Restrictions and their reporting in systematic reviews of effectiveness: an observational study.

BACKGROUND: Restrictions in systematic reviews (SRs) can lead to bias and may affect conclusions. Therefore, it is important to report whether and which restrictions were used. This study aims to examine the use of restrictions regarding language, publication period, and study type, as well as the transparency of reporting in SRs of effectiveness. METHODS: A retrospective observational study was conducted with a random sample of 535 SRs of effectiveness indexed in PubMed between 2000 and 2019. The use of restrictions and their reporting were analysed using descriptive statistics. RESULTS: Of the total 535 SRs included, four out of every ten (41.3%) lacked information on at least one of the three restrictions considered (language, publication period, or study type). Overall, 14.6% of SRs did not provide information on restrictions regarding publication period, 19.1% regarding study type, and 18.3% regarding language. Of all included SRs, language was restricted in 46.4%, and in more than half of the SRs with restricted language (130/248), it was unclear whether the restriction was applied during either the search or the screening process, or both. The restrictions were justified for publication period in 22.2% of the respective SRs (33/149), study type in 6.5% (28/433), and language in 3.2% (8/248). Differences in reporting were found between countries as well as between Cochrane and non-Cochrane reviews. CONCLUSIONS: This study suggests that there is a lack of transparency in reporting on restrictions in SRs. Authors as well as editors and reviewers should be encouraged to improve the reporting and justification of restrictions to increase the transparency of SRs.

Characteristics and place of death in home care recipients in Germany - an analysis of nationwide health insurance claims data.

BACKGROUND: Most care-dependent people live at home, where they also would prefer to die. Unfortunately, this wish is often not fulfilled. This study aims to investigate place of death of home care recipients, taking characteristics and changes in care settings into account. METHODS: We retrospectively analysed a cohort of all home-care receiving people of a German statutory health insurance who were at least 65 years and who deceased between January 2016 and June 2019. Next to the care need, duration of care, age, sex, and disease, care setting at death and place of death were considered. We examined the characteristics by place of care, the proportion of dying in hospital by care setting and characterised the deceased cohort stratified by their actual place of death. RESULTS: Of 46,207 care-dependent people initially receiving home care, 57.5% died within 3.5 years (n = 26,590; mean age: 86.8; 66.6% female). More than half of those moved to another care setting before death with long-term nursing home care (32.3%) and short-term nursing home care (11.7%) being the most frequent transitions, while 48.1% were still cared for at home. Overall, 36.9% died in hospital and in-hospital deaths were found most often in those still receiving home care (44.7%) as well as care in semi-residential arrangements (43.9%) at the time of death. People who died in hospital were younger (mean age: 85.5 years) and with lower care dependency (low care need: 28.2%) as in all other analysed care settings. CONCLUSION: In Germany, changes in care settings before death occur often. The proportion of in-hospital death is particularly high in the home setting and in semi-residential arrangements. These settings should be considered in interventions aiming to decrease the number of unwished care transitions and hospitalisations at the end of life.

Socioeconomic position and risk of unplanned hospitalization among nursing home residents: a nationwide cohort study.

BACKGROUND: Socioeconomic inequalities in health and healthcare use in old age have been on the rise during the past two decades. So far, it is unknown whether these inequalities have permeated the nursing home setting. This study aimed to assess whether the socioeconomic position of newly admitted nursing home residents had an influence on their risk of unplanned hospitalization. METHODS: We identified older persons (≥75 years) who were newly admitted to a nursing home between March 2013 and December 2014 using a set of linked routinely collected administrative and healthcare data in Sweden. The number of unplanned hospitalizations for any cause and the cumulative length of stay were defined as primary outcomes. Unplanned hospitalizations for potentially avoidable causes (i.e. fall-related injuries, urinary tract infections, pneumonia and decubitus ulcers) were considered as our secondary outcome. RESULTS: Among 40 545 newly admitted nursing home residents (mean age 86.8 years), the incidence rate of unplanned hospitalization ranged from 53.9 per 100 person-years among residents with tertiary education up to 55.1 among those with primary education. After adjusting for relevant confounders, we observed no meaningful difference in the risk of unplanned hospitalization according to the education level of nursing home residents (IRR for tertiary vs. primary education: 0.96, 95% CI 0.92-1.00) or to their level of income (IRR for highest vs. lowest quartile of income: 0.98, 0.95-1.02). There were also no differences in the cumulative length of hospital stays or in the risk of experiencing unplanned hospitalizations for potentially avoidable causes. CONCLUSIONS: In sum, in this large cohort of newly admitted nursing home residents, we found no evidence of socioeconomic inequalities in the risk of unplanned hospitalization.

