Effectiveness of physician-based interventions with problem drinkers: a review.

OBJECTIVE: To review the results of randomized controlled trials on the effectiveness of brief physician interventions with problem drinkers. DATA SOURCES: The MEDLINE and EMBASE databases were searched for articles published from 1966 and 1972 respectively, with the terms "problem/controlled/responsible/moderate/risk/drink"; "advice/drink"; "physician, nurse, general practitioner"; and "random." Forty-three articles were identified in the EMBASE search and 112 articles in the MEDLINE search. STUDY SELECTION: All trials examining the effectiveness of interventions by physicians in reducing alcohol consumption among problem drinkers attending a health-care facility were reviewed. Trials involving subjects attending an alcohol treatment clinic and those involving interventions delivered solely by nonphysicians were excluded. Eleven trials met the final selection criteria. DATA EXTRACTION: For each article, two of the authors independently assigned a score from 0 to 2 on a number of criteria for validity and generalizability. DATA SYNTHESIS: The four trials with the highest validity scores showed that men in the intervention groups reduced their weekly alcohol consumption by five to seven standard drinks more than the men in the control groups. Results for women were inconsistent. No convincing evidence of declines in alcohol-related morbidity among men or women was found. CONCLUSIONS: The trials support the use of brief interventions by physicians for patients with drinking problems. Although further studies are needed to determine their effect on morbidity and mortality, the public health impact of such interventions is potentially enormous. Further research is needed to determine which patients are best suited for brief interventions, the optimal intensity of treatment and which components of brief interventions are most effective. Research is also needed to establish which strategies are effective in inducing physicians to use brief interventions.     

右美托咪啶与咪达唑仑对老年患者术后谵妄影响的系统评价

目的系统评价右美托咪定和咪达唑仑对老年患者术后谵妄的影响。方法计算机检索Pub Med、SCI、EMbase、The Cochrane Library、CNKI、CBM、Wan Fang Data和VIP等数据库,全面收集右美托咪啶和咪达唑仑麻醉对老年患者术后谵妄影响的随机对照试验(RCT),检索时限均为建库至2013年12月。由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用Rev Man 5.2软件进行Meta分析。结果纳入6个RCT,共170例老年患者。Meta分析结果显示:与咪达唑仑组比较,经右美托咪定诱导后,右美托咪定组的谵妄发生率低于咪达唑[RR=0.17,95%CI(0.09,0.30),P<0.000 01]。结论咪达唑仑在老年患者术后发生谵妄率高于右美托咪啶。但鉴于纳入研究较少且样本量小,特别是质量不高,建议临床上开展大样本、多中心、高质量的随机对照试验进一步论证。     

Effectiveness of teaching quality improvement to clinicians: a systematic review

Context  Accreditation requirements mandate teaching quality improvement (QI) concepts to medical trainees, yet little is known about the effectiveness of teaching QI. Objectives  To perform a systematic review of the effectiveness of published QI curricula for clinicians and to determine whether teaching methods influence the effectiveness of such curricula. Data Sources  The electronic literature databases of MEDLINE, EMBASE, CINAHL, and ERIC were searched for English-language articles published between January 1, 1980, and April 30, 2007. Experts in the field of QI were queried about relevant studies. Study Selection  Two independent reviewers selected studies for inclusion if the curriculum taught QI principles to clinicians and the evaluation used a comparative study design. Data Extraction  Information about the features of each curriculum, its use of 9 principles of adult learning, and the type of educational and clinical outcomes were extracted. The relationship between the outcomes and the number of educational principles used was assessed. Results  Of 39 studies that met eligibility criteria, 31 described team-based projects; 37 combined didactic instruction with experiential learning. The median number of adult learning principles used was 7 (range, 2-8). Evaluations included 22 controlled trials (8 randomized and 14 nonrandomized) and 17 pre/post or time series studies. Fourteen studies described educational outcomes (attitudes, knowledge, or skills or behaviors) and 28 studies described clinical process or patient outcomes. Nine of the 10 studies that evaluated knowledge reported only positive effects but only 2 of these described a validated assessment tool. The 6 assessments of attitudes found mixed results. Four of the 6 studies on skill or behavior outcomes reported only positive effects. Eight of the 28 studies of clinical outcomes reported only beneficial effects. Controlled studies were more likely than other studies to report mixed or null effects. Only 4 studies evaluated both educational and clinical outcomes, providing limited evidence that educational outcomes influence the clinical effectiveness of the interventions. Conclusions  Most published QI curricula apply sound adult learning principles and demonstrate improvement in learners' knowledge or confidence to perform QI. Additional studies are needed to determine whether educational methods have meaningful clinical benefits.      

