Effectiveness of patient‐caregiver dyad discharge interventions on hospital readmissions of elderly patients with community acquired pneumonia: a systematic review A systematic review of the effectiveness of nurse coordinated transitioning of care on readmission rates for patients with heart failure Evaluation of Pharmacist Medication Education and Post-discharge Follow-up in Reducing Readmissions in Patients With ST-Segment Elevation Myocardial Infarction (STEMI) Unrecognized Cognitive Impairment and Its Effect on Heart Failure Readmissions of Elderly Adults. Timing for Delivering Individualized Patient Education Intervention to Coronary Artery Bypass Graft Patients: An RCT Video information combined with individualized information sessions: Effects upon emotional well-being following coronary artery bypass surgery--A randomized trial. Educational Intervention Reduces Complications and Rehospitalizations After Heart Surgery Effects of education and support on self-care and resource utilization in patients with heart failure. Effects of a health education programme with telephone follow-up during cardiac rehabilitation. A systematic review of enhanced recovery protocols in colorectal surgery. One session cognitive behavioural therapy for elderly patients with chronic obstructive pulmonary disease. Technology-adaptable interventions for treating depression in adults with cognitive impairments: protocol for a systematic review Reducing depression in 9-10 year old children in low SES schools: a longitudinal universal randomized controlled trial. Predischarge bundle for patients with acute exacerbations of COPD to reduce readmissions and ED visits: a randomized controlled trial. Effectiveness of interventions that assist caregivers to support people with dementia living in the community: a systematic review Can nurse-led preoperative education reduce anxiety and postoperative complications of patients undergoing cardiac surgery? Group cognitive behavioural therapy for children with anxiety disorder - an evaluation of the 'Friends for Youth' programme. Effectiveness of interventions that assist caregivers to support people with dementia living in the community: a systematic review. The effectiveness of telephone‐based post‐discharge nursing care in decreasing readmission rate in patients with heart failure: a systematic review Effectiveness of MH-Guru, a brief online mental health program for the workplace: A randomised controlled trial Discharge within 24 to 72 hours of colorectal surgery is associated with low readmission rates when using Enhanced Recovery Pathways. Cardiac Home Education and Support Trial (CHEST): a pilot study. A comprehensive approach to rehabilitation interventions following breast cancer treatment - a systematic review of systematic reviews A systematic review of psychological interventions in total hip and knee arthroplasty Computerized cognitive behavioural therapy at work: a randomized controlled trial in employees with recent stress-related absenteeism. Cognitive behaviour therapy for common mental disorders in people with Multiple Sclerosis: A bench marking study. [Curative effects on standardized management of community patients with coronary heart disease complicated with chronic heart failure]. Randomized controlled trial of brief cognitive behavioral intervention for depression and anxiety symptoms preoperatively in patients undergoing coronary artery bypass graft surgery. Elusive search for effective provider interventions: a systematic review of provider interventions to increase adherence to evidence-based treatment for depression The impact of pre-operative education on recovery following coronary artery bypass surgery. A randomized controlled clinical trial. Back to the future – feasibility of recruitment and retention to patient education and telephone follow-up after hip fracture: a pilot randomized controlled trial Effect of a universal anxiety prevention programme (FRIENDS) on children's academic performance: results from a randomised controlled trial A Reengineered Hospital Discharge Program to Decrease Rehospitalization
Background The aim of discharge planning is to reduce unplanned readmission to the hospital and improve coordination of care . As the global population ages , including family caregivers in discharge planning maybe an effective strategy to improve patient outcomes and quality of care . In the United States , hospital readmission following discharge for community acquired pneumonia is a process measure utilized to evaluate discharge planning outcomes . Objectives The objective of this systematic review was to identify the effect of patient‐caregiver dyad discharge learning need interventions on unexpected readmissions within thirty days of elderly patients ( 65 years or older ) with community acquired pneumonia . Methods A systematic review of English language studies published and unpublished after 1991on patient and caregiver learning needs related to discharge education and unplanned hospital readmission . Studies including patients aged 65 and older experiencing discharge from a hospital setting , were the primary focus . A comprehensive search of electronic data bases was performed for the period of 1991‐2010 to find relevant studies . A three‐stage search processwas used consisting of an initial data base search , scanning of reference lists , citation search ing of key papers , contact with authors via the Internet and through personal communication , keyword search ing of the World Wide Web . Four authors independently undertook quality assessment and data analysis using the st and ardized critical appraisal and data extraction tool from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument . Data were summarized by use of narrative methods . Main results Five studies were pertinent to the review . Direct comparisons of the studies are limited due to different methods and subject participants . We found statistically significant results that caregiver education interventions impact positively on decreasing unplanned readmissions . Two r and omized control trials and one quasi‐experimental study were identified that addressed a  multidisciplinary discharge education intervention which included caregivers of elderly pneumonia patients . Multidisciplinary care transition intervention was associated with fewer readmissions in thirty days ( odds ratio = 0.55 ; 95 % CI 0.32‐0.94 ; odds ratio = 0.56 ; 95 % CI 0.24‐1.31 ; odds ratio= 0.41 ; 95 % CI 0.28‐0.75 ) . One case control study and one quasi experimental study identified lack of documented patient or family education as independently associated with unplanned readmissions within thirty days in elderly patient population s that included chronic lung disease ( odds ratio = 2.3 ; 95 % CI = 1.2‐4.5 : odds ratio= 0.52 ; 95 % CI = 0.28‐0.96).Wherein , the first of these studies calculated the rate of readmission when caregiver education is omitted whilst the second calculated readmission when an educational intervention is included . However , whilst improved readmission rates with caregiver education was unlikely due to chance , due to the difficulties in isolating caregiver education as a direct intervention , issues of homogeneity limit the generalizability of this review . Conclusions This review highlights the dearth of information on the caregiver 's need for specific information on discharge and the need for future research . Implication s for practice There is little evidence that education interventions aim ed at caregivers are uniformly effective in decreasing pneumonia readmission rates . The evidence suggests that a structured education intervention that includes caregivers probably brings about a small reduction in unexpected readmissions within thirty days for elderly patients with community acquired pneumonia . The specific caregiver learning needs assessment remains variable and uncertain . Implication s for research Research has been aim ed at implementation of community acquired pneumonia guidelines to improve mortality and unexpected readmissions within thirty days . However , quality of discharge teaching , a key component of coordinated care , is a strong predictor of readiness for discharge and readmission rates . There is a need for quality r and omized studies evaluations of the outcomes specific to patient‐caregiver dyad discharge interventions Background  Readmission rates for patients with heart failure are a major concern for hospitals worldwide . The importance of patient education and a structured care plan to ease the transition from hospital to home has been the focus of many intervention strategies to reduce readmission rates . The use of transitioning of care plans is believed to improve medication reconciliation , communication , patient education , and follow‐up . To date , the evidence has not been systematic ally evaluated to support the effectiveness of a nurse coordinated transitioning of care for patients with heart failure in reducing readmission rates . Objective The objective of the systematic review was to identify the best available evidence on the effectiveness of nurse coordinated transitioning of care between hospital and home on hospital readmission rates for all causes in adult patients hospitalised with heart failure . Search strategy The search strategy aim ed to find both published and unpublished studies in the English language from January 1975 through July 2010 . A search of MEDLINE , CINAHL , PsycINFO , Health source Nursing/academic edition , EMBASE , the Cochrane Library , and the Joanna Briggs Institute Library of Systematic Review s was conducted followed by a reference search of relevant studies . The initial key words search ed were : heart failure , readmission , and transitional care . Inclusion criteria R and omised controlled trials that evaluated the effect of nurse coordinated transitioning of care from hospital to home in adult patients with heart failure on  readmission  rates were selected . The outcome was defined as hospital readmissions for all causes following an initial admission for heart failure . Data collection and analysis Studies selected for retrieval were critically evaluated by two independent review ers for method ological validity using st and ardised critical appraisal instruments from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument ( JBI‐MAStARI ) . Data were extracted and analysed using the JBI‐MAStARI program . Results A total of 16 r and omised controlled studies were included . Ten of the 16 studies included in the review show that a nurse led transitioning of care intervention can reduce the rate of readmission for patients with heart failure . Interventions utilising home visits , or home visits coupled with telephone follow‐up , show a more favourable reduction in readmission rates . Conclusions Reduced readmissions occur when transitioning of care interventions are carried out by a heart failure trained nurse who conducts at least one home visit and follows the patient at least weekly for a minimum of 30 days post discharge with either additional home visits or telephone contact . Implication s for practice This review supports the development of a nurse coordinated transitioning of care plan which will require improvements in communication , in addition to changes in health policy and payment systems that align incentives and performance measures in caring for patients with heart failure . Implication s for research Future research should evaluate the effect of the intensity and duration of the transitioning of care intervention on readmission rates in a large r and omised control trial on an adult population with heart failure to determine the ideal frequency and duration of the post discharge interventions Background : Hospital readmissions have been shown to contribute to both patient morbidity and rising health care expenditures across a number of disease processes . Adherence to a cardioprotective drug regimen is particularly important after ST-segment elevated myocardial infa rct ion ( STEMI ) because it is an acute condition associated with high patient morbidity and mortality . Objective : The objective of this study was to evaluate the effectiveness of pharmacist intervention with regard to reduction in hospital readmissions and improvement in medication adherence and literacy . Methods : This was a prospect i ve single-center study in which patients admitted with STEMI who received stents between January 2015 and April 2015 were included .  