Utilisation of outpatient physiotherapy in patients following total knee arthroplasty - a systematic review.

OBJECTIVE: Data on the utilisation of outpatient physiotherapy (PT) in patients following total knee arthroplasty (TKA) are scarce, and available studies have not been systematically synthesised. This study aims to summarise the existing literature on outpatient PT following TKA as well as to identify factors associated with its use. METHODS: A systematic literature search in MEDLINE (via PubMed), CINAHL, Scopus and PEDro was conducted in July 2020 without language restrictions. Two authors independently selected studies, extracted data and assessed study quality. The primary outcome was the proportion being treated with at least one session of outpatient PT (land- or water-based treatments supervised/provided by a qualified physiotherapist) during any defined period within 12 months following TKA. Furthermore, predictors for the use of PT were assessed. Studies including only revision surgeries or bilateral TKA were excluded. RESULTS: After screening 1934 titles/abstracts and 56 full text articles, 5 studies were included. Proportions of PT utilisation ranged from 16.7 to 84.5%. There were large variations in the time periods after hospital discharge (4 weeks to 12 months) and in the reporting of PT definitions. Female sex was associated with higher PT utilisation, and compared to patients after total hip arthroplasty, utilisation was higher among those following TKA. CONCLUSION: Despite using a broad search strategy, we found only 5 studies assessing the utilisation of PT after hospital discharge in patients with TKA. These studies showed large heterogeneity in PT utilisation, assessed time periods and PT definitions. Clearly, more studies from different countries with uniform PT definitions are needed to address this relevant public health question.

Transversus abdominis plane block in urological procedures: A systematic review and meta-analysis.

BACKGROUND: Transversus abdominis plane (TAP) blocks have been shown to successfully reduce pain and opioid consumption after general and gynaecological surgery. OBJECTIVE: To evaluate whether TAP blocks alleviate pain and opioid consumption after urological procedures. DESIGN: A systematic review and meta-analysis. DATA SOURCES: MEDLINE, Embase and CENTRAL. ELIGIBILITY CRITERIA: Without language restriction, randomised controlled trials (RCTs) that compared the effects of TAP blocks with placebo or no treatment in urological surgery. MAIN OUTCOME MEASURES: Primary outcomes were pain intensities at rest and movement at 6, 12 and 24 h after surgery. Secondary outcomes were postoperative opioid consumption in the first 24 h after surgery and postoperative nausea and vomiting. We performed meta-analyses using random effects models. Effect sizes were expressed as mean differences for continuous variables. We used the Cochrane risk of bias tool (RoB 2.0) to assess risk of bias. RESULTS: We analysed 20 RCTs comprising a total of 1239 patients. The risk of bias of the studies was relatively high. TAP blocks significantly reduced postoperative pain at all time points compared with placebo or no treatment. Mean differences on an 11-point pain intensity scale were between 0.55 (95% CI: -0.90, to -0.21; P = 0.002; I2 = 94%) to 1.13 (95% CI: -1.62 to -0.65; P < 0.001; I2 = 95%) less at rest and 0.74 (95% CI: -1.25 to -0.23; P = 0.005; I2 = 79%) to 1.32 (95% CI: -1.83 to -0.81; P < 0.001; I2 = 68%) less on movements. TAP blocks also reduced opioid consumption in the first 24 h after surgery significantly by 12.25 mg (95% CI: -17.99 to -6.52 mg; P < 0.001; I2 = 99%) morphine equivalents. Possibly, this had no influence on postoperative nausea and vomiting (risk ratio: 0.98; 95% CI: 0.66 to 1.45; P = 0.91; I2 = 30%). CONCLUSION: TAP blocks seem to offer improved analgesia when used after urological surgery. However, due to the large heterogeneity between and the considerable risk of bias within the included studies results should be viewed with caution. SYSTEMIC REVIEW REGISTRATION: PROSPERO CRD42018112737.

[Hospitalization of nursing home residents in the last phase of life: an analysis of health insurance data]. / Krankenhausaufenthalte von Pflegeheimbewohnern in der letzten Lebensphase: eine Analyse von Krankenkassenroutinedaten.

