Objectives
To conduct a systematic review and network meta‐analysis examining the effects of non‐pharmacological interventions on neuropsychiatric symptoms (NPS) in a community‐dwelling population with preclinical and mild dementia to identify the design characteristics of more effective interventions.
Methods
A comprehensive search was conducted in 10 electronic databases. Two reviewers independently appraised the methodological quality of studies using the Risk of Bias 2.0 tool. A pairwise meta‐analysis was performed to estimate the standardized mean differences (SMD) with 95% confidence intervals. Network meta‐analysis was then used to estimate the relative effects and rankings of different interventions.
Results
Twenty‐one studies involving 1773 participants were included. Seven studies focused on preclinical dementia, and 14 studies focused on mild dementia. The majority of studies reported a single domain of NPS (depression, anxiety, apathy or agitation) rather than overall NPS. Data on depression were pooled. Pairwise analysis and network meta‐analysis indicated that multimodal interventions (SMD = −0.47, p = 0.01) were superior to psycho‐behavioral educative interventions (SMD = −0.04; p = 0.65), cognitive training (SMD = −0.27, p = 0.10), and art‐based interventions for improving depression. The more crucial design characteristics included those that emphasized skill transferal into daily life, psycho‐behavioral content to encourage a positive outlook and self‐identity, and disease‐specific educational content to improve symptom management.
Conclusions
This review indicated that multimodal interventions with cognitive, psycho‐behavioral and educative components were the most effective approaches for improving depression in patients with preclinical and mild dementia. More comprehensive evaluations using standardized and robust measures of NPS in patients with preclinical dementia are warranted.
Background
Despite an evidence-based protocol to facilitate same-day discharge (SDD) of patients undergoing elective intracoronary procedures, overnight hospitalization remains a routine practice.
Objectives
This study aimed to determine the frequency of SDD after intracoronary procedures among patients treated before and during the COVID-19 pandemic, and identify factors predictive of a decision for SDD.
Methods
This retrospective cohort study (N = 680) was based on registry data of a cardiac ambulatory center.
Results
The frequency of SDD was significantly higher in 2020 relative to 2019 (p <0.001). No complication were identified during the next-day follow-up among SDD cohort. Compared to those who stayed overnight, SDD patients had a lower 30-day readmission rate (p<0.001), but not 30-day mortality (p=1.000). Radial access, some procedural-related and comorbidities of patients significantly predicted SDD.
Conclusions
SDD is safe and feasible when a dedicated protocol has been implemented. The findings support the routine use of this practice.
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