Impact of Donation Physicians on Deceased Organ Donation: A Systematic Review.

Background: An emerging strategy to increase deceased organ donation is to use dedicated donation physicians to champion organ donation. We sought to conduct a systematic review of the effectiveness of donation physicians in improving organ donation outcomes. Objective: A systematic review was conducted following Cochrane principles. MEDLINE, Embase, and CINHAL databases were searched from inception to March 26, 2020. Methods: Quantitative studies examining the effects of donation physicians on all deceased organ donation outcomes were considered for inclusion. Review articles, editorials and opinion articles, and case studies were excluded. Study selection was completed independently by 2 team members; all discrepancies were resolved by consensus. Two team members independently extracted data from studies. Results: A total of 1017 studies were screened, and 12 met inclusion criteria. Included studies were published between 1994 and 2019. Half used an interrupted time series design (n = 6; 50%), 3 (25%) were cohort studies, and 3 (25%) used a before-and-after study design. Outcomes (reported in greater than 50% of included articles) included consent/refusal rate (n = 8; 67%), number of potential donors (n = 7; 58%), and number of actual donors (n = 7; 58%). Across studies and design types, there was an increase in potential organ donors ranging from 8% to 143% (Mdn = 33%), an increase in actual organ donors from 15% to 113% (Mdn = 27%), an increase in donor consent rate from -3% to 258% (Mdn = 12%), and an increase in deceased donor transplants from 13% to 24% (Mdn = 19%) following the introduction of donation physicians. Conclusions: Donation physicians have the potential to significantly improve deceased organ donation. Further implementation and evaluation of donation physician programs is warranted. However, implementation should be undertaken with a clear plan for a methodologically rigorous evaluation of outcomes.

Contexte: Le recours à des médecins responsables du don d'organes est une stratégie émergente qui vise à favoriser les dons d'organes après le décès. Nous avons voulu vérifier son efficacité par le biais d'une revue systématique. Sources: La revue systématique a été réalisée conformément aux principes de Cochrane. Les bases de données MEDLINE, Embase et CINHAL ont fait l'objet d'une recherche depuis leur création jusqu'au 26 mars 2020. Méthodologie: Ont été sélectionnées les études quantitatives mesurant l'effet des médecins responsables du don d'organes sur tous les résultats de dons d'organes provenant de personnes décédées. Les articles de revue, éditoriaux, articles d'opinion et études de cas ont été exclus. Deux membres de l'équipe ont procédé de façon indépendante à la sélection des études et à l'extraction des données; les divergences ont été résolues par consensus. Résultats: Des 1 017 études sélectionnées, 12 satisfaisaient aux critères d'inclusion. Les études incluses avaient été publiées entre 1994 et 2019. La moitié des études incluses avait utilisé un modèle de série chronologique interrompu (n = 6; 50 %), trois (25 %) étaient des études de cohorte et trois (25 %) avaient une conception d'étude « avant-après ¼. Les résultats (rapportés dans plus de 50 % des articles inclus) comprenaient le taux de consentement/refus (n = 8; 67 %), le nombre de donneurs potentiels (n = 7; 58 %) et le nombre de donneurs réels (n = 7; 58 %). Après l'introduction de médecins responsables du don d'organes, selon l'étude et le type de conception, on a observé une augmentation allant de 8 à 143 % (augmentation médiane [AM]: 33 %) du nombre de donneurs potentiels, de 15 à 113 % (AM: 27 %) du nombre réel de donneurs, de -3 à 258 % (AM: 12 %) du taux de consentement et de 13 à 24 % (AM: 19 %) du nombre de transplantations d'organes provenant de donneurs décédés. Conclusion: L'introduction de médecins responsables du don d'organes est susceptible d'améliorer significativement le don d'organes après le décès. Il est justifié de poursuivre la mise en œuvre et l'évaluation des programmes intégrant des médecins responsables du don d'organes. La mise en œuvre doit cependant être entreprise avec un plan clair visant une évaluation méthodique et rigoureuse des résultats.

Inappropriate use of clinical practices in Canada: a systematic review.