BACKGROUND: Compared to the international literature a higher proportion of German nursing home residents (NHR) die in hospital. Data on longer periods before death and on regional differences are not available. OBJECTIVE: The frequency of hospitalizations of NHR in different periods during their last year of life were investigated. Differences between age, sex, level of nursing care, dementia and federal states were also assessed. MATERIAL AND METHODS: This study used data of a large German health insurance fund and included NHR aged 65+ years who died between 1 January 2010 and 31 December 2014. We assessed the proportion of NHR with at least one hospitalization during different periods before death. In-depth analyses were conducted for 0 (which corresponds to in-hospital death), 28 and 365 days before death. RESULTS: Of the 67,328 deceased residents (mean age: 85.3 years, 69.8% female), 29.5% died in hospital. A total of 51.5% and 74.3% were hospitalized during the last 28 and 365 days of life, respectively. These values were higher in the eastern parts of Germany. Males were hospitalized more often than women in all time periods. A higher care dependency was associated with fewer hospitalizations, especially shortly before death. There was no noticeable difference in the frequency of hospitalization between NHR with and without dementia. CONCLUSION: Approximately half of all NHR in Germany are hospitalized during the last month of life and one third die in hospital, which is relatively high compared to the international literature. No major differences were found between NHR with and without dementia, which is also contradictory to international studies. Overall, there is a need to optimize palliative care for NHR in Germany.

Needs and availability of medical specialists' and allied health professionals' visits in German nursing homes: a cross-sectional study of nursing home staff.

BACKGROUND: The medical care for nursing home residents is estimated to be partly inadequate in Germany. The aim of this study is to investigate the needs and utilization of general practitioners (GPs), medical specialists and allied health professionals. METHODS: A survey was sent to a nationwide random sample of 1069 nursing homes in Germany in January 2019. Nursing staff managers were asked about medical care. Regular nursing home visits by medical specialists and allied health professionals were defined as at least one contact per year to at least one nursing home resident. RESULTS: A total of 486 persons responded (45.5%). On average, nursing homes have contact to 8.6 (interquartile range: 4-10) different GPs. Almost 70% of respondents agreed that residents' medical care should be coordinated by GPs. However, only 46.0% stated that specialist treatment should require GP referral. A high need was seen for care from physiotherapists (91.0%), neurologists or psychiatrists (89.3%), dentists (73.7%), and urologists (71.3%). Regarding the actual utilization of medical specialists and health professionals, most nursing homes have regular contact to physiotherapists (97.1%), psychiatrists or neurologists (90.4%), speech therapists (85.0%), and dentists (84.8%). Remarkable discrepancies between need and utilization were found for urologists and ophthalmologists. CONCLUSION: There is large variance in the number of GPs per nursing home, and needs for medical specialists, especially urologists and ophthalmologists, seem unmet. Interprofessional collaboration between GPs, medical specialists and allied health professionals should be improved, and GPs should play a more coordinating role.

Nursing home staff's perspective on end-of-life care of German nursing home residents: a cross-sectional survey.

BACKGROUND: Nursing homes are becoming more important for end-of-life care. Within the industrialised world, Germany is among the countries with the most end-of-life hospitalizations in nursing home residents. To improve end-of-life care, investigation in the status quo is required. The objective was to gain a better understanding of the perspectives of nursing home staff on the current situation of end-of-life care in Germany. METHODS: A cross-sectional study was conducted as a postal survey among a random sample of 1069 German nursing homes in 2019. The survey was primarily addressed to nursing staff management. Data was analyzed using descriptive statistics. Staff was asked to rate different items regarding common practices and potential deficits of end-of-life care on a 5-point-Likert-scale. Estimations of the proportions of in-hospital deaths, residents with advance directives (AD), cases in which documented ADs were ignored, and most important measures for improvement of end-of-life care were requested. RESULTS: 486 (45.5%) questionnaires were returned, mostly by nursing staff managers (64.7%) and nursing home directors (29.9%). 64.4% of the respondents rated end-of-life care rather good, the remainder rated it as rather bad. The prevalence of in-hospital death was estimated by the respondents at 31.5% (SD: 19.9). Approximately a third suggested that residents receive hospital treatments too frequently. Respondents estimated that 45.9% (SD: 21.6) of the residents held ADs and that 28.4% (SD: 26.8) of available ADs are not being considered. Increased staffing, better qualification, closer involvement of general practitioners and better availability of palliative care concepts were the most important measures for improvement. CONCLUSIONS: Together with higher staffing, better availability and integration of palliative care concepts may well improve end-of-life care. Prerequisite for stronger ties between nursing home and palliative care is high-quality education of those involved in end-of-life care.

A descriptive analysis of the characteristics and the peer review process of systematic review protocols published in an open peer review journal from 2012 to 2017.

