematic reviews (37 references) 27 Primary studies Primary studies (27 references)

Loading references information
想知道我们怎么办？：延迟诊断结果为患者和医护人员的严重后果，并能产生可观的财务费用。虽然研究表明，聚焦于癌症晚期诊断导致发病率和死亡率的增加，其他条件的证据还不太清楚。这个系统的快速的证据评估（SREA）标识在一系列条件的晚期诊断的文献的性质和程度。我们想知道： 1。晚期诊断的患病率是什么？ 6.晚期诊断的决定因素是什么？ 3。晚期诊断的结果是什么？ {0}8、{/0} {1} {/1}对成本的影响，延误诊断是什么？ 5。哪些干预措施减少延误诊断？ 谁想知道吗？：政策制定者，医生，全科医生和病人。我们发现了什么？•延迟诊断与慢性阻塞性肺疾病（COPD），老年痴呆症，人类免疫缺陷病毒（HIV）和1型糖尿病的人最关心的问题。 慢性阻塞性肺疾病的高患病率的晚期诊断，估计有80％的情况下，其余确诊的。许多情况下是在较温和的阶段，这种疾病的患者。 •早期老年痴呆症很难被检测到，与医生承认他们的困难，区分老年痴呆症和正常老化“。 有证据表明，有相当比例（16-51％）的儿童在I型糖尿病中遇到延误诊断。 •那些从事高风险的行为，更容易避免由于艾滋病毒检测的阳性诊断的恐惧，转交令人担忧的影响。健康保护局的数据显示，在英国，有50％新诊断的后期。 从广义上讲，延迟诊断会影响弱势群体，如老年人或那些生活在贫困中。 •延迟的患者从一些条件，包括慢性肾脏病，老年痴呆症，艾滋病，中风，心肌梗死，癫痫病和肺结核的临床医生寻求帮助。晚期症状的误解和缺乏知识介绍。 认识不足和培训的医生及时诊断为慢性肾脏疾病，慢性阻塞性肺病（COPD），老年痴呆症和结核障碍。 •受限制的访问，充分的磋商时间和资源的限制阻碍了诊断。 •延迟诊断对成本的影响是非常小的材料。的含义是什么？：慢性阻塞性肺病的早期诊断医生的培训，老年痴呆症和肺结核提高了检测。媒体宣传，提醒市民中风，心脏病发作和精神病的症状有不同的结果。总体而言，增加了公众的认可，但是这可能不是有助于缩短病人延误。 这项研究包括英国以外的卫生保健系统的信息。然而，决策者可能会发现英国的主要研究未来的评论，这些条件有助于了解问题的性质，在英国范围内进入晚期诊断。我们是如何得到这些结果：43个系统评价，我们审查证据：慢性肾脏病，老年痴呆症，抑郁症，I型糖尿病，癫痫病，艾滋病，心肌梗塞，精神病，中风和肺结核。 我们发现606英国主要对晚期诊断的研究，其中12个研究慢性阻塞性肺病，12个调查肺结核和4个研究癫痫。虽然有系统的评论，借鉴大多数情况下，这是慢性阻塞性肺病（系统评价），肺结核（有限相关的系统评价英国医疗系统）和癫痫（集中在过度诊断的系统评价）的情况下，和所以我们用的主要研究证据。

Broad synthesis

Unclassified

运动处方与慢性阻塞性肺疾病及合并症住院的人：一个综合的系统评价。

automatic
期刊 International journal of chronic obstructive pulmonary disease
Year 2012
連結 Pubmed DOI PubMed Central

此文書包括 53 Systematic reviews Systematic reviews (53 references) 3 Primary studies Primary studies (3 references)

Loading references information
简介：开出的药方住院的患者急性发作的慢性阻塞性肺疾病（AECOPD）的体力活动可并发合并症的存在。目前的研究旨在合成谁的经验的AECOPD与multimorbidities人运动的好处的相关文献，并问：什么是参数和运动的结果AECOPD和系统评价报告的条件，是常见的合并症（SRS ）？ 方法：SR进行使用Cochrane协作协议。九数据库中搜索到2011年7月。文章被包括在内，如果他们（1）参与者AECOPD，慢性阻塞性肺疾病（COPD），或11个常见的合并症之一，（2）SR（3）检查有氧训练（AT），阻力训练（RT） ，平衡训练（BT），或它们的组合，（4）包括至少一个结果，（5）健身相比，运动训练与控制/假。 结果：合成研究58运动训练中的SR AECOPD，慢性阻塞性肺病（COPD），或11常见的慢性疾病与慢性阻​​塞性肺病的人。耐力（有氧运动能力，6分钟步行距离 - 腹式呼吸）的荟萃分析显示显着改善（除骨关节炎，骨质疏松症和抑郁症，在大多数情况下），而强度提高的13个条件中的5搜索的内容：慢性阻塞性肺病，老年人，心脏衰竭，缺血性心脏疾病和糖尿病。不同条件下的一些研究也报道了改善生活，功能，控制或预防成果的质量。Meta分析也表明，锻炼的老年人的死亡率降低了风险，而那些与慢性阻塞性肺病或缺血性心脏疾病。最常见的类型的训练是AT和RT。 BT和功能训练，常用于中老年人。质量的SRS大多数情况下是中度至良好（> 65％）AMSTAR分数评价。 结论：总之，这种合成的证据表明AECOPD，慢性阻塞性肺病（COPD）运动训练的重要利益，条件是常见的合并症。肺康复运动和活动处方在更广泛的做法可能会引起治疗效果，以改善AECOPD和合并症，如列入BT和功能训练与临床后遗症。

Broad synthesis

Unclassified

医院在家里的慢性阻塞性肺疾病（COPD）急性加重期的患者：以证据为基础的分析程序。

automatic
作者 McCurdy B
期刊 Ontario health technology assessment series
Year 2012
連結 Pubmed PubMed Central

此文書包括 4 Systematic reviews Systematic reviews (4 references) 7 Primary studies Primary studies (7 references)

Loading references information
目的：这个分析的目的是比较急性发作的慢性阻塞性肺疾病（COPD）向急诊科（ED）患者的住院护理医院在家里照顾。