Assistance

Week 7 Discussion

·
Select one (1) of the three (3) published articles that was approved in week 4.

· Post the title of the article, authors, purpose, and type of study: Quantitative, Qualitative, or Systematic Review.

· Discuss how it might influence your practice. What changes to your practice would you recommend based on the article?

APPENDIX A

Appraisal Guide

Recommendations of a Clinical Practice Guideline

Citation:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

Synopsis

What group or groups produced the guideline?

What does the guideline address? Clinical questions, conditions, interventions?

What population of patients does the guideline address?

Did the panel use existing SRs or did it conduct its own?

What clinical outcomes was the guideline designed to achieve?

What are the main recommendations?

What system was used to grade the recommendations?

Credibility

Was the panel made up of people with the necessary expertise?  Yes   No   Not clear

Are the goals for developing the guideline explicit and clear?  Yes   No   Not clear

*Does the guideline production process include all the widely

recognized steps?  Yes   No   Not clear

*Were the SRs used of high quality?  Yes   No   Not clear

Are differences in evidence for subpopulations recognized?  Yes   No   Not clear

*Is the evidence supporting each

recommendation graded or stated as adequate to strong?  Yes   No   Not clear

Is the guideline current? (based on

issue date and date of most recent evidence included)  Yes   No   Not clear

Are the recommendations credible?  Yes All   Yes Some   No

Clinical Significance

Are essential elements of any
recommended action or intervention clearly stated?  Yes   No   Not clear

*Is the magnitude of benefit associated
with each recommendation clinically important?  Yes   No   Not clear

*Is the panel’s certainty or confidence
in each recommendation clear?  Yes   No   Not clear

Were patient concerns, values, and risks addressed?  Yes   No   Not clear

Were downsides or costs of each recommendation addressed?  Yes   No   Not clear

Was the guideline reviewed by
outside experts and a member of
the public or field tested?  Yes   No   Not clear

Are the recommendations
clinically significant?  Yes All   Yes Some   No

Applicability

Does the guideline address a problem,
weakness, or decision we are examining in our setting?  Yes   No

Did the research evidence involve
patients similar to ours, and was the
setting similar to ours?  Yes   No   Some

What changes, additions, training, or
purchases would be needed to
implement and sustain a clinical
protocol based on these conclusions? Specify.

____________________________________________________________________________

___________________________________________________

APPENDIX C

Appraisal Guide

Conclusions of a Systematic Review with Narrative Synthesis

Citation:

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Synopsis

What organization or persons produced the systematic review (SR)?

How many persons were involved in conducting the review?

What topic or question did the SR address?

How were potential research reports identified?

What determined if a study was included in the analysis?

How many studies were included in the review?

What research designs were used in the studies?

What were the consistent and important across-studies conclusions?

Credibility

Was the topic clearly defined?  Yes   No   Not clear

Was the search for studies and other
evidence comprehensive and unbiased?  Yes   No   Not clear

Was the screening of citations for
inclusion based on explicit criteria?  Yes   No   Not clear

*Were the included studies assessed
for quality?  Yes   No   Not clear

Were the design characteristics and
findings of the included studies displayed
or discussed in sufficient detail?  Yes   No   Not clear

*Was there a true integration (i.e., synthesis) of the findings—not
merely reporting of findings from
each study individually?  Yes   No   Not clear

*Did the reviewers explore why differences
in findings might have occurred?  Yes   No   Not clear

Did the reviewers distinguish between
conclusions based on consistent findings
from several good studies and those
based on inferior evidence (number or quality)?  Yes   No   Not clear

Which conclusions were supported by
consistent findings from two or more
good or high-quality studies? List

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Are the conclusions
credible?  Yes All   Yes Some   No

Clinical Significance

*Across studies, is the size of the
treatment or the strength of the
association found or the
meaningfulness of qualitative findings
strong enough to make a difference
in patient outcomes or experiences of care?  Yes   No   Not clear

Are the conclusions relevant to the
care the nurse gives?  Yes   No   Not clear

Are the conclusions
clinically significant?  Yes All   Yes Some   No

Applicability

Does the SR address a problem,
situation, or decision we are addressing in our setting?  Yes   No   Not clear

Are the patients in the studies or a
subgroup of pati

APPENDIX F

Appraisal Guide

Findings of a Quantitative Study

Citation:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Synopsis

What was the purpose of the study (research questions, purposes, and hypotheses)?

