Publications by authors named "Patriek Mistiaen"

24 Publications

  • Page 1 of 1

Developing an agency's position with respect to patient involvement in health technology assessment: the importance of the organizational culture.

Int J Technol Assess Health Care 2020 Dec 2;36(6):569-578. Epub 2020 Oct 2.

Sciensano, Belgium.

Objectives: The objective of this study was to map the PI culture at KCE in the context of the development of organization-wide supported position statements about PI.

Methods: A nominal group technique was used to measure the PI culture at KCE. Arguments for and against PI and conditions for PI in different phases of the HTA process were collected. A literature review and interviews fed the draft position statements, for which support was assessed by means of a two-round Delphi process.

Results: Arguments in favor of PI in HTA related to the relevance of the scope, expertise with data collection, bringing in fresh ideas for study design, access to survey participants, validation of data analyses, adherence to recommendations. Disadvantages and risks included the lack of scientific knowledge of involved patients, resources requirements, conflicts of interest, and heterogeneity within patient populations. Conditions for meaningful PI referred to measures mitigating the identified disadvantages. Eighteen position statements supported by KCE could be formulated.

Conclusion: The KCE culture seems predominantly positive toward PI, although attitudes vary between HTA researchers. KCE recognizes the potential value of PI in HTA, but considers the level of involvement to be contingent on the topic and phase in the HTA process.
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http://dx.doi.org/10.1017/S0266462320000513DOI Listing
December 2020

Nutrition Support Teams: A Systematic Review.

JPEN J Parenter Enteral Nutr 2020 08 17;44(6):1004-1020. Epub 2020 Mar 17.

KCE Belgian Health Care Knowledge Centre, Brussels, Belgium.

Background: The concept of a nutrition support team (NST) was first introduced at the end of the 20th century in the US and Europe. Expected benefits include reduced (inappropriate) prescription of (par)enteral nutrition; however, to the authors' knowledge, no recent review has assessed the effectiveness of NSTs. Therefore, this systematic review evaluated the effectiveness of NSTs with respect to the prevalence of adult patients receiving (par)enteral nutrition.

Methods: Five literature databases were searched and completed by citing searches. Studies on NSTs that were published between 2000 and 2018 in Western countries, applied a comparative design, and contained at least outcome data on the prevalence of (par)enteral nutrition were included. Analyses were mainly descriptive because of high heterogeneity that prevented meta-analyses.

Results: The 27 included studies mainly originated from the UK and US. Only 1 of the included studies was a randomized trial; the other studies had a pre-post design (n = 17) or compared groups in a nonrandomized way. All but 2 studies were performed in acute care hospitals, and 5 studies focused only on intensive care patients. There was conflicting evidence of whether NSTs lead to reduction or increase in patients starting parenteral nutrition (PN); however, weak evidence suggested that NSTs might lead to an increase in the ratio of enteral nutrition to PN use and might decrease inappropriate PN use.

Conclusion: Although almost all studies concluded in favor of NSTs, the evidence base is weak and insufficient because of a lack of well-designed studies and successful outcomes.
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http://dx.doi.org/10.1002/jpen.1811DOI Listing
August 2020

Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis.

J R Soc Med 2018 Jul 19;111(7):240-252. Epub 2018 Apr 19.

1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX1 2JD, UK.

Background Practitioners who enhance how they express empathy and create positive expectations of benefit could improve patient outcomes. However, the evidence in this area has not been recently synthesised. Objective To estimate the effects of empathy and expectations interventions for any clinical condition. Design Systematic review and meta-analysis of randomised trials. Data sources Six databases from inception to August 2017. Study selection Randomised trials of empathy or expectations interventions in any clinical setting with patients aged 12 years or older. Review methods Two reviewers independently screened citations, extracted data, assessed risk of bias and graded quality of evidence using GRADE. Random effects model was used for meta-analysis. Results We identified 28 eligible (n = 6017). In seven trials, empathic consultations improved pain, anxiety and satisfaction by a small amount (standardised mean difference -0.18 [95% confidence interval -0.32 to -0.03]). Twenty-two trials tested the effects of positive expectations. Eighteen of these (n = 2014) reported psychological outcomes (mostly pain) and showed a modest benefit (standardised mean difference -0.43 [95% confidence interval -0.65 to -0.21]); 11 (n = 1790) reported physical outcomes (including bronchial function/ length of hospital stay) and showed a small benefit (standardised mean difference -0.18 [95% confidence interval -0.32 to -0.05]). Within 11 trials (n = 2706) assessing harms, there was no evidence of adverse effects (odds ratio 1.04; 95% confidence interval 0.67 to 1.63). The risk of bias was low. The main limitations were difficulties in blinding and high heterogeneity for some comparisons. Conclusions Greater practitioner empathy or communication of positive messages can have small patient benefits for a range of clinical conditions, especially pain. Protocol registration Cochrane Database of Systematic Reviews (protocol) DOI: 10.1002/14651858.CD011934.pub2.
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http://dx.doi.org/10.1177/0141076818769477DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6047264PMC
July 2018

Evaluating the need to reform the organisation of care for major trauma patients in Belgium: an analysis of administrative databases.