Pharmacist intervention included medication reconciliation , medication education , facilitation of the delivery of discharge medications , and post-discharge telephone calls within 48 to 72 hours . A retrospective review of historical STEMI patients who did not have pharmacist transitions of care support was performed to compare readmission rates . Results : All-cause readmission at 30 days decreased from 13 % to 5 % ( P = 0.18 ) . Twelve of 95 patients in the historical control group were readmitted , compared to 2 of 40 patients in the intervention group . In the historical group , 3 of 12 patients required subsequent stent placement upon readmission , compared to none in the intervention group . , Medication adherence and literacy scores improved significantly from baseline to high adherence and literacy at 30 days post-discharge ( P = 0.0005 ) . Conclusion : Pharmacist involvement in medication education signficantly improved medication adherence and literacy . There was a reduction in 30-day readmission rates , but the results were not statistically significant OBJECTIVES To determine whether 30-day readmissions were associated with presence of cognitive impairment more in elderly adults with heart failure ( HF ) than in those with other diagnoses and whether medical teams recognized cognitive impairment . DESIGN One-year prospect i ve cohort quality improvement program of cognitive screening and retrospective chart review of documentation and outcomes . SETTING Academic tertiary care hospital medical unit with a cardiovascular focus and an enhanced discharge program of individualized patient education . PARTICIPANTS Individuals aged 70 and older screened before home discharge ( 241 admission encounters ; 121 with HF as a primary diagnosis , 120 without ) . The HF cohort included individuals with preserved and reduced ejection fraction . Individuals who had undergone transplantation , ventricular assist device implantation , or hemodialysis or who had a primary oncology diagnosis or hospice referral were excluded . MEASUREMENTS  Mini-Cog  administered 48 hours or less before discharge , 30-day all-cause readmission rates , documentation of dementia or cognitive impairment , and caregiver education . RESULTS Mini-Cog scores were less than 4 ( indicating cognitive impairment ) in 157 encounters ( 82 ( 67.7 % ) with HF , 75 ( 62.5 % ) without ) . Mini-Cog scores were similar in rate and distribution between groups . Individuals with HF and cognitive impairment had a significantly higher 30-day readmission rate than did the other groups ( 26.8 % vs 13.2 % ; P = .01 ; HF , no cognitive impairment , 12.8 % ; no HF , no cognitive impairment , 13.3 % ; cognitive impairment , no HF , 13.3 % ) . In individuals with HF and cognitive impairment , those with documented caregiver education had lower readmission rates than those without ( 14.3 % vs 36.2 % ; P = .03 ) . Fewer than 9 % had documentation of cognitive impairment in the medical record . CONCLUSION Cognitive impairment , which is frequently undocumented , may indicate greater risk of readmission for individuals with HF than those without . Screening for cognitive impairment , adapting discharge for it , and involving family and caregivers in discharge education may help reduce readmissions Background : The primary focus of this study is on the timing of the delivery of education to patients who had CABG surgery . Aim : To determine the efficacy of an individualized telephone patient education intervention , delivered at two different points in time ( 1–2 days pre-discharge versus 1–2 days post-discharge ) in enhancing the CABG patient 's knowledge of self-care behaviours , performance of self-care behaviours , and symptom frequency . Method : A r and omized clinical trial that included a convenience sample of first time CABG patients . Individuals who received education pre-discharge were compared to individuals who received education post-discharge on the outcomes . Results : Results indicated no statistically significant difference in outcomes between the two time points . As well , anxiety levels were found to be significantly higher in the pre-discharge group than the post-discharge group . Conclusions : The individualized nature of the educational intervention may have accounted for non-significant findings reported in outcomes between the two time points . Practice implication s : Nurses may consider assessing anxiety levels prior to delivery of educational interventions , implement interventions aim ed at reducing anxiety levels , and provide individualized teaching OBJECTIVE To test the efficacy of an information intervention upon emotional recovery following coronary artery bypass surgery . METHODS R and omized trial .  Video information was combined with individualized information sessions carried out by nurses at admission and at discharge from the hospital . The video was shown pre-operatively and again during the session at admission . Patients were helped to express their questions and worries and congruent information and support was provided . Control group patients received st and ardized information and no video . Recordings were made at baseline , discharge from hospital and during a 2 years follow-up period . RESULTS One hundred and nine patients were r and omized to the intervention or the control groups . A MANOVA was used to test of the variance of the outcome variables at each time point . At discharge intervention patients reported less anxiety ( p = 0.046 ) and better subjective health ( p = 0.005 ) . They reported better subjective health during the whole follow-up period ( 0.040 > or = p > or = 0.000 ) , less anxiety up to 1 year ( 0.042 > or = p > or = 0.004 ) , and less depression from 6 months to 2 years following discharge ( 0.023 > or = p > or = 0.004 ) . CONCLUSION The effects of the intervention probably relate to the combined use of the video and patient centered information sessions . PRACTICE IMPLICATION S The intervention can easily be implemented in clinical practice and nurses strongly identified with its principles The effectiveness of in-hospital self-care patient education , delivered to patients following heart surgery , is question able , as evidence indicates individuals are not able to absorb and /or retain information at this time . In the absence of adequate instruction , individuals will not have the relevant information to engage in specific self-care behaviors , result ing in the onset of complications and /or hospital readmissions . The purpose of this pilot study was to collect preliminary evidence to demonstrate the impact of an individualized education intervention given above and beyond usual care , delivered , at two points in time , following hospital discharge . A r and omized controlled trial was used in which 34 patients were r and omly assigned to one of two groups . Chi-square analyses to examine differences between groups on complications and hospital readmission rates were conducted . Findings point to the impact of the intervention in reducing the number of hospital readmissions and complications at 3 months following hospital discharge AIMS To test the effect of education and support by a nurse on self-care and re source utilization in patients with heart failure . METHODS A total of 179 patients ( mean age 73 , 58 % male , NYHA III-IV ) hospitalized with heart failure were evaluated prospect ively . Patients were r and omized to the study intervention or to ' care as usual '  . The supportive educative intervention consisted of intensive , systematic and planned education by a study nurse about the consequences of heart failure in daily life , using a st and ard nursing care plan developed by the research ers for older patients with heart failure . Education and support took place during the hospital stay and at a home visit within a week of discharge . Data were collected on self-care abilities , self-care behaviour , readmissions , visits to the emergency heart centre and use of other health care re sources . RESULTS Education and support from a nurse in a hospital setting and at home significantly increases self-care behaviour in patients with heart failure . Patients from both the intervention and the control group increased their self-care behaviour within 1 month of discharge , but the increase in the intervention group was significantly more after 1 month . Although self-care behaviour in both groups decreased during the following 8 months , the increase from baseline remained statistically significant in the intervention group , but not in the control group . No significant effects on re source utilization were found . CONCLUSIONS Intensive , systematic , tailored and planned education and support by a nurse results in an increase in patients ' self-care behaviour . No significant effects were found on use of health care re sources . Additional organisational changes , such as longer follow-up and the availability of a heart failure specialist would probably enhance the effects of education and support A health education and counselling programme was offered to myocardial infa rct ion patients during and after hospitalization . A r and omized pre-test-post-test control group design was used to evaluate the effects of the experimental intervention . During hospitalization the intervention consisted of two individual counselling sessions and two group health education sessions focusing on medication , healthy habits , anxiety and depression . On completion of these sessions , weekly telephone calls were made to patients for a period of six weeks after discharge from hospital . The intervention was offered to 30 myocardial infa rct ion patients and their partners ( the experimental group ) in addition to  st and ard medical care . Thirty control patients received st and ard medical care only . Two months after myocardial infa rct ion , patients in the experimental condition reported a significantly greater increase in physical activity , and a significantly greater decrease in unhealthy eating habits . No effects were found regarding smoking cessation , anxiety and depression . Twelve months after discharge from hospital patients in the experimental condition reported a significantly