Articles: outcome.
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Background: Hemodynamic support using vasoactive agents is a mainstay in the management of patients with pediatric fluid-refractory septic shock (FRSS). However, evidence supporting the appropriate choice of vasoactive agent is limited. This study aimed to perform a systematic review and meta-analysis on the effect of different first-line vasoactive strategies on mortality in pediatric FRSS. ⋯ Interpretation: Among children with FRSS receiving a single vasoactive agent, norepinephrine was associated with the lowest mortality rate. Comparing dopamine and epinephrine, patients receiving epinephrine needed less mechanical ventilation and showed a trend for lower mortality rate. Further research is needed to better delineate the first-line vasoactive agent in this population.
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Critical care medicine · Nov 2024
Meta AnalysisThe Impact of Point-of-Care Ultrasound-Guided Resuscitation on Clinical Outcomes in Patients With Shock: A Systematic Review and Meta-Analysis.
To determine the impact of point-of-care ultrasound (POCUS)-guided resuscitation on clinical outcomes in adult patients with shock. ⋯ POCUS-guided resuscitation in shock may yield important patient and health system benefits. Due to lack of sufficient evidence, we were unable to explore how the thresholds of operator competency, frequency, and timing of POCUS scans impact patient outcomes.
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Spinal fusion surgery is known to be an expensive intervention. Although innovative technologies in the field aim at improving operative efficiency and outcomes, total costs must be considered. The authors hope to elucidate any differences between robot-assisted (RA) and computed tomography navigation (CT-nav) or freehand fluoroscopy-guided (FFG) pedicle screw placement in relation to patient outcomes and cost-effectiveness in lumbar fusion surgery (LFS). ⋯ This study shows that RA pedicle screw placement in LFS provides similar patient outcomes to CT-nav and FFG. Robot-assisted operations were found to give rise to cost savings via decreased length of stay when compared to both CT-nav and FFG techniques. Cost-savings of $4086-$4865/patient and $7317-$9654/patient could be achieved when utilizing RA over CT-nav and FFG, respectively. However, extra upfront and maintenance costs may impact full adoption of RA in LFS.
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Review Meta Analysis
Discharge instruction comprehension by older adults in the emergency department: A systematic review and meta-analysis.
Older adults are at high risk of adverse health outcomes in the post-emergency department (ED) discharge period. Prior work has shown that discharged older adults have variable understanding of their discharge instructions which may contribute to these outcomes. To identify discharge comprehension gaps amenable to future interventions, we utilize meta-analysis to determine patient comprehension across five domains of discharge instructions: diagnosis, medications, self-care, routine follow-up, and return precautions. ⋯ Older patients discharged from the ED had greater comprehension of self-care and follow-up instructions than about their medications. These findings suggest that medication instructions may be a priority domain for future interventions.