Eur J Trauma Emerg Surg 2019 Oct 26;45(5):885-892. Epub 2018 Feb 26.

Belgian Healthcare Knowledge Centre, Kruidtuinlaan 55, 1000, Brussels, Belgium.

Purpose: In light of the international evolutions to establish inclusive trauma systems and to concentrate the care for the most severely injured in major trauma centres, we evaluated the degree of dispersion of trauma care in Belgium.

Methods: We used descriptive statistics to illustrate the dispersion of major trauma care in Belgium based on two independent administrative databases: the registry of Mobile Intensive Care Units (2009-2015) and the Belgian Hospital Discharge Dataset (2009-2014).

Results: Patients with a severe trauma (n = 3856 in 2015) were transported towards 145 different hospital sites (on a total of 198 hospital sites) resulting in a median of 17 cases per hospital site (min = 1; P25 = 4; P75 = 30; max = 165). A minority of major trauma patients is after admission transferred to another hospital (8%) with a median of 10 days after admission to the hospital (IQR 3.5-24).

Conclusions: The dispersion of care for major trauma patients in Belgium is so high that a reorganisation of care for severe injured patients in major trauma centres concentrating professional expertise and specialised equipment is recommended to guarantee a high quality of care in a qualitative and sustainable way.
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http://dx.doi.org/10.1007/s00068-018-0932-9DOI Listing
October 2019

Effects of eHealth for patients and informal caregivers confronted with cancer: A meta-review.

Int J Med Inform 2016 Mar 24;87:54-67. Epub 2015 Dec 24.

VU University Medical Center, Department of Public and Occupational Health, The EMGO Institute for Health and Care Research, Amsterdam, Netherlands; Expertise Center for Palliative Care, Amsterdam, Netherlands; NIVEL, Netherlands Institute for Health Services Research Utrecht, Netherlands.

Background: eHealth can be defined as information provision about illness or health care and/or support for patients and/or informal caregivers, using the computer or related technologies. eHealth interventions are increasingly being used in cancer care, e.g. to support patients and informal caregivers in managing symptoms and problems in daily life.

Objectives: To synthesize evidence from systematic reviews on the effects of eHealth for cancer patients or their informal caregivers.

Materials And Methods: A systematic meta-review, in the sense of a systematic review of reviews, was conducted. Searches were performed in PubMed, Embase, CINAHL, PsycINFO, and the Cochrane Library. All steps in the review process were either performed by two reviewers independently or checked by a second reviewer. Disagreements were resolved by consensus.

Results: Ten systematic reviews were included. All reviews focused on the effects of eHealth for patients and none on effects for informal caregivers. Except for one review of high methodological quality, all reviews were of moderate methodological quality. Evidence was found for effects on perceived support, knowledge levels, and information competence of cancer patients. Indications of evidence were found for health status and healthcare participation. Findings were inconsistent for outcomes related to decision-making, psychological wellbeing, depression and anxiety, and quality of life. No evidence was found for effects on physical and functional wellbeing.

Conclusion: There is evidence for positive effects of eHealth on perceived support, knowledge, and information competence of cancer patients. For effects on other outcomes in cancer patients, findings are mainly inconsistent or lacking. This meta-review did not find relevant reviews focusing on or including the effects of eHealth on informal caregivers, which seems a rather unexplored area.
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http://dx.doi.org/10.1016/j.ijmedinf.2015.12.013DOI Listing
March 2016

The effectiveness of interventions in supporting self-management of informal caregivers of people with dementia; a systematic meta review.

BMC Geriatr 2015 Nov 11;15:147. Epub 2015 Nov 11.

Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.

Background: Informal caregivers of people with dementia are challenged in managing the consequences of dementia in daily life. The objective of this meta-review was to synthesize evidence from previous systematic reviews about professional self-management support interventions for this group.

Methods: In March 2014, searches were conducted in PubMed, CINAHL, Cochrane Library, Embase and PsycINFO. The PRISMA Statement was followed. Interventions were grouped using Martin's targets of self-management, covering 5 targets: relationship with family, maintaining an active lifestyle, psychological wellbeing, techniques to cope with memory changes and information about dementia. Using an evidence synthesis, the outcomes from the included interventions were synthesized and conclusions were drawn about the level of evidence for the effectiveness of interventions within each target.

Results: Ten high-quality systematic reviews were selected. Evidence exists for the effectiveness of professional self-management support interventions targeting psychological wellbeing on stress and social outcomes of informal caregivers. In addition, evidence exists for the effectiveness of interventions targeting information on ability/knowledge. Limited evidence was found for the effectiveness of interventions targeting techniques to cope with memory change on coping skills and mood, and for interventions targeting information on the outcomes sense of competence and decision-making confidence of informal caregivers.

