Background: A meta-analysis was performed to evaluate the use of clinical pathways for hip and knee joint replacements when compared with standard medical care. The impact of clinical pathways was evaluated assessing the major outcomes of in-hospital hip and knee joint replacement processes: postoperative complications, number of patients discharged at home, length of in-hospital stay and direct costs.

BackgroundCare pathways have become a popular tool to enhance the quality of care by improving patient outcomes, promoting patient safety, increasing patient satisfaction, and optimizing the use of resources. We performed a disease specific systematic review to determine how care pathways in the hospital treatment of heart failure affect in-hospital mortality, length of in-hospital stay, readmission rate and hospitalisation cost when compared with standard care.MethodsMedline, Cinahl, Embase and the Cochrane Central Register of Controlled Trials were searched from 1985 to 2010. Each study was assessed independently by two reviewers. Methodological quality of the included studies was assed using the Jadad methodological approach for randomised controlled trials, controlled clinical trials and the New Castle Ottawa Scale for case–control studies, cohort studies and time interrupted series.ResultsSeven studies met the study inclusion criteria and were included in the systematic review with a total sample of 3,690 patients. The combined overall results showed that care pathways have a significant positive effect on mortality and readmission rate. A shorter length of hospital stay was also observed compared with the standard care group. No significant difference was found in the hospitalisation costs. More positive results were observed in controlled trials compared to randomized controlled trials.ConclusionBy combining all possible results, it can be concluded that care pathways for treatment of heart failure decrease mortality rates and length of hospital stay, but no statistically significant difference was observed in the readmission rates and hospitalisation costs. However, one should be cautious with overall conclusions: what works for one organization may not work for another because of the subtle differences in processes and bottlenecks.

A set of key interventions and outcome measures is available to support joint arthroplasty clinical pathways. Team and service outcomes should be further addressed in practice and research. Meta-analysis on the outcome indicators should be performed. Future studies should more rigorously comply with existing reporting standards.

Background: Patients with stroke should have access to a continuum of care from organized stroke units in the acute phase, to appropriate rehabilitation and secondary prevention measures. Moreover to improve the outcomes for acute stroke patients from an organizational perspective, the use of multidisciplinary teams and the delivery of continuous stroke education both to the professionals and to the public, and the implementation of evidence-based stroke care are recommended. Clinical pathways are complex interventions that can be used for this purpose. However in stroke care the use of clinical pathways remains questionable because little prospective controlled data has demonstrated their effectiveness. The purpose of this study is to determine whether clinical pathways could improve the quality of the care provided to the patients affected by stroke in hospital and through the continuum of the care.

Introduction mitral regurgitation is often associated with severe aortic stenosis but the indications for its correction at the time of aortic valve surgery are still unclear. Despite the indication for mitral valve repair or replacement in the case of severe secondary mitral regurgitation, many patients are left untreated. This is due to the common belief that secondary mitral regurgitation mostly improves after the aortic valve is treated. Purpose the aim of the study is to investigate the prevalence and distribution of mitral calcifications, their role in the development of mitral regurgitation and in its reduction after aortic valve replacement. Methods we reviewed all patient’s records who underwent aortic valve replacement for aortic stenosis at our institution from 12/2014 to 12/2016. Pre and post-operative echocardiograms were reviewed by experienced echocardiographer. Patients were then divided into 4 categories (functional, mild, moderate and severe calcification) on the basis of the presence, distribuition and severity of calcification on the mitral apparatus. Results at the end 651 patients were collected and analyzed. Mean age was 74yo. 334 (51,4%) of them were males. Most patients (63,1%) had only mild mitral regurgitation but 147 (22,6%) of them had moderate or severe mitral regurgitation. The presences of moderate or severe calcification of the mitral apparatus resulted to be a risk factor for the presence of mitral regurgitation associated with aortic stenosis as shown in Table 1. After surgical aortic valve replacement less than 21% of the patients showed a reduction of the degree of mitral regurgitation. We found no statistical difference between groups about mitral regurgitation changes after aortic valve replacement. Conclusions Mitral regurgitation is a common finding in patients with severe aortic stenosis and it’s prevalence is higher in patients with mitral calcifications. Few patients, however showed a reduction in the degree of mitral regurgitation after surgical aortic valve replacement with no difference related to the severity of annular or leaflets calcifications. TABLE 1 Logistic regression for the presence of mitral regurgitation Mitral Regurgitation Change after Aortic Valve Replacement CALCIFICATION DEGREE OR C.I. 95% p Reduced p Unchanged p Increased p Functional 53(21%) 176(71%) 18(7%) Mild 1.244571 0.81 - 1.93 0.32 28(20%) 0.86 105(76%) 0.43 6(4%) 0.34 Moderate 1.637297 1.05 - 2.56 0.03* 25(17%) 0.41 109(76%) 0.34 9(6%) 0.86 Severe 2.369245 1.46 - 3.85 <0.01* 29(25%) 0.48 78(68%) 0.67 7(6%) 0.86 OR= Odds Ratio; C.I.=Confidence Interval; Functional= no calcification; Mild, Moderate and Severe= degree of mitral annular and leaflets calcifications.