BACKGROUND: Inappropriate health care leads to negative patient experiences, poor health outcomes and inefficient use of resources. We aimed to conduct a systematic review of inappropriately used clinical practices in Canada. METHODS: We searched multiple bibliometric databases and grey literature to identify inappropriately used clinical practices in Canada between 2007 and 2021. Two team members independently screened citations, extracted data and assessed methodological quality. Findings were synthesized in 2 categories: diagnostics and therapeutics. We reported ranges of proportions of inappropriate use for all practices. Medians and interquartile ranges (IQRs), based on the percentage of patients not receiving recommended practices (underuse) or receiving practices not recommended (overuse), were calculated. All statistics are at the study summary level. RESULTS: We included 174 studies, representing 228 clinical practices and 28 900 762 patients. The median proportion of inappropriate care, as assessed in the studies, was 30.0% (IQR 12.0%-56.6%). Underuse (median 43.9%, IQR 23.8%-66.3%) was more frequent than overuse (median 13.6%, IQR 3.2%-30.7%). The most frequently investigated diagnostics were glycated hemoglobin (underused, range 18.0%-85.7%, n = 9) and thyroid-stimulating hormone (overused, range 3.0%-35.1%, n = 5). The most frequently investigated therapeutics were statin medications (underused, range 18.5%-71.0%, n = 6) and potentially inappropriate medications (overused, range 13.5%-97.3%, n = 9). INTERPRETATION: We have provided a summary of inappropriately used clinical practices in Canadian health care systems. Our findings can be used to support health care professionals and quality agencies to improve patient care and safety in Canada.

Intervention to reduce unnecessary urinary catheter use in a large academic health science centre: A one-group, pretest, posttest study with a theory-based process evaluation.

AIM: To evaluate an intervention to reduce unnecessary urinary catheter use and prevent catheter-associated urinary-tract infections (CAUTI) in hospitalized patients across an academic health science centre. METHODS: We conducted a one-group, pretest, posttest study with a theory-based process evaluation. Phase 1 consisted of a pre/postintervention to test the impact of a CAUTI protocol. Audits on four units were conducted, and data were analysed descriptively. Phase 2 consisted of a theory-based process evaluation to understand the barriers/enablers to the implementation. Semistructured interviews were conducted and then analysed using a systematic approach. RESULTS: In Phase 1, all inpatients with urinary catheters admitted to the units (N = 4) during the study period (N = 99, pre) and (N = 99, post) were included. CAUTI prevalence rate was 18.2% pre versus 14.1% post (p = .563). In Phase 2, participants (N = 18) who worked on the units were interviewed, and a total of 13 barriers and 19 enablers were found.

Impact of sensory interventions on the quality of life of long-term care residents: a scoping review.

INTRODUCTION AND PURPOSE: Residents in long-term care exhibit diminishing senses (hearing, sight, taste, smell or touch). The purpose of this study was to examine the available literature on the impact of sensory interventions on the quality of life of residents living in long-term care settings. METHODS: We conducted a mixed-methods scoping review using Arksey and O'Malley's framework. Seven databases (Medline (Ovid), PubMed (non-Medline-Ovid), CINAHL (EBSCO), Embase (Ovid), Ageline, PsycINFO (Ovid), Cochrane Central Register of Controlled Trials until 1 December 2020) were searched. Two reviewers independently screened the studies for sensory interventions using a two-step process. Eligible studies underwent data extraction and results were synthesised descriptively. RESULTS: We screened 5551 titles and abstracts. A total of 52 articles met our inclusion criteria. Some interventions involved only one sense: hearing (n=3), sight (n=12), smell (n=4) and touch (n=15). Other interventions involved multiple senses (n=18). We grouped the interventions into 16 categories (music programmes, environmental white noise, bright light interventions, visual stimulations, olfactory stimulations, massages, therapeutic touch, tactile stimulations, physical activity plus night-time programmes, pet therapies, various stimuli interventions, Snoezelen rooms, motor and multisensory based strategies, Namaste care, environmental modifications and expressive touch activities). CONCLUSION: This preliminary review summarised some of the available sensory interventions that will help inform a series of future systematic reviews on each of the specific interventions. The evidence-based knowledge for sensory interventions will also inform a future audit programme for assessing the presence of sensory interventions in long-term care.

Engaging patients and informal caregivers to improve safety and facilitate person- and family-centered care during transitions from hospital to home - a qualitative descriptive study.