Conclusions: Scientific evidence exists for the effectiveness of a number of professional self-management support interventions targeting psychological wellbeing and information. Health care professionals could take account of the fact that psycho-education was integrated in most of the self-management support interventions that were found to be effective in this meta-review. Furthermore, longer and more intensive interventions were associated with greater effects.
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http://dx.doi.org/10.1186/s12877-015-0145-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642777PMC
November 2015

[People with dementia have more contact with their general practitioners: contact with GPs peaks around the time of diagnosis].

Ned Tijdschr Geneeskd 2014 ;158(6):A6755

NIVEL, Utrecht.

Objective: To investigate how often and why people with dementia and their partners have contact with the general practitioner (GP) before and after the diagnosis of dementia.

Design: Retrospective cohort study.

Method: Patients given the diagnosis of 'dementia' in the period 2006-2011 were selected from patient records of GP practices participating in the NIVEL Primary Care Database; data were also collected from the patients' partners. Patients and their partners were compared with a reference group. The number of GP contacts from 2 years before until 1 year after diagnosis were analysed.

Results: There were data on 823 patients with dementia and 184 partners. People with dementia had more frequent GP contacts from 4 months before diagnosis until 8 months thereafter. The mean number of GP contacts was 21.5 for people with dementia versus 17.4 for people without dementia in the total 3-year period. Reasons for more frequent contact were depression, abrasions/scratches/blisters and memory/concentration/orientation disorders before diagnosis. After diagnosis, memory/concentration/orientation disorders and general decline were more common reasons for contact than in the reference group. The frequency of GP contacts for partners was not significantly higher.

Conclusion: People with dementia have more contact with their GP than people without dementia. From 1.5 years before diagnosis they visit the GP with specific complaints more often. Their partners also have regular contact with their GP, especially in the year after diagnosis.
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November 2014

The effects of nurse prescribing: a systematic review.

Int J Nurs Stud 2014 Jul 16;51(7):1048-61. Epub 2013 Dec 16.

NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands. Electronic address:

Background: In 2008, we conducted a systematic review on the effects of nurse prescribing using studies with a comparative design. In view of the growing number of countries that are introducing nurse prescribing and the fact that several studies into nurse prescribing have been conducted recently, there is a need for an updated review to reassess the available information on the effects of nurse prescribing when compared to physician prescribing.

Objective: To identify, appraise and synthesise the evidence on the effects of nurse prescribing when compared to physician prescribing on the quantity and types of medication prescribed and on patient outcomes.

Design: A systematic review.

Data Sources: In addition to the previous review, which covered the literature up to 2005, 11 literature databases and four websites were searched for relevant studies from January 2006 up to January 2012 without limitations as to language or country. Moreover, full-text copies of all studies included in the previous review were reviewed.

Review Methods: A three-stage inclusion process, consisting of an initial sifting, checking full-text papers for inclusion criteria and methodological assessment, was performed independently by two reviewers. Data on effects were synthesised using narrative and tabular methods.

Results: Thirty-five studies met the inclusion criteria. All but five studies had a high risk of bias. Nurses prescribe in comparable ways to physicians. They prescribe for equal numbers of patients and prescribe comparable types and doses of medicines. Studies comparing the total amount of medication prescribed by nurses and doctors show mixed results. There appear to be few differences between nurses and physicians in patient health outcomes: clinical parameters were the same or better for treatment by nurses, perceived quality of care was similar or better and patients treated by nurses were just as satisfied or more satisfied.

Conclusions: The effects of nurse prescribing on medication and patient outcomes seem positive when compared to physician prescribing. However, conclusions must remain tentative due to methodological weaknesses in this body of research. More randomised controlled designs in the field of nurse prescribing are required for definitive conclusions about the effects of nurse prescribing.
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http://dx.doi.org/10.1016/j.ijnurstu.2013.12.003DOI Listing
July 2014

Perspectives on care and communication involving incurably ill Turkish and Moroccan patients, relatives and professionals: a systematic literature review.

BMC Palliat Care 2012 Sep 18;11:17. Epub 2012 Sep 18.

NIVEL (Netherlands Institute for Health Services Research), PB 1568, 3500, BN, Utrecht, the Netherlands.

Unlabelled:

Background: Our aim was to obtain a clearer picture of the relevant care experiences and care perceptions of incurably ill Turkish and Moroccan patients, their relatives and professional care providers, as well as of communication and decision-making patterns at the end of life. The ultimate objective is to improve palliative care for Turkish and Moroccan immigrants in the Netherlands, by taking account of socio-cultural factors in the guidelines for palliative care.

