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床边与非床边患者病例汇报在病房查房中的效果:系统评价和荟萃分析。

Effect of Bedside vs. Non-bedside Patient Case Presentation During Ward Rounds: a Systematic Review and Meta-analysis.

机构信息

Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, and University of Basel, Klingelbergstrasse 23, 4056, Basel, Switzerland.

Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.

出版信息

J Gen Intern Med. 2019 Mar;34(3):447-457. doi: 10.1007/s11606-018-4714-1. Epub 2019 Jan 2.

Abstract

BACKGROUND

Ward rounds are important for communicating with patients, but it is unclear whether bedside or non-bedside case presentation is the better approach.

METHODS

We conducted a comprehensive search up to July 2018 to identify randomized controlled trials (RCTs) comparing bedside and non-bedside case presentations. Data was abstracted independently by two researchers and study quality was assessed using the Cochrane Risk of Bias Tool. Our primary outcome was patient's satisfaction with ward rounds. Our main secondary outcome was patient's understanding of disease and the management plan.

RESULTS

Among 1647 identified articles, we included five RCTs involving 655 participants with overall moderate trial quality. We found no difference in having low patient's satisfaction between bedside and non-bedside case presentations (risk ratio [RR], 0.85; 95% CI, 0.66 to 1.09). We also found no impact on patient's understanding of their disease and management plan (RR, 0.92; 95% CI, 0.67 to 1.28). Trial sequential analysis (TSA) indicated low power of our main analysis.

DISCUSSION

We found no differences in patient-relevant outcomes between bedside and non-bedside case presentations with a lack of statistical power among current trials. There is a need for larger studies to find the optimal approach to patient case presentation during ward rounds.

摘要

背景

病房查房对于与患者沟通非常重要,但目前仍不清楚床边查房和非床边查房哪种方式更好。

方法

我们进行了全面的检索,截至 2018 年 7 月,以确定比较床边和非床边病例呈现的随机对照试验(RCT)。由两名研究人员独立提取数据,并使用 Cochrane 偏倚风险工具评估研究质量。我们的主要结局是患者对病房查房的满意度。我们的主要次要结局是患者对疾病和管理计划的理解。

结果

在 1647 篇确定的文章中,我们纳入了 5 项 RCT,涉及 655 名参与者,总体试验质量为中等。我们发现床边查房和非床边查房在患者满意度方面没有差异(风险比[RR],0.85;95%可信区间,0.66 至 1.09)。我们也没有发现对患者对疾病和管理计划的理解有影响(RR,0.92;95%可信区间,0.67 至 1.28)。试验序贯分析(TSA)表明我们的主要分析结果的效力较低。

讨论

我们发现床边查房和非床边查房在患者相关结局方面没有差异,目前的试验缺乏统计学效力。需要更大的研究来确定病房查房中患者病例呈现的最佳方法。

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