Effectiveness of specialized palliative care: a systematic review

Camilla Zimmermann, MD, MSc; Rachel Riechelmann, MD; Monika Krzyzanowska, MD, MPH; Gary Rodin, MD; Ian Tannock, MD, PhD

JAMA. 2008;299(14):1698-1709.

Context  Specialized palliative care teams are increasingly providing care for the terminally ill. However, the impact of such teams on quality of life, satisfaction with care, and economic cost has not been examined systematically using detailed criteria for study quality.

Objective  To systematically review the evidence for effectiveness of specialized palliative care.

Data Sources  We performed a keyword search of the following databases from their inception to January 2008: MEDLINE, Ovid Healthstar, CINAHL, EMBASE, and the Cochrane Central Register of Controlled Trials.

Study Selection  We included all randomized controlled trials in which specialized palliative care was the intervention and for which outcomes included quality of life, satisfaction with care, or economic cost.

Data Extraction  Data on population, intervention, outcome, methods, and methodological quality were extracted by 2 investigators using standardized criteria.

Results  Of 396 reports of randomized controlled trials, 22 met our inclusion criteria. There was most consistent evidence for effectiveness of specialized palliative care in improvement of family satisfaction with care (7 of 10 studies favored the intervention). Only 4 of 13 studies assessing quality of life and 1 of 14 assessing symptoms showed a significant benefit of the intervention; however, most studies lacked statistical power to report conclusive results, and quality-of-life measures were not specific for terminally ill patients. There was evidence of significant cost savings of specialized palliative care in only 1 of the 7 studies that assessed this outcome. Methodological limitations were identified in all trials, including contamination of the control group, failure to account for clustering in cluster randomization studies, and substantial problems with recruitment, attrition, and adherence.

Conclusions  The evidence for benefit from specialized palliative care is sparse and limited by methodological shortcomings. Carefully planned trials, using a standardized palliative care intervention and measures constructed specifically for this population, are needed.

     

No magic bullets: a systematic review of 102 trials of interventions to improve professional practice.

OBJECTIVE: To determine the effectiveness of different types of interventions in improving health professional performance and health outcomes. DATA SOURCES: MEDLINE, SCISEARCH, CINAHL and the Research and Development Resource Base in CME were searched for trials of educational interventions in the health care professions published between 1970 and 1993 inclusive. STUDY SELECTION: Studies were selected if they provided objective measurements of health professional performance or health outcomes and employed random or quasi-random allocation methods in their study designs to assign individual subjects or groups. Interventions included such activities as conferences, outreach visits, the use of local opinion leaders, audit and feedback, and reminder systems. DATA EXTRACTION: Details extracted from the studies included the study design; the unit of allocation (e.g., patient, provider, practice, hospital); the characteristics of the targeted health care professionals, educational interventions and patients (when appropriate); and the main outcome measure. DATA SYNTHESIS: The inclusion criteria were met by 102 trials. Areas of behaviour change included general patient management, preventive services, prescribing practices, treatment of specific conditions such as hypertension or diabetes, and diagnostic service or hospital utilization. Dissemination-only strategies, such as conferences or the mailing of unsolicited materials, demonstrated little or no changes in health professional behaviour or health outcome when used alone. More complex interventions, such as the use of outreach visits or local opinion leaders, ranged from ineffective to highly effective but were most often moderately effective (resulting in reductions of 20% to 50% in the incidence of inappropriate performance). CONCLUSION: There are no "magic bullets" for improving the quality of health care, but there are a wide range of interventions available that, if used appropriately, could lead to important improvements in professional practice and patient outcomes.     

Risk factors for delirium in hospitalized elderly.