Methods: A systematic literature review was undertaken. The data sources were seventeen national and international literature databases, four Dutch journals dedicated to palliative care and 37 websites of relevant national and international organizations. All the references found were checked to see whether they met the structured inclusion criteria. Inclusion was limited to publications dealing with primary empirical research on the relationship between socio-cultural factors and the health or care situation of Turkish or Moroccan patients with an oncological or incurable disease. The selection was made by first reading the titles and abstracts and subsequently the full texts. The process of deciding which studies to include was carried out by two reviewers independently. A generic appraisal instrument was applied to assess the methodological quality.

Results: Fifty-seven studies were found that reported findings for the countries of origin (mainly Turkey) and the immigrant host countries (mainly the Netherlands). The central themes were experiences and perceptions of family care, professional care, end-of-life care and communication. Family care is considered a duty, even when such care becomes a severe burden for the main female family caregiver in particular. Professional hospital care is preferred by many of the patients and relatives because they are looking for a cure and security. End-of-life care is strongly influenced by the continuing hope for recovery. Relatives are often quite influential in end-of-life decisions, such as the decision to withdraw or withhold treatments. The diagnosis, prognosis and end-of-life decisions are seldom discussed with the patient, and communication about pain and mental problems is often limited. Language barriers and the dominance of the family may exacerbate communication problems.

Conclusions: This review confirms the view that family members of patients with a Turkish or Moroccan background have a central role in care, communication and decision making at the end of life. This, in combination with their continuing hope for the patient's recovery may inhibit open communication between patients, relatives and professionals as partners in palliative care. This implies that organizations and professionals involved in palliative care should take patients' socio-cultural characteristics into account and incorporate cultural sensitivity into care standards and care practices.
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http://dx.doi.org/10.1186/1472-684X-11-17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3517329PMC
September 2012

Costs and financial benefits of video communication compared to usual care at home: a systematic review.

J Telemed Telecare 2011 24;17(8):403-11. Epub 2011 Oct 24.

Netherlands Institute for Health Services Research, Utrecht, The Netherlands.

We conducted a systematic review of video communication in home care to provide insight into the ratio between the costs and financial benefits (i.e. cost savings). Four databases (PUBMED, EMBASE, COCHRANE LIBRARY, CINAHL) were searched for studies on video communication for patients living at home (up to December 2009). Studies were only included when data about the costs of video communication as well as the financial benefits were presented. The methodological quality of the included studies was assessed. Nine studies, mainly conducted in the US, met the inclusion criteria. The methodological quality was poor, except for one study. Most studies (8 of the 9) did not demonstrate that the financial benefits were significantly greater than the costs of video communication. One study - the only one with a high methodological quality - found that costs for patients who received video communication were higher than for patients who received traditional care. The review found no evidence that the cost of implementing video communication in home care was lower than the resulting financial benefits. More methodologically well conducted research is needed.
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http://dx.doi.org/10.1258/jtt.2011.110405DOI Listing
March 2012

Problems and unmet needs of patients discharged "home to self-care".

Prof Case Manag 2011 Sep-Oct;16(5):240-50; quiz 251-2

Department of Nursing, College of Medicine, Mayo Clinic, Rochester, MN 55906, USA.

Purpose Of Study: The purpose of this study was to determine the extent to which patients discharged "home to self care" experienced problems and unmet needs. A secondary aim was to explore potential differences in problems and unmet needs between medical and surgical patients.

Primary Practice Setting: The study setting was acute care in 2 hospitals that were part of a large academic medical center in the Midwest.

Methodology And Sample: The prospective, cohort survey study was designed with a systematic sampling strategy to identify 130 cognitively intact adults hospitalized for either medical or surgical reasons who planned to return home after discharge without formal community services. The hospital information system was checked daily to verify whether dispositions were coded "home to self care," and to verify whether the patients were not seen by a discharge planner. The Problems After Discharge Questionnaire-English Version (PADQ-E) was then either mailed or administered via a phone interview approximately 1 week after discharge.

Results: Overall, 73.8% wanted more information about one or more topics related to their care. Most frequently mentioned were "when they would be completely recovered" (38.0%) and "where and how they could get nursing care at home if they needed it" (36.9%). A majority (91.8%) reported difficulties related to at least 1 physical complaint. Pain was most frequently mentioned by surgical patients (88.1%). Getting tired quickly was an issue for both surgical (76.2%) and medical patients (62.8%). More than 85% received help at home from family or friends. Surgical patients received significantly more assistance than medical patients with personal care, household activities, and mobility. Approximately 1 in 4 surgical patients reported an unmet need within the Physical Complaints subscale on the PADQ-E.

Implications For Case Management Practice: Potential problems that may occur after discharge have little chance of getting addressed if not identified during the discharge planning process. Standardized, early screening to accurately identify patients at risk for unmet needs after discharge is critical to the development and implementation of a quality discharge plan. The lack of time available to hospital clinicians to assemble and interpret extensive and complex information calls for improved methods to support identifying patients at risk for poor outcomes, engaging discharge planners efficiently and accurately, providing a standardized assessment to identify and address continuing care needs, and identifying patients who would benefit from post-acute care. Case managers advance their practice by advocating for and participating in the development of improved methods.
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http://dx.doi.org/10.1097/NCM.0b013e31822361d8DOI Listing
January 2012

[Australian Medical Sheepskin for prevention of pressure ulcers: individual patient data meta-analysis shows effectiveness].