greater decrease in unhealthy eating habits . No effects were found regarding smoking cessation , physical activity , anxiety and depression . In addition , two months after myocardial infa rct ion , it was found that patients whose partners participated in the health education sessions showed a significantly greater decrease in smoking and unhealthy eating habits and a significantly greater increase in physical activity than patients with no partner participating . Twelve months after discharge the only significant result favouring the patients whose partner participated in the health education sessions concerned smoking cessation INTRODUCTION Colorectal surgery has been associated with a complication rate of 15 - 20 % and mean post-operative inpatient stays of 6 - 11 days . The principles of enhanced recovery after surgery ( ERAS ) are well established and have been developed to optimise peri-operative care and facilitate discharge . The purpose of this systematic review is to present an up date d review of peri-operative care in colorectal surgery from the available evidence and ERAS group recommendations . METHODS Systematic search es of the PubMed and Embase ™ data bases and the Cochrane library were conducted . A h and search of bibliographies of identified studies was conducted to identify any additional articles missed by the initial search strategy . RESULTS A total of 59 relevant studies were identified . These included six r and omised controlled trials and seven clinical controlled trials that fulfilled the inclusion criteria . These studies showed reductions in duration of inpatient stays in the ERAS groups compared with more traditional care as well as reductions in morbidity and mortality rates . CONCLUSIONS Review ing the data reveals that ERAS protocol s have a role in reducing post-operative morbidity and result in an accelerated recovery following colorectal surgery . Similarly , both primary and overall hospital stays are reduced significantly . However , the available evidence suggests that ERAS protocol s do not reduce hospital readmissions or mortality . These findings help to confirm that ERAS protocol s should now be implemented as the st and ard approach for peri-operative care in colorectal surgery BACKGROUND We hypothesized that compared to an educational intervention , a single 2 h session of cognitive behavioural therapy ( CBT ) , with 6-week follow-up , would reduce anxiety and depression , improve physical and mental functioning , and lead to a better quality of life and greater satisfaction with treatment in older patients with chronic obstructive pulmonary disease ( COPD ) . METHODS Fifty-six subjects were recruited from a large , urban , academically affiliated Veterans Affairs ( VA ) Hospital , a non-profit private hospital , and a local newspaper , for a single blind r and omized controlled clinical trial . One 2 h session of group CBT was design ed to reduce symptoms of anxiety , with specific components including relaxation training , cognitive interventions , and graduated practice , followed by homework and weekly calls for 6 weeks . This was compared to a group that received 2 h of COPD education , followed by weekly calls . Pre- and post-intervention subjects in both groups were administered SF-36 , Geriatric Depression Scale , Beck Anxiety Inventory , 6 min walk test , and the FEV-1 . Following the intervention , both groups completed the Client Satisfaction Question naire . RESULTS When compared with a group that received education about COPD , 2 h CBT group showed decreased depression and anxiety . Contrary to our hypothesis , despite the decrease in depression and anxiety , there was no change in the physical functioning of the patients . CONCLUSIONS Twenty to 40 % of patients with COPD have high levels of anxiety and depression . Our study finds that as little as 2 h of CBT administered in a group setting is able to reduce these anxious and depressive symptoms Background Depression is a common comorbidity in individuals with cognitive impairment . Those with cognitive impairments face unique challenges in receiving the benefits of many conventional therapies for depression , and may have poorer outcomes in areas such as recovery and quality of life . However , the stigmatization of mental health disorders , cost barriers and physical disabilities may prevent these individuals from seeking mental health care . An online , self-help intervention specifically developed for adults with cognitive deficits and depression may be particularly beneficial to this population . We aim to inform the design of such an intervention through a systematic review by answering the following research question : among adults with cognitive impairment ( including those with acquired brain injuries or neurodegenerative diseases ) , which technology-amenable interventions have been shown to effectively decrease symptoms of depression ? Specifically , psychotherapeutic and /or behavioural interventions that could be delivered in a self-guided , online system will be included . Methods Comprehensive electronic search es will be conducted in MEDLINE , EMBASE , PsycINFO and CINAHL . Additional studies will be obtained through manually search ing the references of relevant systematic review s , contacting primary authors of select articles and tracking conference proceedings and trial registries . Article titles and abstract s will be screened using predefined eligibility criteria , and then judged for their amenability to the proposed self-help , technology-based intervention . The full text of those articles with selected interventions will then be screened to determine final eligibility for inclusion . Included articles will be categorized by intervention type and assessed for risk of bias using the Cochrane Effective Practice and Organization of Care Risk of Bias tool for non-r and omized trials , controlled before-after studies and interrupted time series . The primary outcome will be a change in score on a vali date d depression scale , and adverse events will be documented as a secondary outcome . After data extraction from selected articles , pooling of data and meta- analysis will be conducted if a sufficient pool of studies with comparable methodology and quality are identified . Alternatively , plain language summaries will be developed . The quality of evidence will be assessed using the Grading of Recommendations Assessment , Development and Evaluation ( GRADE ) system . Systematic review registration PROSPERO The Aussie Optimism : Positive Thinking Skills Program ( AOP-PTS ) is an innovative curriculum-based mental health promotion program based on cognitive and behavioural strategies . The program is aim ed at preventing depressive and anxiety symptoms and disorders in middle primary school children aged 9 - 10 years . Students from 22 low SES primary schools ( N = 910 ) were r and omly assigned to an intervention or a control group and assessed at baseline , post-test , 6 months and 18 months . The intervention group received the program implemented by teachers and the control group received their regular Health Education curriculum . Students completed question naires on depression , anxiety , and attribution style . At risk students were further assessed with the computerised Diagnostic Interview for Children and Adolescents . Parents reported on their children 's externalising and internalising problems at home . Children in the intervention condition reported a significant pre-post reduction in depressive symptoms , and there was a significant pre-post reduction in parent-reported emotional difficulties which was maintained at 6 month follow-up ; no changes were evident in the control group . Both groups showed significant improvements in child-reported anxiety and attribution style , and significant improvements in parent-reported pro-social behaviours . For both groups , there were no significant post-baseline changes in incidence and recovery rates for depression , anxiety , or internalising symptoms . These findings suggest that AOP-PTS has the potential to treat depressive symptomatology in the immediate term but the effects were not sustained . There is also evidence of improved emotional resilience up to 6 months following the program . Further follow-up to investigate longer term effects is needed BACKGROUND Hospital readmissions for acute exacerbations of COPD ( AE COPD s ) pose burdens to the health-care system and patients . A current gap in knowledge is whether a predischarge screening and educational tool administered to patients with COPD reduces readmissions and ED visits . METHODS A single-center , r and omized trial of admitted patients with AE COPD s was conducted at Henry Ford Hospital between February 2010 and April 2013 . One hundred seventy-two patients were r and omized to either the control ( st and ard care ) or the bundle group in which patients received smoking cessation counseling , screening for gastroesophageal reflux disease and depression or anxiety , st and ardized inhaler education , and a 48-h postdischarge telephone call . The primary end point was the difference in the composite risk of hospitalizations or ED visits for AE COPD between the two groups in the 30 days following discharge . A secondary end point was 90-day readmission rate . RESULTS Of the 172 patients , 18 of 79 in the  control group ( 22.78 % ) and 18 of 93 in the bundle group ( 19.35 % ) were readmitted within 30 days . The risk of ED visits or hospitalizations within 30 days was not different between the groups ( risk difference , -3.43 % ; 95 % CI , -15.68 % to 8.82 % ; P = .58 ) . Overall , the time to readmission in 30 and 90 days was similar between groups ( log-rank test P = .71 and .88 , respectively ) . CONCLUSIONS A predischarge bundle intervention in AE COPD is not sufficient to reduce the 30-day risk of hospitalizations or ED visits . More re sources may be needed to generate a measurable effect on readmission rates . TRIAL REGISTRY Clinical Trials.gov ; No. : NCT02135744 ; URL : www . clinical trials.gov Objectives The objective of this review was to assess the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community . Inclusion criteria Types of participants Adult caregivers who provide support for people with dementia living in the community ( non‐institutional care ) . Types of interventions Interventions design ed to support caregivers in their role such as skills training , education to assist in caring for a person living with dementia and support groups/programs . Interventions of formal approaches to care design ed to support caregivers in their role , care planning , case management and specially design ated members of the healthcare team ‐ for example dementia nurse specialist or volunteers trained in caring for someone with dementia . Types of studies This review considered any meta‐analyses , systematic review s , r and omised control trials , quasi‐experimental studies , cohort studies , case control studies and observational studies without control groups that addressed the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community . Search strategy The search sought to identify published studies from 2000 to 2005 through the use of electronic data bases . Only studies in English were considered for inclusion . The initial search was conducted of the data