OBJECTIVE--To determine risk factors for delirium in elderly hospitalized patients. DESIGN--Cohort analytic study. Using a reliable and valid instrument for detection of delirium, we prospectively followed up a cohort of elderly patients admitted to an acute care hospital. Using standardized criteria, we collected risk factor data from patient medical records. SETTING--General medical and surgical wards of a tertiary-care hospital. PATIENTS--Patients (n = 325) were 65 years of age or older, from either a geographically defined community or a long-term-care institution. We studied those patients (n = 291) not delirious on first evaluation. Fifty-seven patients or their families refused participation. MAIN OUTCOME MEASURES--Incidence of delirium and risk factors calculated as adjusted odds ratios (ORs). MAIN RESULTS--Delirium developed in 91 patients. By stepwise logistic regression, the independent risk factors for in-hospital delirium included prior cognitive impairment (OR, 8.97; 95% confidence interval [CI], 3.99 to 20.14), age over 80 years (OR, 5.22; 95% CI, 2.60 to 10.46), fracture on admission (OR, 6.57; 95% CI, 2.23 to 19.33), symptomatic infection (OR, 2.96; 95% CI, 1.42 to 6.15), and male sex (OR, 2.40; 95% CI, 1.19 to 4.84). Among medication groups, only neuroleptic use (OR, 4.48; 95% CI, 1.82 to 10.45) and narcotic use (OR, 2.54; 95% CI, 1.24 to 5.18) were independently associated with delirium. Anticholinergic use was not associated with delirium. CONCLUSIONS--Delirium in hospitalized patients is most closely associated with factors already present on admission such as prior cognitive impairment, advanced age, and fracture. In the hospital, use of neuroleptics and narcotics and the presence of infection are less strongly associated with this syndrome.     

喹硫平治疗综合医院住院患者并发谵妄的临床疗效分析

目的：研究喹硫平对综合医院住院患者伴急性谵妄的临床疗效。方法：将87例确诊为急性谵妄的患者随机分为两组,研究组44例和对照组43例。在积极治疗原发病的同时,治疗组患者合并使用喹硫平治疗,对照组患者合并使用奥氮平治疗。在治疗前,治疗1周、2周后分别使用简明精神病量表（BPRS）、谵妄评定量表（CAM-CR）、临床总体印象量表（CGI）和药物副作用量表（TESS）给予评分。结果：①喹硫平组和奥氮平组治疗后显效率分别为84.66%与85.37%,两组显效率差异无统计学意义（P〉0.05）。②与治疗前相比,研究组和对照组在治疗1周后的CAM-CR和CGI量表评分均有改善（P〈0.05）;治疗2周后,研究组和对照组患者改善更明显（P〈0.01）,两组间差异无统计学意义（P〉0.05）。③不良反应总的发生率奥氮平组明显高于喹硫平组,两组差异有统计学意义（P〈0.05）。结论：喹硫平与奥氮平治疗谵妄疗效相当,喹硫平不良反应小,可以作为一线药物用于谵妄的治疗。     

静脉输注免疫球蛋白对呼吸机相关肺炎疗效的系统评价

目的：系统评价免疫球蛋白( IVIG)治疗呼吸机相关性肺炎( VAP)相关研究,分析其有效性,为临床治疗策略提供依据。方法系统检索CNKI、万方、CBM、Pubmed、Embase、ISI及Cochrane数据库中相关文献,采用Cochrane标准评价纳入研究偏倚风险,Meta分析结合描述性分析研究数据。结果①纳入6个随机对照研究,435例低体质量儿、早产儿及婴儿VAP患者,质量一般。②Meta分析结果显示IVIG组死亡率低于非IVIG组[RR=0．33,95%CI(0．18~0．60),P=0．0002];IVIG组血液免疫球蛋白浓度比对照组高3．19 mg/L [MD=3．19,95%CI(3．02~3．37),P<0．05];③IVIG组败血症[RR=0．14,95%CI(0．04~0．51),P=0．003]和多器官功能衰竭发生率[RR=0．51,95%CI(0．30~0．88),P=0．02]低于对照。结论 IVIG主要用于早产儿及低体质量儿VAP患者,可能提高体液免疫,降低败血症和多器官功能衰竭发生率,减少患者病死率,改善预后。     

Educational and organizational interventions to improve the management of depression in primary care: a systematic review