How was the sample obtained?

What inclusion or exclusion criteria were used?

Who from the sample actually participated or contributed data (demographic or clinical profile and dropout rate)?

What methods were used to collect data (e.g., sequence, timing, types of data, and measures)?

Was an intervention tested?  Yes   No

1. How was the sample size determined?

2. Were patients randomly assigned to treatment groups?

What are the main findings?

Credibility

Is the study published in a source
that required peer review?  Yes   No   Not clear

*Did the data obtained and the
analysis conducted answer the
research question?  Yes   No   Not clear

Were the measuring instruments
reliable and valid?  Yes   No   Not clear

*Were important extraneous
variables and bias controlled?  Yes   No   Not clear

*If an intervention was tested,
answer the following five questions:  Yes   No   Not clear

1. Were participants randomly
assigned to groups and were
the two groups similar at the
start (before the intervention)?  Yes   No   Not clear

2. Were the interventions well
defined and consistently
delivered?  Yes   No   Not clear

3. Were the groups treated
equally other than the
difference in interventions?  Yes   No   Not clear

4. If no difference was found, was
the sample size large enough
to detect a difference if one existed?  Yes   No   Not clear

5. If a difference was found, are
you confident it was due to the
intervention?  Yes   No   Not clear

Are the findings consistent with
findings from other studies?  Yes   Some   No   Not clear

Are the findings credible?
 Yes All   Yes Some   No

Clinical Significance

Note any difference in means, r2s, or measures of clinical effects (ABI, NNT, RR, OR)

*Is the target population clearly
described?  Yes   No   Not clear

*Is the frequency, association, or
treatment effect impressive enough
for you to be confident that the finding
would make a clinical difference if used
as the basis for care?  Yes   No   Not clear

Are the findings
clinically significant?  Yes All   Yes Some   No

* = Important criteria

Comments

___________________________________________________________________________

____________________________________________________________________

APPENDIX E

Appraisal Guide

Findings of a Qualitative Study

Citation:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Synopsis

What experience, situation, or subculture does the researcher seek to understand?

Does the researcher want to produce a description of an experience, a social process, or an event, or is the goal to generate a theory?

How was data collected?

How did the researcher control his or her biases and preconceptions?

Are specific pieces of data (e.g., direct quotes) and more generalized statements (themes, theories) included in the report?

What are the main findings of the study?

Credibility

Is the study published in a source
that required peer review?  Yes   No   Not clear

Were the methods used appropriate
to the study purpose?  Yes   No   Not clear

Was the sampling of observations or
interviews appropriate and varied
enough to serve the purpose of the study?  Yes   No   Not clear

*Were data collection methods
effective in obtaining in-depth data?  Yes   No   Not clear

Did the data collection methods
avoid the possibility of oversight,
underrepresentation, or
overrepresentation from certain
types of sources?  Yes   No   Not clear

Were data collection and analysis
intermingled in a dynamic way?  Yes   No   Not clear

*Is the data presented in ways that
provide a vivid portrayal of what was
experienced or happened and its
context?  Yes   No   Not clear

*Does the data provided justify
generalized statements, themes,
or theory?  Yes   No   Not clear

Are the findings credible?  Yes All   Yes Some   No

Clinical Significance

*Are the findings rich and informative?  Yes   No   Not clear

*Is the perspective provided
potentially useful in providing
insight, support, or guidance
for assessing patient status
or progress?  Yes   Some  No  Not clear

Are the findings
clinically significant?  Yes All   Yes Some   No

* = Important criteria

Comments

___________________________________________________________________________

___________________________________________________________________________

APP E-2 Brown

Brown APP E-1

Griffiths et al. BMC Fam Pract (2021) 22:176
https://doi.org/10.1186/s12875-021-01524-7