bases , CINAHL , MEDLINE and PsychINFO using search strategies adapted from the Cochrane Dementia and Cognitive Improvement Group . A second more extensive search was then conducted using the appropriate Medical Subject Headings ( MeSH ) and keywords for other available data bases . Finally , h and search ing of reference lists of articles retrieved and of core dementia , geriatric and psycho geriatric journals was undertaken . Assessment of quality Method ological quality of each of the articles was assessed by two independent review ers using appraisal checklist developed by the Joanna Briggs Institute and based on the work of the Cochrane Collaboration and Centre for Review s and Dissemination . Data collection and analysis St and ardised mean differences or weighted mean differences and their 95 % confidence intervals were calculated for each included study reported in the meta‐ analysis . Results from comparable groups of studies were pooled in statistical meta‐ analysis using Review Manager Software from the Cochrane Collaboration . Heterogeneity between combined studies was tested using st and ard chi‐square test . Where statistical pooling was not appropriate or possible , the findings are summarised in narrative form . Results A comprehensive search of relevant data bases , h and search ing and cross referencing found 685 articles that were assessed for relevance to the review . Eighty‐five papers appeared to meet the inclusion criteria based on title and abstract , and the full paper was retrieved . Of the 85 full papers review ed , 40 were accepted for inclusion , three were systematic review s , three were meta‐ analysis , and the remaining 34 were r and omised controlled trials . For the r and omised controlled trials that were able to be included in a meta‐ analysis , st and ardised mean differences or weighted mean differences and their 95 % confidence intervals were calculated for each . Results from comparable groups of studies were pooled in statistical meta‐ analysis using Review Manager Software and heterogeneity between combined studies was assessed by using the chi‐square test . Where statistical pooling was not appropriate or possible , the findings are summarised in narrative form . The results are discussed in two main sections . Firstly it was possible to assess the effectiveness of different types of caregiver interventions on the outcome categories of depression , health , subjective well‐being , self‐efficacy and burden . Secondly , results are reported by main outcome category . For each of these sections , meta‐ analysis was conducted where it was possible ; otherwise , a narrative summary describes the findings . Effectiveness of intervention type Four categories of intervention were included in the review ‐ psycho‐educational , support , multi‐component and other . Psycho‐educational Thirteen studies used  psycho‐educational interventions , and all but one showed positive results across a range of outcomes . Eight studies were entered in a meta‐ analysis . No significant impact of psycho‐educational interventions was found for the outcome categories of subjective well‐being , self‐efficacy or health . However , small but significant results were found for the categories of depression and burden . Support Seven studies discussed support only interventions and two of these showed significant results . These two studies were suitable for meta‐ analysis and demonstrated a small but significant improvement on caregiver burden . Multi‐component Twelve of the studies report multi‐component interventions and 10 of these report significant outcomes across a broad range of outcome measures including self‐efficacy , depression , subjective well‐being and burden . Unfortunately because of the heterogeneity of study design s and outcome measures , no meta‐ analysis was possible . Other interventions Other interventions included the use of exercise or nutrition which result ed in improvements in psychological distress and health benefits .  Case management and a computer aided support intervention provided mixed results . One cognitive behavioural therapy study reported a reduction in anxiety and positive impacts on patient behaviour . Effectiveness of interventions using specific outcome categories In addition to analysis by type of intervention it was possible to analyse results based on some outcome categories that were used across the studies . In particular the impact of interventions on  caregiver depression was available for meta‐ analysis from eight studies . This indicated that multi‐component and psycho‐educational interventions showed a small but significant positive effect on caregiver depression . Five studies using the outcome category of caregiver burden  were entered into a meta‐ analysis and findings indicated that there were no significant effects of any of interventions . No meta‐ analysis was possible for the outcome categories of health , self‐efficacy or subjective well‐being . Implication s for practice From this review there is evidence to support the use of well‐ design ed psycho‐educational or multi‐component interventions for caregivers of people with dementia who live in the community . Factors that appear to positively contribute to effective interventions are those which : Provide opportunities within the intervention for the person with dementia as well as the caregiver to be involved Encourage active participation in educational interventions for caregivers Offer individualised programs rather than group sessions Provide information on an ongoing basis , with specific information about services and coaching regarding their new role Target the care recipient particularly by reduction in behaviours Factors which do not appear to have benefit in interventions are those which : Simply refer caregivers to support groups Only provide self help material s Only offer peer Background : The effect of preoperative education on anxiety and postoperative outcomes of cardiac surgery patients remains unclear . Aim : The aim of the study was to estimate the effectiveness of a nurse-led preoperative education on anxiety and postoperative outcomes . Methods : A r and omised controlled study was design ed . All the patients who were admitted for elective cardiac surgery in a general hospital in Athens with knowledge of the Greek language were eligible to take part in the study . Patients in the intervention group received preoperative education by specially trained nurses . The control group received the st and ard information by the ward personnel . Measurements of anxiety were conducted on admission-A , before surgery-B and before discharge-C by the state – trait anxiety inventory . Results : The sample consisted of 395 patients ( intervention group : 205 , control group : 190 ) . The state anxiety on the day before surgery decreased only in the intervention group ( 34.0 ( 8.4 ) versus 36.9 ( 10.7 ) ; P=0.001 ) . The mean decrease in state score during the follow-up period was greater in the intervention group ( P=0.001 ) . No significant difference was found in the length of stay or readmission . Lower proportions of chest infection were found in the intervention group ( 10 ( 5.3 ) versus 1 ( 0.5 ) ; P=0.004 ) . Multivariate linear regression revealed that education and score in trait anxiety scale on admission are independent predictors of a reduction in state anxiety . Conclusion : Preoperative education delivered by nurses reduced anxiety and postoperative complications of patients undergoing cardiac surgery , but it was not effective in reducing readmissions or length of stay OBJECTIVES This study evaluated the effectiveness of group cognitive behavioural therapy ( GCBT ) for the treatment of anxiety disorders in children over an initial period of 12 weeks and to one-month follow-up . Parents of the children receiving GCBT  participated in adjunctive psycho-education sessions and the effect of these sessions on parental anxiety was also evaluated . METHODS Participants were 12 children , six male and six female , aged between 11 and 15 years who were attending a child mental health service . Participants were interviewed with their parents and anxiety symptoms assessed , using the following measures : Anxiety Disorder Interview Schedule - revised , the Children 's Depression Inventory , the Revised Children 's Manifest Anxiety Scale , the Coopersmith Self-Esteem Inventory and the Child Behaviour Checklist . Parental anxiety levels were assessed using the Depression , Anxiety and Stress Scale . The 12 children were r and omly assigned into two age- and sex-matched groups . While the first group received therapy , the second group acted as a treatment-as-usual control ( TAU ) group . The second group began group cognitive behavioural therapy after the 10-week waiting period . All participants and their parents provided structured feedback on the intervention . RESULTS Group cognitive behavioural therapy was significantly effective in reducing both child-reported depressive symptoms , and anxiety on the physiological , worry and total anxiety subscales of the Revised Children 's Manifest Anxiety Scale . There were associated significant increases in the childrens ' subjective levels of general and total self-esteem , that relating to their self-confidence with peers and when engaging in social and academic pursuits . Diagnosis of anxiety disorder reduced by an average of 67 % immediately post-treatment , and by 72 % by the onemonth follow-up period . Parents reported significant reductions in their children 's levels of internalising symptoms , thought and attention problems . However , parents reported no significantly positive changes in their own levels of depression , anxiety and stress symptoms . CONCLUSIONS Group cognitive-behavioural therapy is a useful and clinical ly effective intervention for the treatment of anxiety disorder in children OBJECTIVES The objective of this review was to assess the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community . INCLUSION CRITERIA Types of participants Adult caregivers who provide support for people with dementia living in the community ( non-institutional care).Types of interventions Interventions design ed to support caregivers in their role such as skills training , education to assist in caring for a person living with dementia and support groups/programs . Interventions of formal approaches to care design ed to support caregivers in their role , care planning , case management and specially design ated members of the healthcare team - for example dementia nurse specialist or volunteers trained in caring for someone with dementia . Types of studies This review considered any meta-analyses , systematic review s , r and omised control trials , quasi-experimental studies , cohort studies , case control studies and observational studies without control groups that addressed the effectiveness of interventions that assist caregivers to provide support for people living with dementia in the community . SEARCH STRATEGY The search sought to identify published studies from 2000 to 2005 through the use of electronic data bases . Only studies in English were considered for inclusion . The initial search was conducted of the data bases , CINAHL , MEDLINE and PsychINFO using search strategies adapted from the Cochrane Dementia and Cognitive Improvement Group . A second more extensive search was then conducted using the appropriate Medical Subject Headings ( MeSH ) and keywords for other available data bases . Finally , h and search ing of reference lists of articles retrieved and of core dementia , geriatric and psycho geriatric journals was undertaken . ASSESSMENT OF QUALITY Method ological quality of each of the articles was assessed by two independent review ers using appraisal checklist developed by the Joanna Briggs Institute and based on the work of the Cochrane Collaboration and Centre for Review s and Dissemination . DATA COLLECTION AND ANALYSIS St and ardised mean differences or weighted mean differences and their 95 % confidence intervals were calculated for each included study reported in the meta- analysis . Results from comparable groups of studies were pooled in statistical meta- analysis using Review Manager Software from the Cochrane Collaboration . Heterogeneity between combined studies was tested using st and ard chi-square test . Where statistical pooling was not appropriate or possible , the findings are summarised in narrative form . RESULTS A comprehensive search of relevant data bases , h and search ing and cross referencing found 685 articles that were assessed for relevance to the review . Eighty-five papers appeared to meet the inclusion criteria based on title and abstract , and the full paper was retrieved . Of the 85 full papers review ed , 40 were accepted for inclusion , three were systematic review s , three were meta- analysis , and the remaining 34 were r and omised controlled trials . For the r and omised controlled trials that were able to be included in a meta- analysis , st and ardised mean differences or weighted mean differences and their 95 % confidence intervals were calculated for each . Results from comparable groups of studies were pooled in statistical meta- analysis using Review Manager Software and heterogeneity between combined studies was assessed by using the chi-square test . Where statistical pooling was not appropriate or possible , the findings are summarised in narrative form . The results are discussed in two main sections . Firstly it was possible to assess the effectiveness of different types of caregiver interventions on the outcome categories of depression , health , subjective well-being , self-efficacy and burden . Secondly , results are reported by main outcome category . For each of these sections , meta- analysis was conducted where it was possible ; otherwise , a narrative summary describes the findings . EFFECTIVENESS OF INTERVENTION TYPE Four categories of intervention were included in the review - psycho-educational , support , multi-component and other . Psycho-educational Thirteen studies used  psycho-educational interventions  , and all but one showed positive results across a range of outcomes . Eight studies were entered in a meta- analysis . No significant impact of psycho-educational interventions was found for the outcome categories of subjective well-being , self-efficacy or health . However , small but significant results were found for the categories of depression and burden . Support Seven studies discussed support only interventions and two of these showed significant results . These two studies were suitable for meta- analysis and demonstrated a small but significant improvement on caregiver burden . Multi-component Twelve of the studies report multi-component interventions and 10 of these report significant outcomes across a broad range of outcome measures including self-efficacy , depression , subjective well-being and burden . Unfortunately because of the heterogeneity of study design s and outcome measures , no meta- analysis was possible . Other interventions Other interventions included the use of exercise or nutrition which result ed in improvements in psychological distress and health benefits . Case management and a computer aided support intervention provided mixed results . One cognitive behavioural therapy study reported a reduction in anxiety and positive impacts on patient behaviour . EFFECTIVENESS OF INTERVENTIONS USING SPECIFIC OUTCOME CATEGORIES In addition to analysis by type of intervention it was possible to analyse results based on some outcome categories that were used across the studies . In particular the impact of interventions on caregiver depression was available for meta- analysis from eight studies . This indicated that multi-component and psycho-educational interventions showed a small but significant positive effect on caregiver depression . Five studies using the outcome category of caregiver burden  were entered into a meta- analysis and findings indicated that there were no significant effects of any of interventions . No meta- analysis was possible for the outcome categories of health , self-efficacy or subjective well-being . IMPLICATION S FOR PRACTICE From this review there is evidence to support the use of well- design ed psycho-educational or multi-component interventions for caregivers of people with dementia who live in the community . Factors that appear to positively contribute to effective interventions are those which : Factors which do not appear to have benefit in interventions are those which Background The importance of comprehensive discharge planning plus post discharge support intervention studies have been advocated for patients with heart failure .  Telephone‐based post‐discharge nursing care was reported as a significant nursing care approach that is believed to promote continuity of care . However , there is a lack of systematic ally examined evidence to support the effectiveness of nurse‐led telephone‐based post‐discharge care for the heart failure patients . Objective The purpose of this study was to examine the best available evidence to determine the effectiveness of telephone‐based post‐discharge nursing care of patient with HF and to quantify the effect on all‐cause readmission rates of these patients . Search strategy A thorough search of published and unpublished literature was conducted from 1990 to 2009 . First , computer data bases such as CINAHL , MEDLINE , COCHRANE EMBASE , and Dissertation Abstract s International were included and then , reference search was conducted with relevant studies . Initial keywords were “ readmission , ” “ heart failure , ” “ * tele * ” , “ nurs * , “ post‐discharge ” , telephone‐based . ” Selection criteria R and omized controlled trial studies using the telephone‐based post‐discharge nursing care was selected . Outcome was defined as frequency of unplanned HF symptoms associated all‐cause hospital readmission rate during the 6 months after discharge . Data collection and analysis Included studies were critically evaluated for method ological quality by independent two review ers . Data were extracted and then analyzed using the JBI‐MASTARI and the RevMan 5 program . Main results A total of 10 r and omized controlled trial studies were included for this study . The study result showed that telephone‐based post‐discharge nursing care was a significant intervention especially decreasing hospital readmission rate among HF patients . Conclusion The findings of this review suggest a positive effect of telephone‐based post‐discharge nursing care and that it is an effective intervention in decreasing readmission rate among HF patients . Implication s for practice / research The results of this systematic review indicate the need for well design ed studies that examine other aspects of post‐discharge nursing telephone interventions to decrease hospital readmission rate among HF patients including : cost‐effectiveness , feasibility and appropriateness Background Depression and anxiety interfere with an individual 's quality of life and result in substantial economic costs to the workplace through lost productivity . The internet offers an unparalleled opportunity for the large scale , cost-effective delivery of mental health awareness and destigmatisation programs in the workplace . However , to date high quality assessment s of the effectiveness of such workplace programs have been confined to health professional setting s. The current study reports the effectiveness of Mental Health Guru ( MH-Guru ) , a two-module online mental health workplace induction program . Methods A total of 507 employees from a large multi-departmental government workplace were r and omised to a 2-week online depression and anxiety educational program ( Mental Health Guru ; MH-Guru ) , or a Wait List Control condition . Participants completed online surveys at baseline , 1 week post-intervention and at 6-month follow-up . Primary outcome measures included depression and anxiety literacy , personal stigma about depression and anxiety , and help seeking intentions for anxiety and depression at post-test . Secondary measures included help-seeking attitudes and self-reported help seeking behaviour . Satisfaction measures were also collected . Results Dropout at post intervention was 26.7 % and 21.0 % for the MH-Guru and Control conditions respectively . Relative to Control , MH-Guru participants showed significantly greater improvements in depression and anxiety literacy at post intervention . Between group st and ardized effect sizes at post-test and 6-months were 0.78 and 0.81 for depression literacy and 0.80 and 0.79 for anxiety literacy . Compared to the Control participants , the MH-Guru group also showed significantly greater reductions in depression and anxiety personal stigma . Between group effect sizes in stigma for depression were − 0.56 and − 0.47 at post-test and 6-months respectively and − 0.42 at both time points for anxiety  . The MH-Guru intervention was not associated with a differentially greater increase in anxiety or depression help-seeking intentions or improvement in help seeking attitudes compared to the Control group . However , self-reported help-seeking behaviour was significantly greater in the MH-Guru group at post-test . In addition , the MH-Guru group showed greater intentions to seek help for depression from the Internet at 6-month follow-up . Satisfaction items suggested that the program was acceptable to employees . Conclusions Brief online programs such as MH-Guru have the potential to play an important role in increasing mental health awareness and decreasing stigmatizing attitudes in the workplace , and by extension the general community BACKGROUND Enhanced Recovery Pathways ( ERPs ) have demonstrated reduced hospital length of stay and improved outcomes after colorectal surgery . Concerns exist about increases in readmission rates . Laparoscopic colorectal surgery with an ERP can permit earlier discharge without compromising safety or increasing readmission rates . STUDY DESIGN A review of a prospect i ve data base was performed for major elective colorectal procedures by a single surgeon . All patients followed a st and ardized ERP and discharge criteria . Patients were categorized by approach and day of discharge ( DoD ) of ≤ 1 , ≤ 2 , ≤ 3 , ≤ 7 , and > 7 days . Main outcomes measures were length of stay and 30-day readmission rates in each group . RESULTS Eight hundred and six cases ( 609 laparoscopic , 197 open ) were identified during a 64-month period . Mean age was similar for the laparoscopic ( 59.1 years ) and open ( 58.3 years ) groups . Mean overall DoD was at 5 days ( ± 4.8 days ) ; by approach , the mean laparoscopic DoD was at 3.9 days and open DoD was at 8.4 days . Twenty-nine percent were discharged within 48 hours ( 38 % laparoscopic and 8 % open ) and 50 % were discharged within 72 hours ( 62 % laparoscopic and 19 % open ) . Only 8.9 % of all patients ( n = 72 ) were readmitted ( 7.2 % laparoscopic , 14.2 % open ) . The cumulative readmission rate for laparoscopic patients in early DoD groups postoperative days 1 , 2 , and 3 were 0.2 % , 1.6 % , and 3.4 % , respectively . CONCLUSIONS Combining laparoscopy with an ERP optimizes patient care in colorectal surgery . The combination permits early discharge ; 38 % were discharged within 2 days and 62 % within 3 days of surgery , with low readmission rates . These results support that early DoD is possible without compromising patient safety or increasing readmission rates . This might be a marker for low readmission rate , and suggests that readmission rate alone might not be an adequate marker of quality BACKGROUND Coronary artery bypass graft ( CABG ) surgery is performed more frequently in individuals who are older and sicker than in previous years . Increased patient acuity and reduced hospital length of stays leave individuals ill prepared for their recovery . OBJECTIVES To test the feasibility of a peer support program and determine indicators of the effects of peer support on recovery outcomes of individuals following CABG surgery . METHODS AND RESULTS A pre-post test pilot r and omized clinical trial design enrolled men and women undergoing first-time nonemergency CABG surgery at a single site in Ontario . Patients were r and omly assigned to either usual care or peer support . Patients allocated to usual care ( n=50 ) received st and ard preoperative and postoperative education . Patients in the  peer support group  ( n=45 ) received individualized education and support via telephone from trained cardiac surgery peer volunteers for eight weeks following hospital discharge . Most ( 93 % ) peer volunteers believed they were prepared for their role , with 98 % of peer volunteers initiating calls within 72 h of the patient 's discharge . Peer volunteers made an average of 12 calls , less than 30 min in duration over the eight-week recovery period . Patients were satisfied with their peer support ( n=45 , 98 % ) . The intervention group reported statistical trends toward improved physical function ( physical component score ) ( t [89]=-1.6 ; P=0.12 ) role function ( t [93]=-1.9 ; P=0.06 ) , less pain ( t [93]=1.30 ; P=0.20 ) and improved cardiac rehabilitation enrollment ( chi2=2.50 , P=0.11 ) . CONCLUSIONS These preliminary results suggest that peer support may improve recovery outcomes following CABG . Data from the present pilot trial also indicate that a home-based peer support intervention is feasible and an adequately powered trial should be conducted Background Breast cancer ( BC ) is the most common type of cancer in women worldwide . Post-treatment , patients suffer from side effects and have various rehabilitation needs , which means that individualization is fundamental for optimal rehabilitation . This systematic review ( SR ) of SRs aims to evaluate the current evidence on rehabilitation interventions in female patients following BC treatment . Methods Full-text SRs published in English from 2009 were search ed in Embase , PubMed , Cinahl Complete , PsycINFO , AMED , SCOPUS , and Cochrane Library . Inclusion criteria : SRs of r and omized or non-r and omized controlled trials investigating the effects of  rehabilitation interventions in women following BC treatment . All outcomes were considered . Method ological quality was evaluated using the AMSTAR 2 tool and interrater agreement was evaluated . Out of 1269 citations retrieved , 37 SRs were included . Results Five rehabilitation areas were identified : exercise and physical activity ( PA ) , complementary and alternative medicine ( CAM ) , yoga , lymphoedema treatment , and psychosocial interventions . The most solid evidence was found in exercise/PA and yoga . Exercise interventions improved outcomes such as shoulder mobility , lymphoedema , pain , fatigue and quality of life ( QoL ) . Effects of yoga were shown on QoL , anxiety , depression , sleep disturbance , fatigue and gastrointestinal symptoms . The effect of CAM was shown on nausea , pain , fatigue , anger and anxiety but these results need to be interpreted with caution because of low method ological quality in included studies in the SRs . Among the lymphoedema treatments , positive effects were seen for resistance training on volume reduction and muscle strength and psychosocial interventions such as cognitive behavioural therapy had positive effects on QoL , anxiety , depression and mood disturbance . Conclusions This SR of SRs show solid positive effects of exercise/PA and yoga for women following BC treatment , and provides extended knowledge of the effects of CAM , yoga , lymphoedema treatment and psychosocial interventions . It is evident that more than one intervention could have positive effects on a specific symptom and that the effects depend not only on intervention type but also on how and when the intervention is provided . The results can be used as a foundation for individualized rehabilitation and aid health care professionals in meeting patients ’ individual needs and preferences . Trial registration PROSPERO ( CRD42017060912 ) Background The current practice in elective orthopaedics does not routinely include psychological interventions despite evidence that psychological factors such as personality , anxiety , depression and negative thinking styles can influence outcomes and recovery from surgery . The objective of this paper was to review the effectiveness of psychological interventions used in conjunction with total hip ( THA ) and knee arthroplasty ( TKA ) , in improving patient reported joint outcomes . Methods An extensive literature search was conducted according to Preferred Reporting Items for Systematic review s and Meta-Analyses guidelines . Search terms included psychology , interventions , and orthopaedics . Articles were included if they were r and omised controlled trials ( RCTs ) of psychological interventions involving active patient participation measured with patient reported joint outcomes in patients undergoing hip or knee arthroplasty . Results A total of 19,489 titles were screened . Seven studies met the inclusion criteria and were included . Five of seven studies did not show improvements in patient reported outcomes after surgery . Specifically , psycho-education alone was not effective at improving patient reported joint outcomes in two out of two studies . Conclusion The current literature does not support routine psychological interventions for TKA and THA . However , it should be noted that the literature for psychological interventions in conjunction with TKA and THA is still in its infancy . This gap in the literature is surprising , considering the importance of the role of psychological factors in recovery . Further RCTs with long term follow ups , multidisciplinary involvement , and more comprehensive and focused interventions that go beyond educating patients are needed . Future studies should account for the dem and effect , include measures of psychological variables to determine whether psychological interventions are more beneficial for some patients compared to others , and compare the different modes of delivery and timing of interventions to determine the optimal nature and duration of psychological interventions for TKA and THA BACKGROUND Emotional distress has major implication s for employees and employers .  Cognitive behavioural therapy ( CBT ) is a recommended treatment , but dem and outstrips supply . CBT is well suited to computerization . Most employee assistance programmes have not been systematic ally evaluated and computerized CBT has not previously been studied in the workplace . AIMS To evaluate the effect of an 8 week computerized cognitive behavioural therapy programme , ' Beating The Blues ' , on emotional distress in employees with recent stress-related absenteeism , and to explore the reasons for non-participation . METHODS An open , r and omized trial in a London NHS occupational health department . Forty-eight public sector employees , with 10 or more cumulative days stress-related absenteeism in the last 6 months , r and omized equally to ' Beating The Blues ' plus conventional care , or conventional care alone . Main outcome measures were Hospital Anxiety and Depression Scale and Attributional Style Question naire scores at end of treatment and 1 , 3 and 6 months later ; and reasons for non-participation . RESULTS At end of treatment and 1 month later , adjusted mean depression scores and adjusted mean negative attributional style scores were significantly lower in the intervention group . One month post-treatment , adjusted mean anxiety scores were also significantly lower in the intervention group . The differences were not statistically significant at 3 and 6 months post-treatment . Non-participation was common and related to access problems , preference for other treatments , time commitment , scepticism about the intervention and the employer connection . CONCLUSIONS ' Beating The Blues ' may accelerate psychological recovery in employees with recent stress-related absenteeism . Greater flexibility and accessibility might improve uptake BACKGROUND Mental health problems such as depression and anxiety are common in Multiple Sclerosis ( MS ) and are often under treated . AIMS This paper reports on the clinical effectiveness of a cognitive behaviour therapy service for common mental disorders in people with MS and compares it to previous r and omised controlled trials ( RCTs ) of cognitive behaviour therapy ( CBT ) in this population . METHODS 49 patients were deemed appropriate for CBT and 29 accepted treatment . Assessment s were completed at baseline and end of treatment and included the Hospital Anxiety & Depression Scale . Results in the form of a st and ardized effect of treatment were compared with five previous RCTs . RESULTS The results from this clinical service indicated statistically significant outcomes with reductions in depression and anxiety . The uncontrolled effect size was large but inferior to those found in published RCTs . CONCLUSIONS Cognitive behaviour therapy is effective for people with MS in routine clinical practice . Possible limits on effectiveness include more liberal patient selection , lack of specificity in rating scales and heterogeneity of target problems . Given the high rates of distress in this population , routine psychological interventions within neurology services are justifiable . Future research should aim to maximise CBT in such setting OBJECTIVE To explore the effects on the st and ardized management of patients with coronary atherosclerotic heart disease complicated with chronic heart failure . METHODS A total of 823 patients discharged from our department were r and omly enrolled . Among 734 patients with follow-up consents , they were divided into management and control groups ( n = 440 , 294 ) . The management group received st and ardized out-of-hospital management , regular health education and follow-ups of telephone and outpatient visits . RESULTS Compared with the control group , the management group