Highlights Healthcare workers are at high risk of mental health problems during viral epidemic outbreaks This review of 117 studies offers pooled estimations of prevalence of acute stress disorder (40%), followed by anxiety (30%), burnout (28%), depression (24%), and post-traumatic stress disorder (13%). It identifies a number of factors (sociodemographic, occupational and social) associated with mental health problems. Interventional high-quality research is urgently needed to inform evidence-based policies for viral pandemics.

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Background Admission avoidance hospital at home provides active treatment by healthcare professionals in the patient's home for a condition that otherwise would require acute hospital inpatient care, and always for a limited time period. This is the third update of the original review. Objectives To determine the effectiveness and cost of managing patients with admission avoidance hospital at home compared with inpatient hospital care. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, two other databases, and two trials registers on 2 March 2016. We checked the reference lists of eligible articles. We sought unpublished studies by contacting providers and researchers who were known to be involved in the field. Selection criteria Randomised controlled trials recruiting participants aged 18 years and over. Studies comparing admission avoidance hospital at home with acute hospital inpatient care. Data collection and analysis We followed the standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. We performed meta-analysis for trials that compared similar interventions and reported comparable outcomes with sufficient data, requested individual patient data from trialists, and relied on published data when this was not available. We used the GRADE approach to assess the certainty of the body of evidence for the most important outcomes.

Analysis 2.1. Comparison 2 Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 1 Mortality at 3-6 months-older people with a mix of conditions.. .. .. .. .. .. Analysis 2.2. Comparison 2 Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 2 Mortality-chronic obstructive pulmonary disease.. .. .. .. .. .. .. .. .. Analysis 2.3. Comparison 2 Early discharge hospital at home versus inpatient care for older people with a mix of conditions, Outcome 3 Hospital readmission at 3 months-older people with a mix of conditions.. .. .. .. .. Analysis 2.4. Comparison 2 Early discharge hospital at home versus inpatient care for older people with a mix of conditions,

Patient reported outcomes (PROs) refer to any report of the status of a patient's health condition that comes directly from the patient. While PROs are a well-developed technology with robust standards in research their use for informing health care decisions is generally poorly understood. In this paper we review relevant examples of their application in health care provision to date, and examine the challenges associated with routinely implementing PROs in clinical settings. We evaluate evidence for their use, and examine key barriers, such as where there is a lack of alignment between interpretation of scores and clinical decision making on the ground. Based on available evidence we have developed a framework of the key requirements for the successful implementation of PROs in clinical practice. We conclude by exploring potential future developments for the use of PROs in clinical practice, such as individualised measurement and efficient administration through the use of computer adaptive tests (CATs).[Abstract word limit = 120 words, currently 154] Manuscript for J Comparative Effect Res

Higginson 2000 Higginson IJ, Sen-Gupta GJA. Place of care in advanced cancer: a qualitative systematic literature review of patient preferences.

Objectives:To examine the impact of providing healthcare during or after health emergencies caused by viral epidemic outbreaks on healthcare workers´(HCWs) mental health, and to assess the available evidence base regarding interventions to reduce such impact.Design: Systematic rapid review and meta-analysis.Data sources: MEDLINE, Embase, and PsycINFO, searched up to 23 March 2020. Method:We selected observational and experimental studies examining the impact on mental health of epidemic outbreaks on HCWs. One reviewer screened titles and abstracts, and two reviewers independently reviewed full texts. We extracted study characteristics, symptoms, prevalence of mental health problems, risk factors, mental health interventions, and its impact. We assessed risk of bias for each individual study and used GRADE to ascertain the certainty of the evidence. We conducted a narrative and tabulated synthesis of the results. We pooled data using random-effects meta-analyses to estimate the prevalence of specific mental health problems. Results:We included 61 studies (56 examining impact on mental health and five about interventions to reduce such impact). Most were conducted in Asia (59%), in the hospital setting (79%), and examined the impact of the SARS epidemic (69%). The pooled prevalence was higher for anxiety (45%, 95% CI 21 to 69%; 6 studies, 3,373 participants), followed by

Background Inspection systems are used in healthcare to promote quality improvements (i.e. to achieve changes in organisational structures or processes, healthcare provider behaviour and patient outcomes). These systems are based on the assumption that externally promoted adherence to evidence-based standards (through inspection/assessment) will result in higher quality of healthcare. However, the benefits of external inspection in terms of organisational-, provider-and patient-level outcomes are not clear. This is the first update of the original Cochrane review, published in 2011.