BACKGROUND: An a priori design is essential to reduce the risk of bias in systematic reviews (SRs). To this end, authors can register their SR with PROSPERO, and/or publish a SR protocol in an academic journal. The latter has the advantage that the manuscript for the SR protocol is usually peer-reviewed. However, since authors ought not to begin/continue the SR before their protocol has been accepted for publication, it is crucial that SR protocols are processed in a timely manner. Our main aim was to descriptively analyse the peer review process of SR protocols published in 'BMC Systematic Reviews' from 2012 to 2017. METHODS: We systematically searched MEDLINE via PubMed for all SR protocols published in 'BMC Systematic Reviews' between 2012 and 2017, except for protocols for overviews, scoping reviews or realist reviews. Data were extracted from the SR protocols and Open Peer Review reports. For each round of peer review, two researchers judged the extent of revision (minor/major) based on the reviewer reports. Their content was further investigated by two researchers in a random 10%-sample using PRISMA-P as a guideline. All data were analysed descriptively. RESULTS: We identified 544 eligible protocols published in 'BMC Systematic Reviews' between 2012 and 2017. Of those, 485 (89.2%) also registered the SR in PROSPERO, the majority (87.4%) before first submission of the manuscript for the SR protocol (median 49 days). The absolute number of published SR protocols increased from 2012 to 2017 (21 vs 145 protocols), as did the median processing time (61 vs 142 days from submission to acceptance) and the proportion of protocols requiring a major revision after first peer review (19.1% vs 52.4%). Reviewer comments most frequently addressed the PRISMA-P item 'Eligibility criteria'. Overall, 76.0% of the reviewer comments suggested more transparency. CONCLUSIONS: The number of published SR protocols increased over the years, but so did the processing time. In 2017, it took several months from submission to acceptance, which is critical from an author's perspective. New models of peer review such as post publication peer review for SR protocols should be investigated. This could probably be realized with PROSPERO.

Hospitalizations of nursing home residents at the end of life: A systematic review.

BACKGROUND: End-of-life hospitalizations in nursing home residents are common, although they are often burdensome and potentially avoidable. AIM: We aimed to summarize the existing evidence on end-of-life hospitalizations in nursing home residents. DESIGN: Systematic review (PROSPERO registration number CRD42017072276). DATA SOURCES: A systematic literature search was carried out in PubMed, CINAHL, and Scopus (date of search 9 April 2019). Studies were included if they reported proportions of in-hospital deaths or hospitalizations of nursing home residents in the last month of life. Two authors independently selected studies, extracted data, and assessed the quality of studies. Median with interquartile range was used to summarize proportions. RESULTS: A total of 35 studies were identified, more than half of which were from the United States (n = 18). While 29 studies reported in-hospital deaths, 12 studies examined hospitalizations during the last month of life. The proportion of in-hospital deaths varied markedly between 5.9% and 77.1%, with an overall median of 22.6% (interquartile range: 16.3%-29.5%). The proportion of residents being hospitalized during the last month of life ranged from 25.5% to 69.7%, and the median was 33.2% (interquartile range: 30.8%-38.4%). Most studies investigating the influence of age found that younger age was associated with a higher likelihood of end-of-life hospitalization. Four studies assessed trends over time, showing heterogeneous findings. CONCLUSION: There is a wide variation in end-of-life hospitalizations, even between studies from the same country. Overall, such hospitalizations are common among nursing home residents, which indicates that interventions tailored to each specific health care system are needed to improve end-of-life care.

Hospitalization at the end of life among nursing home residents with dementia: a systematic review.

BACKGROUND: Half of nursing home residents (NHR) suffer from dementia. End-of-life hospitalizations are often burdensome in residents with dementia. A systematic review was conducted to study the occurrence of hospitalizations at the end of life in NHR with dementia and to compare these figures to NHR without dementia. METHODS: A systematic literature search in MEDLINE, CINAHL and Scopus was conducted in May 2018. Studies were included if they reported proportions of in-hospital deaths or hospitalizations of NHR with dementia in the last month of life. Two authors independently selected studies, extracted data, and assessed quality of studies. RESULTS: Nine hundred forty-five citations were retrieved; 13 studies were included. Overall, 7 studies reported data on in-hospital death with proportions ranging between 0% in Canada and 53.3% in the UK. Studies reporting on the last 30 days of life (n = 8) varied between 8.0% in the Netherlands and 51.3% in Germany. Two studies each assessed the influence of age and sex. There seem to be fewer end-of-life hospitalizations in older age groups. The influence of sex is inconclusive. All but one study found that at the end of life residents with dementia were hospitalized less often than those without (n = 6). CONCLUSIONS: We found large variations in end-of-life hospitalizations of NHR with dementia, probably being explained by differences between countries. The influence of sex and age might differ when compared to residents without dementia. More studies should compare NHR with dementia to those without and assess the influence of sex and age. TRIAL REGISTRATION: PROSPERO registration number CRD42018104263 .