Context  Depression is commonly encountered in primary care settings yet is often missed or suboptimally managed. A number of organizational and educational strategies to improve management of depression have been proposed. The clinical effectiveness and cost-effectiveness of these strategies have not yet been subjected to systematic review. Objective  To systematically evaluate the effectiveness of organizational and educational interventions to improve the management of depression in primary care settings. Data Sources  We searched electronic medical and psychological databases from inception to March 2003 (MEDLINE, PsycLIT, EMBASE, CINAHL, Cochrane Controlled Trials Register, United Kingdom National Health Service Economic Evaluations Database, Cochrane Depression Anxiety and Neurosis Group register, and Cochrane Effective Professional and Organisational Change Group specialist register); conducted correspondence with authors; and used reference lists. Search terms were related to depression, primary care, and all guidelines and organizational and educational interventions. Study Selection  We selected 36 studies, including 29 randomized controlled trials and nonrandomized controlled clinical trials, 5 controlled before-and-after studies, and 2 interrupted time-series studies. Outcomes relating to management and outcome of depression were sought. Data Extraction  Methodological details and outcomes were extracted and checked by 2 reviewers. Summary relative risks were, where possible, calculated from original data and attempts were made to correct for unit of analysis error. Data Synthesis  A narrative synthesis was conducted. Twenty-one studies with positive results were found. Strategies effective in improving patient outcome generally were those with complex interventions that incorporated clinician education, an enhanced role of the nurse (nurse case management), and a greater degree of integration between primary and secondary care (consultation-liaison). Telephone medication counseling delivered by practice nurses or trained counselors was also effective. Simple guideline implementation and educational strategies were generally ineffective. Conclusions  There is substantial potential to improve the management of depression in primary care. Commonly used guidelines and educational strategies are likely to be ineffective. The implementation of the findings from this research will require substantial investment in primary care services and a major shift in the organization and provision of care.      

Effectiveness of azithromycin mass drug administration on trachoma: a systematic review

Backgrounds:Azithromycin mass drug administration (MDA) is a key part of the strategy for controlling trachoma. This systematic review aimed to comprehensively summarize the present studies of azithromycin MDA on trachoma; provide an overview of the impact of azithromycin MDA on trachoma in different districts; and explore the possible methods to enhance the effectiveness of azithromycin MDA in hyperendemic districts.Methods:PubMed, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and ClinicalTrials.gov were searched up to February 2021 with no language restriction. Studies reporting the effect of azithromycin MDA on trachoma were included. Mathematical modeling studies, animal studies, case reports, and reviews were excluded. The trachomatous inflammation-follicular (TF) <5.0% was used to judge the effect of azithromycin MDA on eliminating trachoma as a public health problem. Two researchers independently conducted the selection process and risk of bias assessment.Results:A total of 1543 studies were screened, of which 67 studies including 13 cluster-randomized controlled trials and 54 non-randomized studies were included. The effect of azithromycin MDA on trachoma was closely related to the baseline prevalence in districts. For the districts with baseline prevalence between 5.0% and 9.9%, a single round of MDA achieved a TF <5.0%. For the districts with baseline between 10.0% and 29.9%, annual MDA for 3 to 5 years reduced TF <5.0%. However, for the districts with high level of baseline prevalence (TF >30.0%), especially with baseline TF >50.0%, annual MDA was unable to achieve the TF <5.0% even after 5 to 7 years of treatment. Quarterly MDA is more effective in controlling trachoma in these hyperendemic districts.Conclusions:Azithromycin MDA for controlling trachoma depends on the baseline prevalence. The recommendation by the World Health Organization that annual MDA for 3 to 5 years in the districts with TF baseline >10.0% is not appropriate for all eligible districts.     

更昔洛韦对防治肾移植后巨细胞病毒感染预防性治疗的系统评价

 目的 系统评价更昔洛韦防治肾移植后巨细胞病毒（cytomegalovirus,CMV）感染的有效性。方法 计算机检索PubMed、SCI、EMBASE、Cochrane Library、中国期刊全文数据库、中国生物医学文献数据库、中文科技期刊数据库和中华医学会数字化期刊群,并辅手工检索和其他检索,收集肾移植后给予更昔洛韦防治CMV感染的随机对照试验,检索时间截止到2009年6月。按照纳入标准由2名研究者独立筛选文献并提取资料,采用Cochrane Handbook推荐评价标准评价纳入研究质量,采用RevMan 5.0软件进行统计处理。结果 共纳入12个随机对照试验。Meta分析结果显示：(1)与不服用抗病毒药相比,更昔洛韦并不能降低术后3个月和6个月CMV感染率和CMV发病率,但可降低12个月CMV发病率,可以延缓术后发生CMV感染的时间;(2)与伐昔洛韦相比,两者降低CMV感染率和发病率的差别不大;(3)与阿昔洛韦比较,更昔洛韦可降低6个月CMV发病率;(4)与抗CMV-IgG和缬更昔洛韦比较,在降低CMV发病率方面在统计学上无显著性差异（P=0.93;P=0.14）。结论 对肾移植患者给予长时间更昔洛韦可以预防CMV感染,其疗效与伐昔洛韦、抗CMV-IgG、缬更昔洛韦无区别,较阿昔洛韦好。     