Ned Tijdschr Geneeskd 2011 ;155(18):A3034

NIVEL, afd. Verpleging en Verzorging, Utrecht, the Netherlands.

Objective: To assess the effectiveness of the Australian Medical Sheepskin (AMS) on the prevention of sacral pressure ulcers based on combined data from 3 previously published trials.

Design: Meta-analysis of randomised clinical trials (RCTs).

Method: The effectiveness of these specially treated sheepskins from the Merino sheep was studied in three RCT's (2 involving Australian hospital patients and 1 involving Dutch nursing-home patients). In all 3 trials patients were randomized to 1 of 2 groups: a control group, who received standard care, and an intervention group, who, in addition to standard care, had at least one AMS placed under the sacral area when in bed. The total research population consisted of 1,281 patients from 11 institutions with 45 nursing wards. Data from the 3 RCT's were pooled and analysed: (a) with conventional meta-analysis based on the published effect sizes and (b) with multilevel logistic regression analysis based on the combined individual patient data for each trial separately and for the combined dataset. The primary outcome measure was the incidence of sacral pressure ulcers.

Results: The incidence of sacral pressure ulcers was 12.2% in the control group versus 5.4% in the intervention group. The odds-ratio was 0.37 (95% CI: 0.17-0.77) with conventional meta-analysis, and 0.35 (95% CI: 0.23-0.55) with multilevel logistic regression analysis on the combined individual patient data.

Conclusion: Both analysis methods confirm that the AMS is effective in preventing sacral pressure ulcers. The confidence interval in the multilevel logistic regression analysis on individual patient data was almost 50% smaller than in the conventional meta-analysis, and gave a more reliable picture of the actual effect.
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February 2018

A multilevel analysis of three randomised controlled trials of the Australian Medical Sheepskin in the prevention of sacral pressure ulcers.

Med J Aust 2010 Dec 6-20;193(11-12):638-41

Nursing Department, NIVEL-Netherlands Institute for Health Services Research, Utrecht, The Netherlands.

Objective: To assess the effectiveness of the Australian Medical Sheepskin in preventing sacral pressure ulcers (PUs), based on combined data from existing published trials.

Design And Setting: Data from two randomised controlled trials (RCTs) among Australian hospital patients and one RCT among Dutch nursing home patients were pooled, comprising a total population of 1281 patients from 45 nursing wards in 11 institutions. These data were analysed in two ways: with conventional meta-analysis based on the published effect sizes; and with multilevel binary logistic regression based on the combined individual patient data. In the multilevel analysis, patient, nursing ward and institution were used as levels and we controlled for sex, age, PU risk and number of days of observation.

Main Outcome Measure: Incidence of sacral PUs.

Results: Overall, the incidence of sacral PUs was 12.2% in the control group versus 5.4% in the intervention group with an Australian Medical Sheepskin. Conventional meta-analysis showed significantly reduced odds of developing a PU while using the sheepskin (odds ratio [OR], 0.37 [95% CI, 0.17-0.77]). Multilevel analysis gave an OR of 0.35 and narrowed the confidence interval by almost 50% (95% CI, 0.23-0.55).

Conclusions: These analyses of pooled data confirm that the Australian Medical Sheepskin is effective in preventing sacral PUs. Multilevel analysis of individual patient data gives a more precise effect estimate than conventional meta-analysis.
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http://dx.doi.org/10.5694/j.1326-5377.2011.tb04185.xDOI Listing
February 2011

The effectiveness of the Australian Medical Sheepskin for the prevention of pressure ulcers in somatic nursing home patients: a prospective multicenter randomized-controlled trial (ISRCTN17553857).

Wound Repair Regen 2010 Nov-Dec;18(6):572-9. Epub 2010 Oct 13.

NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.

A multicenter prospective randomized clinical trial was undertaken to investigate the effectiveness of the Australian Medical Sheepskin (AMS) in the prevention of sacral pressure ulcers in somatic nursing home patients. Patients were randomized at admission and were then followed daily for 30 days. The experimental group received usual care plus an AMS as a layer on the mattress within ultimately 48 hours after admission; the control group received usual care only. Usual care was all the care that nursing wards normally applied for pressure ulcer prevention without any further standardization for this study. A total of 588 patients were randomized (293 control and 295 experimental group) and the data of 543 patients could be analyzed (272 from the control and 271 from the experimental group). The incidence of sacral pressure ulcers grade 1 or higher was significantly lower in the experimental group than in the control group (8.9% vs. 14.7%). In a multilevel analysis on the incidence of pressure ulcers adjusted for Braden risk score, age, and gender, it shows an odds ratio of 0.53 (95% confidence interval: 0.29-0.95), meaning a significant protective effect of the AMS. These results are in line with the results of two earlier trials on the AMS in hospital patients. The majority of patients in our trial that used an AMS rated it positively, but one-third found the sheepskin too warm. We conclude that the AMS is an effective aid in the prevention of sacral pressure ulcers in nursing home patients.
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http://dx.doi.org/10.1111/j.1524-475X.2010.00629.xDOI Listing
May 2011

An economic appraisal of the Australian Medical Sheepskin for the prevention of sacral pressure ulcers from a nursing home perspective.

