护理SCI晨读:以患者为中心的成年心力衰竭患者过渡期护理干预对健康结局的干预效果:包括剂量反应关系的系统评价和荟萃分析

2021
03/05

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NursingResearch护理研究前
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护理SCI晨读:

以患者为中心的成年心力衰竭患者过渡期护理干预对健康结局的干预效果:包括剂量反应关系的系统评价和荟萃分析

 

 


 

 


摘要

背景

过渡期的医疗干预措施弥合了从医院到家庭的医疗缺口,已被证明可以有效减少医院的再住院,从而减轻医疗保健系统的负担。然而,对以患为中心的过渡性护理干预对死亡率,生活质量和情绪困扰的健康结果的影响尚不清楚。

评估以患者为中心的过渡期治疗对心力衰竭患者死亡率、生活质量和情绪困扰健康结果的有效性和剂量反应,并确定可能影响整体有效性的试验水平特征。

设计

对随机对照试验的随机效应进行系统评价和荟萃分析,荟萃回归和剂量反应分析,比较在心力衰竭住院的成年人中的过渡护理与常规护理之间的差异。

数据源

2000年1月1日到2020年6月31日,系统检索MEDLINE,Embase,Cochrane和CINAHL等电子数据库。

审查方法

根据纳入和排除标准独立审查检索到的文章,提取数据,并使用Cochrane偏见风险工具2.0版评估偏倚风险。使用随机效应荟萃分析汇总了每项研究的数据,并进行了荟萃回归,以探讨预先指定的试验水平因素的影响。还进行了剂量反应荟萃分析,以检查过渡护理措施的强度(即干预的频率和持续时间)与复杂性(即干预组成的数量)和治疗效果之间的关系。

结果

纳入42项研究,涵盖了10784名心力衰竭患者。证据表明,与常规护理组相比,过渡期护理干预组死亡率平均降低了18%(0.82,95 %CI 0.71至0.95,P = 0.009),生活质量得到了更好的改善(-4.37,95%CI -7.20)至-1.54,P = 0.002)。没有足够的数据来确定干预对焦虑和抑郁的影响。在由多学科团队进行干预的试验中,Meta回归显示出更高的疗效。剂量反应分析表明,随着过渡护理措施的强度和复杂性的提高,死亡率和生活质量得到改善。

结论

过渡期护理干预措施可有效降低心力衰竭成人的死亡率并改善其生活质量。由于数据不足,对情绪困扰的影响尚无定论,突显了进一步研究的必要性。

 


 

 


英文摘要

ABSTRACT

Background

Transitional care interventions that bridge the care gap from hospital to home have proven to be effective in lessening the burden of healthcare systems by reducing hospital readmissions. Yet, the effects of transitional care interventions on patient-centered health outcomes of mortality, quality of life, and emotional distress remains unclear.

Objectives

To evaluate the effectiveness and dose-response of transitional care interventions on patient-centered health outcomes of mortality, quality of life, and emotional distress among individuals with heart failure and to identify the trial-level characteristics potentially affecting the overall effectiveness.

Design

Systematic review with random-effects meta-analysis, meta-regression, and dose-response analysis of randomized controlled trials comparing transitional care interventions with usual care in adult people hospitalized with heart failure.

Data sources

Electronic databases including MEDLINE, Embase, Cochrane Library, and CINAHL, were systematically searched from January 1, 2000, to June 31, 2020.

Review methods

Authors independently reviewed the retrieved articles based on inclusion and exclusion criteria, extracted data, and assessed risk of bias using the Cochrane risk-of-bias tool version 2.0. We pooled data from each study using random-effects meta-analysis and performed meta-regression to explore the impact of pre-specified trial-level factors. Dose-response meta-analysis was conducted to examine the relationship between the intensity (i.e., frequency and duration of interventions) and complexity (i.e., number of intervention components) of transitional care interventions and the treatment effects.

Results

Data were synthesized from 42 trials covering a total of 10784 people with heart failure. Comparing to usual care, transitional care interventions achieved pooled evidence of a mean 18% risk reduction on mortality (0.82, 95% CI 0.71 to 0.95, P=0.009) and better improvement in quality of life (-4.37, 95% CI -7.20 to -1.54, P=0.002). There were insufficient data to determine with certainty the effects on anxiety and depression. Meta-regression showed greater efficacy in trials that delivered the intervention by a multidisciplinary team. Dose-response analyses demonstrated that mortality and quality of life were improved with increased intensity and complexity of the transitional care interventions.

Conclusions

Transitional care interventions were effective in reducing mortality and improving quality of life for adult people with heart failure. The effects on emotional distress were inconclusive due to insufficient data, highlighting the need for further research.

本文由作者自行上传,并且作者对本文图文涉及知识产权负全部责任。如有侵权请及时联系(邮箱:nanxingjun@hmkx.cn
关键词:
心力衰竭,过渡期,SCI,死亡率,护理,剂量,CI

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