had lower rates of all-cause mortality , cardiac death and readmission due to cardiovascular events ( CVE ) declining by 26.5 % , 32.2 % and 57.0 % respectively . Over a 4-year period , the annular survival rate of management group was 92 % , 85 % , 83 % and 82 % while that of control group 95 % , 89 % , 82 % and 75 % respectively . Patient compliance of digoxin and diuretics in the control group was inferior to that in the management group . CONCLUSION Through st and ardized out-of-hospital management , the patients with coronary atherosclerotic heart disease plus chronic heart failure may achieve significant benefits through reducing the rates of all-cause mortality , cardiac death and readmission due to CVE and improving survival rate OBJECTIVE The goal of this study was to examine the feasibility , acceptability , and efficacy of a brief , tailored cognitive-behavioral intervention for patients with symptoms of preoperative depression or anxiety before undergoing a coronary artery bypass graft ( CABG ) operation . METHODS Patients were recruited from a university teaching hospital between February 2007 and May 2009 . Patients were r and omly assigned to receive treatment as usual ( TAU ) or a cognitive behavioral therapy ( CBT ) intervention called Managing Anxiety and Depression using Education and Skills ( MADES ) . A total of 100 subjects were r and omized into the study . Length of hospital stay was assessed with a 1-way analysis of variance . Depression , anxiety , and quality of life were assessed with mixed-model repeated measures analyses . RESULTS Overall , the intervention was feasible , and patients had a positive impression of the MADES . Patients in the TAU group stayed longer in the hospital than did those in the MADES group ( 7.9 days ± 2.6 vs 9.2 days ± 3.5 ; P = .049 ) . Depressive symptoms increased at time of hospital discharge for the TAU group , whereas the MADES group had a decrease in depressive symptoms at the time of discharge . Quality of life and anxiety symptoms improved in both groups at 3 to 4 weeks of follow-up . However , the MADES group had greater improvements than did the TAU group . CONCLUSIONS This study demonstrated that brief , tailored CBT targeting preoperative depression and anxiety is both feasible and acceptable for patients undergoing CABG surgery . Most important , this intervention improved depressive and anxiety symptoms , as well as quality of life . Moreover , it reduced in-hospital length of stay . This study found that a cognitive-behavioral intervention for patients undergoing CABG surgery for symptoms of preoperative depression/anxiety is both feasible and acceptable . Most important , this intervention improved depressive and anxiety symptoms , as well as quality of life . It also reduced in-hospital length of stay Background Depression is a common mental health disorder for which clinical practice guidelines have been developed . Prior systematic review s have identified complex organizational interventions , such as collaborative care , as effective for guideline implementation ; yet , many healthcare delivery organizations are interested in less re source -intensive methods to increase provider adherence to guidelines and guideline -concordant practice s. The objective of this systematic review was to assess the effectiveness of  healthcare provider  interventions that aim to increase adherence to evidence -based treatment of depression in routine clinical practice . Methods We search ed five data bases through August 2017 using a comprehensive search strategy to identify English- language r and omized controlled trials ( RCTs ) in the quality improvement , implementation science , and behavior change literature that evaluated outpatient provider interventions , in the absence of practice re design efforts , to increase adherence to treatment guidelines or guideline -concordant practice s for depression . We used meta- analysis to summarize odds ratios , st and ardized mean differences , and incidence rate ratios , and assessed quality of evidence ( QoE ) using the GRADE approach . Results Twenty-two RCTs promoting adherence to clinical practice guidelines or guideline -concordant practice s met inclusion criteria . Studies evaluated diverse provider interventions , including distributing guidelines to providers , education/training such as academic detailing , and combinations of education with other components such as targeting implementation barriers . Results were heterogeneous and analyses comparing provider interventions with usual clinical practice did not indicate a statistically significant difference in guideline adherence across studies . There was some evidence that provider interventions improved individual outcomes such as medication prescribing and indirect comparisons indicated more complex provider interventions may be associated with more favorable outcomes . We did not identify types of provider interventions that were consistently associated with improvements across indicators of adherence and across studies . Effects on patients ’ health in these RCTs were inconsistent across studies and outcomes . Conclusions Existing RCTs describe a range of provider interventions to increase adherence to depression guidelines . Low QoE and lack of replication of specific intervention strategies across studies limited conclusions that can be drawn from the existing research . Continued efforts are needed to identify successful strategies to maximize the impact of provider interventions on increasing adherence to evidence -based treatment for depression . Trial registration PROSPERO record CRD42017060460 on AIMS Research has demonstrated the beneficial impact that pre-operative education exerts on the postoperative recovery of patients having surgery but little work has focused specifically on cardiac surgery . Therefore a r and omized controlled trial was design ed to eluci date the consequences of pre-operative education , given before admission , on postoperative pain , anxiety , depression and wellbeing in the 6 months following a first episode of coronary artery surgery . METHOD AND RESULTS Three hundred and fifty-six people were r and omized into the study , with 188 in the experimental and 168 in the control arms . Patients in the experimental group received the intervention , a day of education by members of the multidisciplinary team , prior to admission for surgery . Experimental and control subjects had the usual care , which involved education on admission and throughout their stay in hospital . Measurement was conducted on entry to the study , before r and omization , and at 3 days , 6 weeks , 3 months and 6 months following operation . A variety of tools were used : the SF-36 Health Status question naire , the Hospital Anxiety and Depression scale , the General Well-Being question naire and a pain measurement tool . Analysis was done using the intention-totreat principle and non-parametric statistics . There were no significant differences between groups in the primary outcomes namely anxiety ( P=0.09 ) and pain ( P=0.48 ) , or in depression ( P=0.62 ) and wellbeing ( ' worn out ' P=0.11 ; ' tense and uptight ' P=0.29 ) 6 months after operation . This was also the case 3 days after coronary artery surgery . There was a significant difference in length of hospital stay ( P=0.01 ) with the experimental group having the longer stay . These findings contrast with much of the existing evidence . CONCLUSION The findings demonstrate that there is no benefit to be gained from this form of pre-operative education and that there is an associated increase in length of hospital stay . Future research could examine an ongoing programme of education and support , and might use alternative methods such as CD-ROM or the Internet Objectives Our primary aim of this pilot study was to test feasibility of the planned design , the interventions ( education plus telephone coaching ) , and the outcome measures , and to facilitate a power calculation for a future r and omized controlled trial to improve adherence to recovery goals following hip fracture . Design This is a parallel 1:1 r and omized controlled feasibility study . Setting The study was conducted in a teaching hospital in Vancouver , BC , Canada . Participants Participants were community-dwelling adults over 60 years of age with a recent hip fracture . They were recruited and assessed in hospital , and then r and omized after hospital discharge to the intervention or control group by a web-based r and omization service . Treatment allocation was concealed to the investigators , measurement team , and data entry assistants and analysts . Participants and the research physiotherapist were aware of treatment allocation . Intervention Intervention included usual care for hip fracture plus a 1-hour in-hospital educational session using a patient-centered educational manual and four videos , and up to five postdischarge telephone calls from a physiotherapist to provide recovery coaching . The control group received usual care plus a 1-hour in-hospital educational session using the educational manual and videos . Measurement Our primary outcome was feasibility , specifically recruitment and retention of participants . We also collected selected health outcomes , including health-related quality of life ( EQ5D-5L ) , gait speed , and psychosocial factors ( ICEpop CAPability measure for Older people and the Hospital Anxiety and Depression Scale ) . Results Our pilot study results indicate that it is feasible to recruit , retain , and provide follow-up telephone coaching to older adults after hip fracture . We enrolled 30 older adults ( mean age 81.5 years ; range 61–97 years ) , representing a 42 % recruitment rate . Participants excluded were those who were not community dwelling on admission , were discharged to a residential care facility , had physician-diagnosed dementia , and /or had medical contraindications to participation . There were 27 participants who completed the study : eleven in the intervention group , 15 in the control group , and one participant completed a qualitative interview only . There were no differences between groups for health measures . Conclusion We highlight the feasibility of telephone coaching for older adults after hip fracture to improve adherence to mobility recovery goals Background Evaluations of  school‐based anxiety prevention programmes  have reported improvements in psychological functioning although little is known about their effect upon educational outcomes . Methods One thous and three hundred and sixty‐two children from 40 primary schools in Engl and took part in the r and omised controlled trial , Preventing Anxiety in Children through Education in Schools . The trial investigated the effectiveness of a universal school‐based cognitive behaviour therapy prevention programme , FRIENDS , delivered by health care staff or school staff compared with usual personal , social , health and education ( PSHE ) lessons .  