中国2004—2010艾滋病母婴传播率及母婴阻断药物应用状况的系统评价

目的:了解我国2004-2010年艾滋病母婴传播及母婴阻断药物应用状况。方法：全面检索CBM和Pubmed等中英文数据库,检索时间均从建库到2013年5月。对纳入的文献采用参照AHRQ横断面研究评价标准和STROBE声明拟定的四条标准进行质量评价。并将样本量、监测地点和监测年份作为主要异质性来源进行meta回归分析。采用Comprehensive Meta-Analysis V2.0 software 进行meta分析。结果：共检索到文献2356篇,最终纳入51篇进行分析。2004-2010年我国艾滋病母婴传播率依次分别为12.90%（95% CI: 7.48 %- 21.36%）,16.35%（95% CI: 10.41%- 24.73%）,6.45%（95% CI: 3.73 %- 10.93%）,6.25%（95% CI: 2.39%- 15.36%）,5.56%（95% CI: 2.79 %- 10.76%）,3.10%（95% CI: 1.59 %- 5.97%）,2.29%（95% CI: 1.36 %- 3.83%）。2004-2010年,我国艾滋病孕产妇中阻断药物应用率依次分别为70.39%（95% CI: 24.42%-94.59%）,71.99%（95% CI: 61.49%-80.54%）,78.79%（95% CI: 70.19%-85.43%）,86.84%（95% CI: 79.24%-91.94%）,82.71%（95% CI: 76.62%-87.48%）,81.85%（95% CI: 75.55%-86.80%）,86.16%（95% CI: 53.20%-97.15%）。2005-2010年婴儿阻断药物应用率依次分别为80.72%（95%CI: 72.89%-86.70%）,81.84%（95% CI:71.55%-88.98%）,85.43%（95% CI:80.99%-88.97%）,89.75%（95% CI: 81.82%-94.45%）,92.39%（95% CI: 84.97%-96.31%）,90.34%（95% CI: 85.50%-93.68%）。 结论：近年来我国艾滋病母婴传播率呈下降趋势,孕产妇及婴儿阻断药物应用率都有所升高。     

医疗干预措施系统综述中结果概要表简介

结果概要表（Summary of findings table,SoF table）以简单清晰的表格形式呈现系统综述的主要结果,有助于临床医生或医疗卫生决策者从系统综述中迅速理解和获取重要的发现,通过权衡利弊,作出合理的医疗决策。利用结果概要表有助于对证据的理解和使用,促进循证的临床实践。就《Cochrane系统评价员手册》中结果概要表的内容、特点、制作方法进行介绍,并通过一个实例进行解读,便于临床医生的理解和使用。     

The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature

Background

Many patients experience difficulties in adhering to long-term treatment. Although patients'' reasons for not being adherent are diverse, one of the most commonly reported barriers is forgetfulness. Reminding patients to take their medication may provide a solution. Electronic reminders (automatically sent reminders without personal contact between the healthcare provider and patient) are now increasingly being used in the effort to improve adherence.

Objective

To examine the effectiveness of interventions using electronic reminders in improving patients'' adherence to chronic medication.

Methods

A comprehensive literature search was conducted in PubMed, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials. Electronic searches were supplemented by manual searching of reference lists and reviews. Two reviewers independently screened all citations. Full text was obtained from selected citations and screened for final inclusion. The methodological quality of studies was assessed.

Results

Thirteen studies met the inclusion criteria. Four studies evaluated short message service (SMS) reminders, seven audiovisual reminders from electronic reminder devices (ERD), and two pager messages. Best evidence synthesis revealed evidence for the effectiveness of electronic reminders, provided by eight (four high, four low quality) studies showing significant effects on patients'' adherence, seven of which measured short-term effects (follow-up period <6 months). Improved adherence was found in all but one study using SMS reminders, four studies using ERD and one pager intervention. In addition, one high quality study using an ERD found subgroup effects.