Purpose: The purpose was to describe patients and informal caregivers' perspectives on how to improve and monitor care during transitions from hospital to home as part of a larger research study to prioritize the components that most influence the development of successful care transition interventions. Methods: We conducted a qualitative descriptive study between July and August 2016, during which time semi-structured telephone interviews (n=8) were completed with patients and informal caregivers across select Canadian provinces. Interviews were audio-recorded, transcribed and thematically analyzed. Results: Main themes included: the need for effective communication between providers and patients and informal caregivers; the need for improving key aspects of the discharge process; and increasing patients and informal caregivers involvement in care practices. Participants also provided suggestions on how to best monitor care transitions. Conclusion: This study highlighted the following strategies with patients and informal caregivers: focus on effective communication regarding important information; provide appropriate resources; and increase involvement. Future research is needed to incorporate the input from patients and informal caregivers into the design and implementation of care transition interventions.

What is the impact of sensory practices on the quality of life of long-term care residents? A mixed-methods systematic review protocol.

BACKGROUND: With age, the acuity of the five senses (i.e., hearing, sight, taste, smell, touch) is reduced. These types of sensory changes can affect day-to-day activities, making it more difficult for individuals to communicate and to interact with the world around them. The five senses allow us to receive information from the environment in the form of sound, light, smell, taste, and touch. As an older person's senses decline, they need more stimulation to be aware of these sensations. In long-term care settings, appropriate sensory practices are needed to address the diminishing senses of older adults. The objective of this mixed-methods systematic review is to examine the relationship between the sensory practices and the quality of life of residents living in long-term care settings and to develop an aggregated synthesis of mixed-methods studies to derive recommendations for policy, practice, and research. METHODS: We will conduct a mixed-methods systematic review in accordance with the Cochrane Handbook. A search strategy has been developed with an expert health sciences librarian and peer reviewed using Peer Review for Electronic Search Strategies (PRESS). Seven databases: MEDLINE (Ovid), PubMed (non-MEDLINE-Ovid), CINAHL (EBSCO), Embase (Ovid), Ageline, PsycINFO (Ovid), and Cochrane Central Register of Controlled Trials (CENTRAL) will be searched for studies that meet the inclusion criteria. Two reviewers will independently screen the results of the literature search using a two-step process. Eligible studies will undergo a quality assessment and data extraction. Disagreements will be resolved through consultation with a third reviewer. We will assess the quality of individual studies using the Mixed Methods Appraisal Tool (MMAT). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) will be used to summarize the strength of the quantitative evidence, and the Confidence in the Evidence from Reviews of Qualitative research (CERQual) tool to assess confidence in the qualitative syntheses. DISCUSSION: This systematic review will summarize evidence-based knowledge for sensory practices, identify gaps in the literature, and inform an audit program for assessing the presence of sensory practices in the long-term care setting. The results will be relevant to policy makers, decision-makers, clinicians, and residents/families in long-term care settings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration # CRD42017032330 .

Use of participatory visual narrative methods to explore older adults' experiences of managing multiple chronic conditions during care transitions.

BACKGROUND: Older adults with multiple chronic conditions typically have more complex care needs that require multiple transitions between healthcare settings. Poor care transitions often lead to fragmentation in care, decreased quality of care, and increased adverse events. Emerging research recommends the strong need to engage patients and families to improve the quality of their care. However, there are gaps in evidence on the most effective approaches for fully engaging patients/clients and families in their transitional care. The purpose of this study was to engage older adults with multiple chronic conditions and their family members in the detailed exploration of their experiences during transitions across health care settings and identify potential areas for future interventions. METHODS: This was a qualitative study using participatory visual narrative methods informed by a socio-ecological perspective. Narrated photo walkabouts were conducted with older adults and family members (n = 4 older adults alone, n = 3 family members alone, and n = 2 older adult/family member together) between February and September 2016. The data analysis of the transcripts consisted of an iterative process until consensus on the coding and analysis was reached. RESULTS: A common emerging theme was that older adults and their family members identified the importance of active involvement in managing their own care transitions. Other themes included positive experiences during care transitions; accessing community services and resources; as well as challenges with follow-up care. Participants also felt a lack of meaningful engagement during discharge planning, and they also identified the presence of systemic barriers in care transitions. CONCLUSION: The results contribute to our understanding that person- and family-centered care transitions should focus on the need for active involvement of older adults and their families in managing care transitions. Based on the results, three areas for improvement specific to older adults managing chronic conditions during care transitions emerged: strengthening support for person- and family-centered care, engaging older adults and families in their care transitions, and providing better support and resources.