Self‐report psychological outcomes and educational attainment on national st and ardised attainment tests in reading , writing and maths were collected 12 months postintervention . Analysis was performed at individual level using multivariable mixed effect models controlling for gender , type of intervention and school effect . Registered trial : IS RCT N : 23563048 . Results At 12 months , anxiety reduced in the health‐led FRIENDS group compared to school‐led FRIENDS and PSHE . There were no between‐group differences in academic performance regardless of gender , deprivation , ethnicity and additional educational needs . Conclusions School‐based mental health interventions should assess psychological and educational outcomes . Further research should directly compare the effects of interventions led by health and school staff Context Emergency department visits and rehospitalizations are common after hospital discharge . Contribution This trial demonstrated that a nurse discharge advocate and clinical pharmacist working together to coordinate hospital discharge , educate patients , and reconcile medications led to fewer follow-up emergency visits and rehospitalizations than usual care alone . Caution The trial was conducted at a single center , and not all eligible patients were enrolled . Implication A systematic approach to hospital discharges can reduce unnecessary health service use . The Editors One in 5 hospitalizations is complicated by postdischarge adverse events ( 1 , 2 ) , some of which may lead to preventable emergency department visits or readmissions . Despite this finding , hospital discharge procedures have not been st and ardized ( 3 ) . In addition , the declining presence of primary care providers ( PCPs ) in hospitals has not been adequately accompanied by systems to ensure that patient data are transferred to subsequent caregivers ( 4 , 5 ) . For example , discharge summaries  frequently lack critical data and are not sent to the PCP in a timely fashion ( 6 , 7 ) , result ing in outpatient clinicians being unaware of test results that were pending at discharge ( 8) and evaluations that were scheduled to be done after discharge not being completed ( 9 ) . Similarly , patients are often left unprepared at discharge ; many do not underst and their discharge medications and can not recall their chief diagnoses ( 10 ) . With more than 32 million adult discharges in the United States each year ( 11 ) , these deficiencies in the transition of care increase illness , unnecessary hospital utilization , and cost . Some peridischarge interventions have shown a reduction in hospital readmission rates and cost ( 1214 ) , emergency department visits ( 15 ) , and postdischarge adverse events ( 16 ) , whereas some have shown little or no effect ( 1720 ) . Peridischarge interventions have also shown improved PCP follow-up and outpatient work-ups ( 21 ) and higher patient satisfaction ( 15 ) . Most of these studies have focused on specific diagnoses ( 14 , 22 , 23 ) or highly selected population s , such as geriatric adults ( 12 , 13 , 19 , 24 ) . Some have focused on specific aspects of the discharge , such as increasing access to primary care follow-up ( 25 ) , connecting with transitional nursing services ( 26 ) , or improving patients ' ability to advocate for themselves after discharge ( 12 ) . To date , no study has evaluated a st and ardized discharge intervention that includes patient education , comprehensive discharge planning , and postdischarge telephone reinforcement in a general medical population . In 2004 , we began an in-depth examination of hospital discharge , for which we design ed a package of services to minimize discharge failuresa process called reengineered discharge ( RED ) ( Table 1 ) ( 3 , 27 ) . We did a r and omized , controlled trial to evaluate the clinical effect of implementing RED among patients admitted to a general medical service . Table 1 . Components of Reengineered Hospital Discharge Methods Setting and Participants We conducted a 2-group , r and omized , controlled trial of English-speaking patients 18 years of age or older who were admitted to the medical teaching service of Boston Medical Center , Boston , Massachusettsa large , urban , safety-net hospital with an ethnically diverse patient population . Patients had to have a telephone , be able to comprehend study details and the consent process in English , and have plans to be discharged to a U.S. community . We did not enroll patients if they were admitted from a skilled nursing facility or other hospital , transferred to a different hospital service before enrollment , admitted for a planned hospitalization , were on hospital pre caution s or suicide watch , or were deaf or blind . Boston University 's institutional review board approved all study activities . R and omization Each morning , a list of admitted patients was review ed for initial eligibility ( hospital location , age , date and time of admission , and previous enrollment ) . Last names of potential participants were ranked by using a r and om-number sequence to determine the order in which to approach patients for enrollment . A trained research assistant then approached each patient and further determined eligibility according to inclusion and exclusion criteria ( Figure 1 ) . Figure 1 . Study flow diagram . * Patients did not meet inclusion criteria if they were admitted from or planned discharge to an institutional setting ( n= 74 ) , planned hospitalization ( n= 3 ) or discharge to a non-U.S. community ( n= 5 ) , were transferred to different hospital service ( n= 8) , did not speak English ( n= 371 ) or have a telephone ( n= 71 ) , were on hospital pre caution s ( n= 274 ) or suicide watch with a sitter ( n= 10 ) , were unable to consent ( n= 181 ) , had sickle cell disease as the admitting diagnosis ( n= 38 ) , had privacy status ( n= 8) , were deaf or blind ( n= 2 ) , or other ( n= 4 ) . Usual care participants did not meet eligibility criteria if they were discharged to a nursing facility ( n= 28 ) , were transferred to another hospital service ( n= 1 ) , were previously enrolled ( n= 1 ) , died during index admission ( n= 2 ) , requested to be removed ( n= 5 ) , or other ( n= 3 ) . Intervention participants did not meet eligibility criteria if they were discharged to a nursing facility ( n= 21 ) , were transferred to another hospital service ( n= 6 ) , died during index admission ( n= 1 ) , requested to be removed ( n= 2 ) , or other ( n= 8) . 107 intervention participants did not receive a reinforcement call because they could not be reached by telephone ( n= 93 ) , they were readmitted the same or next day ( n= 2 ) , there was no staffing coverage ( n= 8) , or other ( n= 4 ) . By using block r and omization ( 28 ) with varying block sizes of 6 and 8 , we r and omly arranged index cards indicating either the usual care or intervention group . We placed the cards in opaque envelopes labeled consecutively with study numbers . We assigned eligible participants who consented to enrollment to a study group by revealing the concealed index card . This process continued until 2 participants were enrolled each day of the week ( or 3 participants if the first 2 participants were r and omly assigned to the usual care group ) . This protocol ensured that research assistants could not selectively choose potential participants for enrollment or predict assignment . Participants r and omly assigned to usual care received no further intervention . There were 40 participants in the usual care group and 38 in the intervention group who were enrolled but no longer met inclusion criteria at discharge ( most commonly because they were discharged to a nursing facility ) . Because the primary analysis was by intention to treat , we included these participants in the analysis , with the exception of those who died before index discharge , requested to be removed , or were previously enrolled ( Figure 1 ) . Interventions Nurse discharge advocates ( DAs ) carried out all aspects of the in-hospital intervention . We hired 6 part-time DAs to work with intervention participants to ensure coverage by 1 DA 7 days a week , 5 hours a day . We trained all DAs to deliver the RED intervention by using a manual containing detailed scripts , observation of relevant clinical interactions , and simulated practice sessions . The primary goals of the DA were to coordinate the discharge plan with the hospital team and educate and prepare the participant for discharge . At admission , the DA completed the RED intervention components outlined in Table 1 . Additional information about the DA training manual is published elsewhere ( 3 ) and can be found on our Web site ( www.bu.edu/fammed/projectred/index.html ) . With information collected from the hospital team and the participant , the DA created the after-hospital care plan ( AHCP ) , which contained medical provider contact information , date s for appointments and tests , an appointment calendar , a color-coded medication schedule , a list of tests with pending results at discharge , an illustrated description of the discharge diagnosis , and information about what to do if a problem arises . Information for the AHCP was manually entered into a Microsoft Word ( Microsoft , Redmond , Washington ) template , printed , and spiral-bound to produce an individualized , color booklet design ed to be accessible to individuals with limited health literacy . By using scripts from the training manual , the DA used a teach-back methodology ( 29 ) to review the contents of the AHCP with the participant . On the day of discharge , the AHCP and discharge summary were faxed to the PCP . A clinical pharmacist telephoned the participants 2 to 4 days after the index discharge to reinforce the discharge plan by using a scripted interview . The pharmacist had access to the AHCP and hospital discharge summary and , over several days , made at least 3 attempts to reach each participant . The pharmacist asked participants to bring their medications to the telephone to review them and address medication-related problems ; the pharmacist communicated these issues to the PCP or DA . Outcomes Measures and Follow-up At the time of recruitment , research assistants collected baseline data , including sociodemographic characteristics ; the Short Form-12 Health Survey , Version 2 ( 30 ) ; the depression subscale from the Patient Health Question naire-9 ( 31 ) ; and the Rapid Estimate of Adult Literacy in Medicine ( 32 ) . We calculated the Charlson Comorbidity Index score by using primary and secondary diagnoses recorded on the index admission discharge summary ( 33 ) . We determined the number of hospital admissions and emergency department visits in the 6 months before index admission through medical record review ( Boston Medical Center hospital utilization ) and participant report ( all other hospital utilization ) . The primary end point was the rate of hospital utilizationthe total number of emergency department visits and readmissions per participant within 30 days of the index discharge .
The findings from this systematic review suggest favorable effects on the readmission rates .
As well , the individualized patient education intervention is effective in promoting statistically significant changes in quality of life , performance of health behaviours , depression , and anxiety
The objective of this systematic review was to compare the effectiveness of individualized patient education interventions to st and ardized patient education interventions on the rate of readmission , performance of specific health behaviours , depression , anxiety , and cognition during the post-hospital discharge recovery period following cardiovascular surgery .