Dataset Information

Predictors of the length of stay of psychiatric inpatients: protocol for a systematic review and meta-analysis.

ABSTRACT:

Background

Length of stay (LOS) for inpatient psychiatric services is an important factor with serious drawbacks when it is extended more than needed. Impacts on economy, social functioning, and stigma can hamper improvement and affect the patients' experiences on future mental healthcare. Predictions of which patients have a higher chance for prolonged LOS have been extensively researched. Previous systematic reviews found consistent predictors of both longer and shorter LOS. However, they do not provide an estimate from the pooled effect sizes. Furthermore, to our knowledge, there is no meta-analysis on the influence of these factors. The primary objective of this study will be to provide point estimates on the effect sizes of all studied predictors of the LOS of psychiatric inpatients.

Methods

We will conduct a systematic search in PubMed, MEDLINE, EMBASE, and PsycINFO for observational studies evaluating the effect size of independent factors on the length of stay of psychiatric inpatients. Prospective and retrospective cohorts that assess the influence of predictors through the reporting of standardized regression coefficients will be included. We will provide a qualitative synthesis of the findings from each study and perform a meta-analysis from pooled regression coefficients that were adjusted for other variables or confounders in order to obtain a point estimate and confidence interval for all factors extracted from the included studies.

Discussion

The results from this study may provide more accurate predictions for mental health institutions, psychiatrists, mental health service providers, patients, and families on the prognosis regarding the length of stay for needed inpatient care. This information may be used to anticipate individuals with a higher chance for prolonged hospitalization to plan the necessary interventions for these specific situations. Considering both the benefits and disadvantages of longer and shorter stays, the pooled estimates for independent factors may be used by mental healthcare providers and patients for informed decision-making. The results from this study will also update results presented in previous studies and identify the strengths and limitations from the current available evidence.

Systematic review registration

PROSPERO ID CRD42020172840.

SUBMITTER: Carranza Navarro F

PROVIDER: S-EPMC7927412 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Publications

Predictors of the length of stay of psychiatric inpatients: protocol for a systematic review and meta-analysis.

Carranza Navarro Farid F Álvarez Villalobos Neri Alejandro NA Contreras Muñoz Andrea Muriel AM Guerrero Medrano Andrea Fernanda AF Tamayo Rodríguez Natalia Sofía NS Saucedo Uribe Erasmo E

Systematic reviews 20210302 1

<h4>Background</h4>Length of stay (LOS) for inpatient psychiatric services is an important factor with serious drawbacks when it is extended more than needed. Impacts on economy, social functioning, and stigma can hamper improvement and affect the patients' experiences on future mental healthcare. Predictions of which patients have a higher chance for prolonged LOS have been extensively researched. Previous systematic reviews found consistent predictors of both longer and shorter LOS. However, t ...[more]

PMID: 33653413

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Project description:BACKGROUND:The present protocol was designed for a systematic review and meta-analysis aimed at determining the association of telomere length with substance use disorders with the exclusion of nicotine addiction, and to identify potential moderators of the effect of telomere length. Such methodological information may provide guidance to improve the quality of future research on this important topic. METHODS:Potential studies will be identified through electronic databases (PubMed/MEDLINE, EMBASE, PsycINFO, and Web of Science) up from inception onwards. The inclusion criteria will include published or unpublished observational studies (cohort, case-control, and cross-sectional studies) reporting telomere length in adult patients with substance use disorder compared with a control group. Non-human studies or other study designs such as reviews, case-only, family-based, and/or population studies with only healthy participants will be excluded, as well as those focused solely on nicotine addiction. The main outcome will be telomere length in adults with substance use disorder (primary) and, specifically, in those with alcohol use disorder (secondary). Two investigators will independently evaluate the preselected studies for possible inclusion and will extract data following a standardized protocol. Disagreements will be resolved by consensus. The risk of bias of all included studies will be assessed using the Newcastle-Ottawa Quality Assessment Scale for non-randomized studies. Data will be converted into standardized mean differences as effect size index, and random-effects models will be used for the meta-analysis. Cochran's Q statistic, I2 index, and visual inspection of the forest plot will be used to verify study heterogeneity. Subgroup analyses and meta-regressions will be conducted to ascertain heterogeneity. Several sensitivity analyses will be conducted to address the influence of potential confounding factors. Publication bias will be examined using the "funnel plot" method with Duval and Tweedie's trim-and-fill method and Egger test. DISCUSSION:This systematic review will assess the association of telomere length with substance use disorders aside from nicotine addiction. SYSTEMATIC REVIEW REGISTRATION:PROSPERO registration number CRD42019119785.