Conclusion

This review provides evidence for the short-term effectiveness of electronic reminders, especially SMS reminders. However, long-term effects remain unclear.     

The burden of the digital environment: a systematic review on organization-directed workplace interventions to mitigate physician burnout

ObjectiveTo conduct a systematic review identifying workplace interventions that mitigate physician burnout related to the digital environment including health information technologies (eg, electronic health records) and decision support systems) with or without the application of advanced analytics for clinical care.Materials and MethodsLiterature published from January 1, 2007 to June 3, 2020 was systematically reviewed from multiple databases and hand searches. Subgroup analysis identified relevant physician burnout studies with interventions examining digital tool burden, related workflow inefficiencies, and measures of burnout, stress, or job satisfaction in all practice settings.ResultsThe search strategy identified 4806 citations of which 81 met inclusion criteria. Thirty-eight studies reported interventions to decrease digital tool burden. Sixty-eight percent of these studies reported improvement in burnout and/or its proxy measures. Burnout was decreased by interventions that optimized technologies (primarily electronic health records), provided training, reduced documentation and task time, expanded the care team, and leveraged quality improvement processes in workflows.DiscussionThe contribution of digital tools to physician burnout can be mitigated by careful examination of usability, introducing technologies to save or optimize time, and applying quality improvement to workflows.ConclusionPhysician burnout is not reduced by technology implementation but can be mitigated by technology and workflow optimization, training, team expansion, and careful consideration of factors affecting burnout, including specialty, practice setting, regulatory pressures, and how physicians spend their time.     

基于患者社会网络的干预对COPD自我管理等影响的系统评价

目的 评价基于患者社会网络的干预对慢性阻塞性肺疾病(COPD)患者自我管理、生活质量的影响。 方法 采用主题检索与自由检索相结合的方式,计算机检索中文数据库如中国期刊全文数据库、万方数据库、中国生物医学文献服务系统、维普数据库,以及英文数据库(The Cochrane Library、PubMed、Embase、Web of science、Proquest)中基于患者社会网络的干预措施对COPD患者自我管理、生活质量影响的随机对照试验,检索时限为建库至2019年12月。由2名研究者按照纳入和排除标准筛选文献、提取资料、并评价纳入研究的偏倚风险,然后采用RevMan 5.3进行Meta分析或进行描述性分析。 结果 共纳入10项研究,共包括967例COPD患者。Meta分析结果显示,干预组自我管理量表评分高于对照组,差异有统计学意义[SMD=1.89,95%CI(0.24,3.54),P=0.020],干预组患者生活质量优于对照组,差异有统计学意义[MD=-8.43,95%CI(-11.10,-2.77),P<0.001)]。 结论 现有证据显示,基于患者社会网络的干预对提高COPD患者自我管理能力有积极作用,有利于改善患者生活质量。由于研究设计和样本的限制,需要更多大样本研究以进一步证实。      

A prospective study of delirium in hospitalized elderly

The prevalence, risk factors, and outcomes of delirium were studied in 229 elderly patients. Fifty patients (22%) met criteria for delirium; nondelirious elderly constituted the control group. Abnormal sodium levels, illness severity, dementia, fever or hypothermia, psychoactive drug use, and azotemia were associated with risk of delirium. Patients with three or more risk factors had a 60% rate of delirium. Delirious patients stayed 12.1 days in the hospital vs 7.2 days for controls and were more likely to die (8% vs 1%) or be institutionalized (16% vs 3%). Illness severity predicted 6-month mortality, but the effect of delirium was not significant. Delirium occurs commonly in hospitalized elderly, is associated with chronic and acute problems, and identifies elderly at risk for death, longer hospitalization, and institutionalization. The increased mortality associated with delirium appears to be explained by greater severity of illness.     

Influence of clinical pathways used the hospitals of Traditional Chinese Medicine on patients hospitalized with stroke: a systematic review and Meta-analysis

Objective

To evaluate the influence of clinical pathways in the hospitals using the Traditional Chinese Medicine in treatment of stroke in terms of postoperative complications, length of stay (LOS), costs incurred during hospitalization, compared with standard medical care.