BMC Health Serv Res 2010 Aug 5;10:226. Epub 2010 Aug 5.

NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands.

Background: Many devices are in use to prevent pressure ulcers, but from most little is known about their effects and costs. One such preventive device is the Australian Medical Sheepskin that has been proven effective in three randomized trials. In this study the costs and savings from the use of the Australian Medical Sheepskin were investigated from the perspective of a nursing home.

Methods: An economic model was developed in which monetary costs and monetary savings in respect of the sheepskin were balanced against each other. The model was applied to a fictional (Dutch) nursing home with 100 beds for rehabilitation patients and a time horizon of one year. Input variables for the model consisted of investment costs for using the sheepskin (purchase and laundry), and savings through the prevented cases of pressure ulcers. The input values for the investment costs and for the effectiveness were empirically based on a trial with newly admitted rehabilitation patients from eight nursing homes. The input values for the costs of pressure ulcer treatment were estimated by means of four different approaches.

Results: Investment costs for using the Australian Medical Sheepskin were larger than the monetary savings obtained by preventing pressure ulcers. Use of the Australian Medical Sheepskin involves an additional cost of approximately 2 euro per patient per day. Preventing one case of a sacral pressure ulcer by means of the Australian Medical Sheepskin involves an investment of 2,974 euro when the sheepskin is given to all patients. When the sheepskin is selectively used for more critical patients only, the investment to prevent one case of sacral pressure ulcers decreases to 2,479 euro (pressure ulcer risk patients) or 1,847 euro (ADL-severely impaired patients). The factors with the strongest influence on the balance are the frequency of changing the sheepskin and the costs of washing related to this. The economic model was hampered by considerable uncertainty in the estimations of the costs of pressure ulcer treatment.

Conclusions: From a nursing home perspective, the investment costs for use of the Australian Medical Sheepskin in newly admitted rehabilitation patients are larger than the monetary savings obtained by preventing pressure ulcers.
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http://dx.doi.org/10.1186/1472-6963-10-226DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924330PMC
August 2010

Prevention and treatment of intertrigo in large skin folds of adults: a systematic review.

BMC Nurs 2010 Jul 13;9:12. Epub 2010 Jul 13.

LEVV, The Netherlands Centre of Excellence in Nursing, PO Box 3135, 3502 GC Utrecht, The Netherlands.

Background: Intertrigo in the large skin folds is a common problem. There is a plethora of treatments, but a lack of evidence about their efficacy. A nursing guideline on this matter had to be updated and broadened in scope to other health care professionals.

Methods: A systematic review was performed. Thirteen databases were sensitively searched, supplemented by reference tracking and forward citation searches. All types of empirical research relating to the prevention or treatment of intertrigo were included. Study selection, assessment of bias, data-extraction and analysis were done by two independent review-authors.

Results: Sixty-eight studies fulfilled the inclusion criteria. Only 4 studies were RCTs and even these had a considerable risk of bias. Study populations were generally small.No studies were found about the prevention of intertrigo. The therapies concerned mostly the topical application of antimycotics, corticosteroids, antibiotics, antiseptics or a combination of these. Besides these pharmaceutical interventions, surgical breast reduction was also studied. Although most study-authors were positive, we could not draw firm conclusions about any of the pharmaceutical interventions. Even patients that received placebo intervention showed improvement. There is weak evidence that reduction mammaplasty may be helpful to treat inframammary intertrigo. All research found had considerable risk of bias, prohibiting firm conclusions.

Conclusions: There is no evidence at all about the prevention of intertrigo and there is no firm evidence about its treatment. Well designed studies are needed.
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http://dx.doi.org/10.1186/1472-6955-9-12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2918610PMC
July 2010

A review of quality assessment of the methodology used in guidelines and systematic reviews on oral mucositis.

J Clin Nurs 2009 Jan;18(1):3-12

RN Nursing Science, Department of Haematology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

Aims And Objectives: The objective of this study was to identify and to assess the quality of evidence-based guidelines and systematic reviews we used in the case of oral mucositis, to apply general quality criteria for the prevention and treatment of oral mucositis in patients receiving chemotherapy, radiotherapy or both.

Design: Systematic review.