RESEARCH

“She knows me best”: a qualitative study
of patient and caregiver views on the role
of the primary care physician follow-up
post-hospital discharge in individuals admitted
with chronic obstructive pulmonary disease
or congestive heart failure
Sarah Griffiths1, Gaibrie Stephen1, Tara Kiran1,2,3,4 and Karen Okrainec4,5,6,7*

Abstract

Background: Patients with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are at
high-risk of readmission after hospital discharge. There is conflicting evidence however on whether timely follow-up
with a primary care provider reduces that risk. The objective of this study is to understand the perspectives of patients
with COPD and CHF, and their caregivers, on the role of primary care provider follow-up after hospital discharge.

Methods: A qualitative study design with semi-structured interviews was conducted among patients or their fam-
ily caregivers admitted with COPD or CHF who were enrolled in a randomized controlled study at three acute care
hospitals in Ontario, Canada. Participants were interviewed between December 2017 to January 2019, the majority
discharged from hospital at least 30 days prior to their interview. Interviews were analyzed independently by three
authors using a deductive directed content analysis, with the fourth author cross-comparing themes.

Results: Interviews with 16 participants (eight patients and eight caregivers) revealed four main themes. First,
participants valued visiting their primary care provider after discharge to build upon their longitudinal relationship.
Second, primary care providers played a key role in coordinating care. Third, there were mixed views on the ideal time
for follow-up, with many participants expressing a desire to delay follow-up to stabilize following their acute hospitali-
zation. Fourth, the link between the post-discharge visit and preventing hospital readmissions was unclear to partici-
pants, who often self-triaged based on their symptoms when deciding on the need for emergency care.

Conclusions: Patients and caregivers valued in-person follow-up with their primary care provider following dis-
charge from hospital because of the trust established through pre-existing longitudinal relationships. Our results
suggest policy makers should focus on improving rates of primary care provider attachment and systems supporting
informational continuity.

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the
original author(s) and the source, provide a link to the Creative Commons licence, and indi

Contents lists available at ScienceDirect

Psychiatry Research

journal homepage: www.elsevier.com/locate/psychres

Timely follow-up visits after psychiatric hospitalization and readmission in
schizophrenia and bipolar disorder in Japan

Yasuyuki Okumuraa,b,⁎, Naoya Sugiyamac, Toshie Nodad

a Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
bDepartment of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
cNumazu Chuo Hospital, Fukkokai Foundation, Shizuoka, Japan
d Atami Chuo Clinic, Fukkokai Foundation, Shizuoka, Japan

A R T I C L E I N F O

Keywords:
Bipolar disorder
Schizophrenia
Transition care
Quality of health care

A B S T R A C T

The study objective was to investigate the association between timely follow-up visits after psychiatric hospi-
talization and the risk of readmission in patients with schizophrenia or bipolar disorder. A retrospective cohort
study was conducted using a nationwide claims database in Japan. Between April 2014 and March 2015, all
psychiatric hospitalization data were obtained and patients with a principal diagnosis of schizophrenia or bi-
polar disorder were followed up from 180 days before admission to 210 days after discharge. The primary
outcome of this study was psychiatric readmission during the 180-day period (between 31 and 210 days) after
the index discharge. A total of 48,579 eligible patients were identified. After psychiatric hospitalization, 15% of
patients received no follow-up visits to a psychiatrist within 30 days. Patients who received follow-up visits had
lower readmission rates during the subsequent 180 days (21.7% vs. 37.5%; adjusted risk ratio, 0.54 [95%
confidence interval, 0.52–0.57]) than those who did not. Timely follow-up visits after discharge could be helpful
for reducing the readmission risk in patients.

