Interventions to Reduce Benzodiazepine and Sedative-Hypnotic Drug Use in Acute Care Hospitals: A Scoping Review
Notice bibliographique
Résumé
Abstract Background Benzodiazepines and sedative-hypnotics (BZD/SHD) are commonly utilized in the acute care setting for insomnia and anxiety and are associated with cognitive impairment, falls, fractures, and increased mortality. Interventions to reduce use of BZD/SHD in hospitals are not well characterized. The objective of the scoping review was to identify and characterize interventions to reduce the use of BZD/SHD by adults for anxiety and sedation in hospitals.Methods We included studies and abstracts published in English that described an intervention to reduce BZD/SHD in adult hospital patients. Six databases (PubMed, EMBASE, CINAHL, PsycINFO, Scopus, and Web of Science) and the grey literature (Opengrey, Grey Matters, Google Advanced) were searched up to July 2018. Titles and abstracts were screened and full-text articles were reviewed for potential inclusion by three independent reviewers. Data on each eligible study was charted in a Microsoft Excel® database. Stakeholder consultation occurred before and after the scoping review was completed. Results There were 9480 records identified from all sources and 35 studies were included in the scoping review. Included studies were divided into two categories that emerged from stakeholder feedback: sedatives prescribed in hospital or home medications. The most common study designs were pre-/post-test (24, 68.6%) and randomized controlled trials (6, 17.1%). The majority of studies tested a single intervention (28, 80%) and these were most commonly education, relaxation training and sleep protocols. Patients were frequently the target of relaxation training and behavior change interventions, while sleep protocols, multifaceted interventions and education were usually directed at healthcare providers, either alone or in combination with patients. Most studies reported positive outcomes in decreasing BZD/SHD use (23, 65.7%), including some that were statistically significant (13, 37.1%). Conclusions This scoping review found a variety of interventions aimed at decreasing the utilization of BZD/SHD in the acute care setting, where previously little was known. Current literature addressed the initiation of BZD/SHD in hospital, rather than chronic medications that had been prescribed in the community. Stakeholder consultation supported these findings and pointed out important factors to consider when designing an intervention for hospital patients. Registration: Open Science Framework, https://osf.io/u7s4h/?view_only=15a9b9134be743b6a4177ba2eec9e91a
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,020 | 0,081 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,007 | 0,007 |
| Bibliométrie | 0,019 | 0,015 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,005 | 0,004 |
| Science ouverte | 0,003 | 0,003 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».