Methods: Literature searches were carried out in several electronic databases and websites. Publications were included if they concerned oral mucositis involving adults treated for cancer and had been published after 1 January 2000. As far as systematic reviews were concerned, the article had to report a search strategy, if the search was minimally conducted in the database PubMed or Medline and the articles included in the review were subjected to some kind of methodological assessment. The Appraisal of Guidelines for Research and Education (AGREE) instrument was used to assess the quality of the guidelines and the Overview Quality Assessment Questionnaire (OQAQ) was used for the quality of systematic reviews.

Results: Thirty-one articles met the inclusion criteria of which 11 were guidelines and 20 were systematic reviews. Nine of the 11 guidelines did not explicitly describe how they identified, selected and summarised the available evidence. Reviews suffered from lack of clarity, for instance, in performing a thorough literature search. The quality varied among the different guidelines and reviews.

Conclusion: Most guidelines and systematic reviews had serious methodological flaws.

Relevance To Clinical Practice: There is a need to improve the methodological quality of guidelines and systematic reviews for the prevention and treatment of oral mucositis if they are to be used in clinical practice.
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http://dx.doi.org/10.1111/j.1365-2702.2008.02493.xDOI Listing
January 2009

Factors influencing the implementation of clinical guidelines for health care professionals: a systematic meta-review.

BMC Med Inform Decis Mak 2008 Sep 12;8:38. Epub 2008 Sep 12.

NIVEL - Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands.

Background: Nowadays more and more clinical guidelines for health care professionals are being developed. However, this does not automatically mean that these guidelines are actually implemented. The aim of this meta-review is twofold: firstly, to gain a better understanding of which factors affect the implementation of guidelines, and secondly, to provide insight into the "state-of-the-art" regarding research within this field.

Methods: A search of five literature databases and one website was performed to find relevant existing systematic reviews or meta-reviews. Subsequently, a two-step inclusion process was conducted: (1) screening on the basis of references and abstracts and (2) screening based on full-text papers. After that, relevant data from the included reviews were extracted and the methodological quality of the reviews was assessed by using the Quality Assessment Checklist for Reviews.

Results: Twelve systematic reviews met our inclusion criteria. No previous systematic meta-reviews meeting all our inclusion criteria were found. Two of the twelve reviews scored high on the checklist used, indicating only "minimal" or "minor flaws". The other ten reviews scored in the lowest of middle ranges, indicating "extensive" or "major" flaws. A substantial proportion (although not all) of the reviews indicates that effective strategies often have multiple components and that the use of one single strategy, such as reminders only or an educational intervention, is less effective. Besides, characteristics of the guidelines themselves affect actual use. For instance, guidelines that are easy to understand, can easily be tried out, and do not require specific resources, have a greater chance of implementation. In addition, characteristics of professionals - e.g., awareness of the existence of the guideline and familiarity with its content - likewise affect implementation. Furthermore, patient characteristics appear to exert influence: for instance, co-morbidity reduces the chance that guidelines are followed. Finally, environmental characteristics may influence guideline implementation. For example, a lack of support from peers or superiors, as well as insufficient staff and time, appear to be the main impediments.

Conclusion: Existing reviews describe various factors that influence whether guidelines are actually used. However, the evidence base is still thin, and future sound research - for instance comparing combinations of implementation strategies versus single strategies - is needed.
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http://dx.doi.org/10.1186/1472-6947-8-38DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2551591PMC
September 2008

Cost-effectiveness of the Australian Medical Sheepskin for the prevention of pressure ulcers in somatic nursing home patients: study protocol for a prospective multi-centre randomised controlled trial (ISRCTN17553857).

BMC Health Serv Res 2008 Jan 7;8. Epub 2008 Jan 7.

NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands.

Background: Pressure ulcers are a major problem, especially in nursing home patients, although they are regarded as preventable and there are many pressure relieving methods and materials. One such pressure relieving material is the recently developed Australian Medical Sheepskin, which has been shown in two randomized controlled trials 12 to be an effective intervention in the prevention of sacral pressure ulcers in hospital patients. However, the use of sheepskins has been debated and in general discouraged by most pressure ulcer working groups and pressure ulcer guidelines, but these debates were based on old forms of sheepskins. Furthermore, nothing is yet known about the (cost-)effectiveness of the Australian Medical sheepskin in nursing home patients. The objective of this study is to assess the effects and costs of the use of the Australian Medical Sheepskin combined with usual care with regard to the prevention of sacral pressure ulcers in somatic nursing home patients, versus usual care only.

Methods/design: In a multi-centre randomised controlled trial 750 patients admitted for a primarily somatic reason to one of the five participating nursing homes, and not having pressure ulcers on the sacrum at admission, will be randomized to either usual care only or usual care plus the use of the Australian Medical Sheepskin as an overlay on the mattress. Outcome measures are: incidence of sacral pressure ulcers in the first month after admission; sacrum pressure ulcer free days; costs; patient comfort; and ease of use. The skin of all the patients will be observed once a day from admission on for 30 days. Patient characteristics and pressure risk scores are assessed at admission and at day 30 after it. Additional to the empirical phase, systematic reviews will be performed in order to obtain data for economic weighting and modelling. The protocol is registered in the Controlled Trial Register as ISRCTN17553857.
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http://dx.doi.org/10.1186/1472-6963-8-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2245931PMC
January 2008

Interventions aimed at reducing problems in adult patients discharged from hospital to home: a systematic meta-review.