1. Introduction

Timely follow-up visits after psychiatric hospitalization are con-
sidered an important component in the clinical process for promoting
further recovery and preventing relapse (Hermann et al., 2004). How-
ever, it remains unclear whether timely follow-up visits after psychia-
tric hospitalization are associated with a reduced risk of readmission
(Beadles et al., 2015; Kurdyak et al., 2018; Lin and Lee, 2008; Marcus
et al., 2017).

A cohort study of 24,934 Medicaid patients, aged 22–64 years, re-
ported no association between follow-up visits within 30-days after
discharge and readmission within the subsequent 6-months in a de-
pression cohort and a small association in a schizophrenia cohort
(Beadles et al., 2015). A recent cohort study of 71,776 commercially
and Medicaid insured patients, aged 18–64 years, showed that receipt
of a follow-up visit within 30 days after discharge was associated w

Review

Posthospitalization Follow-Up of Patients With Heart Failure Using
eHealth Solutions: Restricted Systematic Review

Ingvild Margreta Morken1,2*, PhD; Marianne Storm3,4*, Prof Dr; Jon Arne Søreide5,6*, Prof Dr; Kristin Hjorthaug

Urstad1,7*, Prof Dr; Bjørg Karlsen3*, Prof Dr; Anne Marie Lunde Husebø2,3*, Prof Dr
1Department of Quality and Health Technologies, University of Stavanger, Stavanger, Norway
2Research Group for Nursing and Health Sciences, Stavanger University Hospital, Stavanger, Norway
3Department of Public Health, University of Stavanger, Stavanger, Norway
4Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
5Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
6Department of Clinical Medicine, University of Bergen, Bergen, Norway
7Faculty of Health Studies, VID Specialized University, Oslo, Norway
*all authors contributed equally

Corresponding Author:
Anne Marie Lunde Husebø, Prof Dr
Department of Public Health
University of Stavanger
Prof Olav Hanssens vei 10
Stavanger, 4021
Norway
Phone: 47 99262805
Email: [email protected]

Abstract

Background: Heart failure (HF) is a clinical syndrome with high incidence rates, a substantial symptom and treatment burden,
and a significant risk of readmission within 30 days after hospitalization. The COVID-19 pandemic has revealed the significance
of using eHealth interventions to follow up on the care needs of patients with HF to support self-care, increase quality of life
(QoL), and reduce readmission rates during the transition between hospital and home.

Objective: The aims of this review are to summarize research on the content and delivery modes of HF posthospitalization
eHealth interventions, explore patient adherence to the interventions, and examine the effects on the patient outcomes of self-care,
QoL, and readmissions.

Methods: A restricted systematic review study design was used. Literature searches and reviews followed the (PRISMA-S)
Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension checklist, and the CINAHL,
MEDLINE, Embase, and Cochrane Library databases were searched for studies published between 2015 and 2020. The review
process involved 3 groups of researchers working in pairs. The Mixed Methods Appraisal Tool was used to assess the included
studies’ methodological quality. A thematic analysis method was used to analyze data extracted from the studies.

Results: A total of 18 studies were examined in this review. The studies were published between 2015 and 2019, with 56%
(10/18) of them published in the United States. Of the 18 studies, 16 (89%) were randomized controlled trials, and 14 (78%)
recruited patients upon hospital discharge

soap and water, wipe the electrode area with
a washcloth or gauze to roughen a small area
of the skin when appropriate. Do not use
alcohol for skin preparation; it dries out the
skin. [level B]

b. Consider daily ECG electrode changes. [level E]
c. Do not use Spo2 finger clip sensor on the ear.

[level C]
d. Place Spo2 probe on warm extremities.

[level C]

2. Assess alarm parameter settings and customize
according to individual patient’s condition and
age to reduce clinically insignificant alarms. Check
alarm settings at the start of every shift, with any

AACN Practice Alert

Scope and Impact of the Problem
Alarm fatigue is a patient safety risk, occurring when

clinicians are exposed to excessive numbers of alarms,
particularly false and clinically insignificant alarms. This
overexposure results in sensory overload and desensiti-
zation to alarms. Consequently, response to alarms may
be delayed or alarms may be missed altogether. Patien

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