Project description:BackgroundNowadays, psychiatric morbidities are more and more common, which imposes huge social and economic burden on all countries across the world. Mental illnesses are found to be related to genetics. Over the past few years, a large number of risk genes and loci related to psychiatric morbidities have been reported. The brain-derived neurotrophic factor (BDNF) is one of the main candidates in neuropsychiatric genetics. However, different studies have shown inconsistencies regarding effect modification of BDNF polymorphisms on psychiatric morbidities. Therefore, in the present study, we aim to qualitatively and quantitatively summarize the relationship between BDNF single nucleotide polymorphisms (SNPs) and various psychiatric morbidities through a meta-analysis.MethodsPubMed, Web of Science and Embase will be searched using a specified search strategy to identify relevant studies up to April 2020. The meta-analysis will be performed on (1) allele model, (2) dominant model, (3) recessive model, (4) homozygote, and (5) heterozygote model. Sensitivity analyses will be conducted to explore the impact of individual studies on the overall result by evaluating the odd ratios (ORs) with their corresponding 95% confidence intervals (CIs) before and after removing each of the studies from our meta-analysis. Chi-square test will be used to determine whether the observed allele or genotype frequencies in the controls are consistent with HWE. The statistical heterogeneity will be verified by I statistics. The fixed effects model is needed to estimate the ORs and 95% CIs when there was no heterogeneity between results of included studies (I < 50%); instead, the random effects model should be used when results of included studies showed significant heterogeneity (I > 50%). Publication bias will be evaluated with the use of Begg test and Egger test (P < .05 is considered statistically significant).DiscussionWith this protocol, a methodology is established that explores the effect modification of BDNF polymorphisms on the association with psychiatric morbidities. Findings from this meta-analysis can provide significant insight into the etiology of psychiatric morbidities.RegistrationOpen Science Framework (OSF) Preregistration. September 15, 2020. OSF.IO/QS7XT.

Project description:BackgroundTo perform a systematic review about the effect of using clinical pathways on length of stay (LOS), hospital costs and patient outcomes. To provide a framework for local healthcare organisations considering the effectiveness of clinical pathways as a patient management strategy.MethodsAs participants, we considered hospitalized children and adults of every age and indication whose treatment involved the management strategy "clinical pathways". We include only randomised controlled trials (RCT) and controlled clinical trials (CCT), not restricted by language or country of publication. Single measures of continuous and dichotomous study outcomes were extracted from each study. Separate analyses were done in order to compare effects of clinical pathways on length of stay (LOS), hospital costs and patient outcomes. A random effects meta-analysis was performed with untransformed and log transformed outcomes.ResultsIn total 17 trials met inclusion criteria, representing 4,070 patients. The quality of the included studies was moderate and studies reporting economic data can be described by a very limited scope of evaluation. In general, the majority of studies reporting economic data (LOS and hospital costs) showed a positive impact. Out of 16 reporting effects on LOS, 12 found significant shortening. Furthermore, in a subgroup-analysis, clinical pathways for invasive procedures showed a stronger LOS reduction (weighted mean difference (WMD) -2.5 days versus -0.8 days)).There was no evidence of differences in readmission to hospitals or in-hospital complications. The overall Odds Ratio (OR) for re-admission was 1.1 (95% CI: 0.57 to 2.08) and for in-hospital complications, the overall OR was 0.7 (95% CI: 0.49 to 1.0). Six studies examined costs, and four showed significantly lower costs for the pathway group. However, heterogeneity between studies reporting on LOS and cost effects was substantial.ConclusionAs a result of the relatively small number of studies meeting inclusion criteria, this evidence base is not conclusive enough to provide a replicable framework for all pathway strategies. Considering the clinical areas for implementation, clinical pathways seem to be effective especially for invasive care. When implementing clinical pathways, the decision makers need to consider the benefits and costs under different circumstances (e.g. market forces).

Dataset Information

Predictors of the length of stay of psychiatric inpatients: protocol for a systematic review and meta-analysis.

Background

Methods

Discussion

Systematic review registration

Publications

Predictors of the length of stay of psychiatric inpatients: protocol for a systematic review and meta-analysis.

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