BMC Health Serv Res 2007 Apr 4;7:47. Epub 2007 Apr 4.

NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.

Background: Many patients encounter a variety of problems after discharge from hospital and many discharge (planning and support) interventions have been developed and studied. These primary studies have already been synthesized in several literature reviews with conflicting conclusions. We therefore set out a systematic review of the reviews examining discharge interventions. The objective was to synthesize the evidence presented in literature on the effectiveness of interventions aimed to reduce post-discharge problems in adults discharged home from an acute general care hospital.

Methods: A comprehensive search of seventeen literature databases and twenty-five websites was performed for the period 1994-2004 to find relevant reviews. A three-stage inclusion process consisting of initial sifting, checking full-text papers on inclusion criteria, and methodological assessment, was performed independently by two reviewers. Data on effects were synthesized by use of narrative and tabular methods.

Results: Fifteen systematic reviews met our inclusion criteria. All reviews had to deal with considerable heterogeneity in interventions, populations and outcomes, making synthesizing and pooling difficult. Although a statistical significant effect was occasionally found, most review authors reached no firm conclusions that the discharge interventions they studied were effective. We found limited evidence that some interventions may improve knowledge of patients, may help in keeping patients at home or may reduce readmissions to hospital. Interventions that combine discharge planning and discharge support tend to lead to the greatest effects. There is little evidence that discharge interventions have an impact on length of stay, discharge destination or dependency at discharge. We found no evidence that discharge interventions have a positive impact on the physical status of patients after discharge, on health care use after discharge, or on costs.

Conclusion: Based on fifteen high quality systematic reviews, there is some evidence that some interventions may have a positive impact, particularly those with educational components and those that combine pre-discharge and post-discharge interventions. However, on the whole there is only limited summarized evidence that discharge planning and discharge support interventions have a positive impact on patient status at hospital discharge, on patient functioning after discharge, on health care use after discharge, or on costs.
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http://dx.doi.org/10.1186/1472-6963-7-47DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1853085PMC
April 2007

The evidence for nursing interventions in the Cochrane Database of Systematic Reviews.

Nurse Res 2004 ;12(2):71-80

NIVEL, Netherlands Institute for Health Services Research, Utrecht.

In this paper, Patriek Mistiaen, Else Poot, Sophie Hickox, and Cordula Wagner describe how they conducted a search of the Cochrane Database of Systematic Reviews in order to explore the evidence for nursing interventions. They identify the number of studies, the number of participants, and the conclusions of systematic reviews concerning nursing interventions. They conclude that the Cochrane Database of Systematic Reviews is a valuable source of evidence about nursing interventions, and can be used as a means of developing a research agenda in the case of inconclusive reviews.
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February 2005

The evidence for nursing interventions in the Cochrane Database of Systematic Reviews.

Nurse Res 2004 Oct;12(2):71-80

NIVEL, Utrecht, The Netherlands.

In this paper, Patriek Mistiaen, Else Poot, Sophie Hickox, and Cordula Wagner describe how they conducted a search of the Cochrane Database of Systematic Reviews in order to explore the evidence for nursing interventions. They identify the number of studies, the number of participants, and the conclusions of systematic reviews concerning nursing interventions. They conclude that the Cochrane Database of Systematic Reviews is a valuable source of evidence about nursing interventions, and can be used as a means of developing a research agenda in the case of inconclusive reviews.
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http://dx.doi.org/10.7748/nr.12.2.71.s7DOI Listing
October 2004

Preventing and treating intertrigo in the large skin folds of adults: a literature overview.

Dermatol Nurs 2004 Feb;16(1):43-6, 49-57

Netherlands Institute of Health Services Research, Utrecht, The Netherlands.

Intertrigo is an inflammatory dermatosis of the skin folds of the body, for which a large variety of topical medications may be recommended. A systematic literature review was performed to find scientific evidence for preventing and treating intertrigo within the nursing domain. Seven electronic databases were searched with a simple broad-scope search strategy. The aim was to identify all publications that concerned intertrigo itself and other conditions that were related to intertriginous regions. This search produced 451 references. A final set of 24 studies was retained and analyzed on content and methodologic quality. Most studies concerned treatments with antifungals or disinfectants in heterogeneous research samples, with only small subsamples of people with intertrigo. Six studies were randomized controlled trials. In general, the methodologic quality of the studies was poor. The analyzed studies provided no scientific evidence for any type of nursing prevention or treatment strategy. There is a great need for well-designed clinical studies on intertrigo.
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February 2004
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