Tony Stevens

A systematic review of comprehensive geriatric assessment to improve outcomes for frail older people being rapidly discharged from acute hospital: ‘interface geriatrics’

BACKGROUND many frail older people who attend acute hospital settings and who are discharged home within short periods (up to 72 h) have poor outcomes. This review assessed the role of comprehensive geriatric assessment (CGA) for such people. METHODS standard bibliographic databases were searched for high-quality randomised controlled trials (RCTs) of CGA in this setting. When appropriate, intervention effects were presented as rate ratios with 95% confidence intervals. RESULTS five trials of sufficient quality were included. There was no clear evidence of benefit for CGA interventions in this population in terms of mortality [RR 0.92 (95% CI 0.55-1.52)] or readmissions [RR 0.95 (95% CI 0.83-1.08)] or for subsequent institutionalisation, functional ability, quality-of-life or cognition. CONCLUSIONS there is no clear evidence of benefit for CGA interventions in frail older people being discharged from emergency departments or acute medical units. However, few such trials have been carried out and their overall quality was poor. Further well designed trials are justified.

Parenting interventions to prevent unintentional injury: update and extension of a Cochrane systematic review

Background Parenting programmes can improve behaviour problems in childhood; improve maternal psychosocial health and a range of health outcomes for teenage mothers and their children. Our previous Cochrane review showed parenting programmes can reduce childhood injuries and we now update that review and explore characteristics of programmes that are associated with effectiveness. Aims/Objectives/Purpose To evaluate the effect of parenting programmes on reducing childhood injury and improving safety practices and behaviours and to explore characteristics of programmes that are more and less effective. Methods Systematic review using Cochrane methodology. We included RCTs, non-RCTs, quasi-RCTs and controlled-before-and-after studies, providing individual or group based parenting interventions to parents of children aged≤18 years which reported injuries, safety equipment, safety behaviours, safety practices or composite scores with a home safety dimension (eg, HOME score). Random effects meta analysis was used to estimate risk ratios and 95% CI. Sub group analyses and meta regressions will explore associations between programme characteristics and effectiveness. Results/Outcome 22 studies were included, 16 of which were RCTs. Parenting interventions significantly reduced injuries in RCTs (10 trials; RR 0.83, 95% CI 0.73 to 0.94; I2=2%). A similar effect size was seen in studies of all designs (14 studies; RR 0.82, 95% CI 0.74 to 0.91; I2=0%). Findings from sub group analyses and meta-regressions will be presented. Significance/Contribution to the Field Parenting interventions reduce childhood injuries, but some programmes may be more effective than others. Characteristics of effective programmes will be discussed.