Age and sex differences in emergency department visits of nursing home residents: a systematic review.

BACKGROUND: Nursing home residents (NHRs) are often transferred to emergency departments (EDs). A great proportion of ED visits is considered inappropriate. There is evidence that male NHRs are more often hospitalised, but this is less clear for ED visits. It is unclear, which influence age has on ED visits. We aimed to study the epidemiology of ED visits in NHRs focusing on age- and sex-specific differences. METHODS: A systematic review was carried out based on articles found in MEDLINE (via PubMed), CINAHL and Scopus. Articles published on or before Aug 31, 2017 were eligible. Two reviewers independently identified articles for inclusion. The quality of studies was assessed by the Joanna Briggs Institute critical appraisal tool for prevalence studies. RESULTS: Out of 1192 references, we found seven studies meeting our inclusion criteria. Six studies were conducted in the USA or Canada. Overall, 29-62% of NHRs had at least one ED visit over the course of 1 year. Most studies assessing the influence of sex found that male residents visited EDs more frequently. All but one of the five studies with multivariable analyses reported a statistically significant positive association (with odds or rate ratios of 1.05-1.38). All studies assessed the influence of age. There was no clear pattern with some studies showing no association between ED visits and age and other studies reporting decreasing ED visits with increasing age or increasing proportions followed by a decrease in the highest age group. Studies used 85+ or 86+ years as the highest age category. Hospital admission rate ranged from 36.4 to 48.7%. There was no study reporting stratified analyses by age and sex. Only one study reported main diagnoses leading to ED visits stratified by sex. CONCLUSION: Male NHRs visit EDs more often than females, but there is no evidence on reasons. The association with age is unclear. Any future study on acute care of NHRs should assess the influence of age and sex. These studies should include large sample sizes to provide a more differentiated age categorisation. TRIAL REGISTRATION: PROSPERO CRD42017074845 .

Mortality and hospitalization at the end of life in newly admitted nursing home residents with and without dementia.

PURPOSE: The proportion of deaths occurring in nursing homes is increasing and end of life hospitalizations in residents are common. This study aimed to obtain the time from nursing home admission to death and the frequency of hospitalizations prior to death among residents with and without dementia. METHODS: This retrospective cohort study analyzed claims data of 127,227 nursing home residents aged 65 years and older newly admitted to a nursing home between 2010 and 2014. We analyzed hospitalizations during the last year of life and assessed mortality rates per 100 person-years. Factors potentially associated with time to death were analyzed in Cox proportional hazard models. RESULTS: The median time from nursing home admission to death was 777 and 635 days in residents with and without dementia, respectively. Being male, older age and a higher level of care decreased the survival time. Sex and age had a higher influence on survival time in residents with dementia, whereas level of care was found to have a higher influence in residents without dementia. Half of the residents of both groups were hospitalized during the last month and about 37% during the last week before death. Leading causes of hospitalizations were infections (with dementia: 20.6% vs. without dementia: 17.2%) and cardiovascular diseases (with dementia: 16.6% vs. without dementia: 19.0%). CONCLUSIONS: A high proportion of residents with and without dementia are hospitalized shortly before death. There should be an open debate about the appropriateness of hospitalizing nursing home residents especially those with dementia near death.

The economic impact of epilepsy: a systematic review.

BACKGROUND: In this review we aimed to determine the economic impact of epilepsy and factors associated with costs to individuals and health systems. METHODS: A narrative systematic review of incidence and case series studies with prospective consecutive patient recruitment and economic outcomes published before July 2014 were retrieved from Medline, Embase and PsycInfo. RESULTS: Of 322 studies reviewed, 22 studies met the inclusion criteria and 14 were from high income country settings. The total costs associated with epilepsy varied significantly in relation to the duration and severity of the condition, response to treatment, and health care setting. Where assessed, 'out of pocket' costs and productivity losses were found to create substantial burden on households which may be offset by health insurance. However, populations covered ostensibly for the upfront costs of care can still bear a significant economic burden. CONCLUSIONS: Epilepsy poses a substantial economic burden for health systems and individuals and their families. There is uncertainty over the degree to which private health insurance or social health insurance coverage provides adequate protection from the costs of epilepsy. Future research is required to examine the role of different models of care and insurance programs in protecting against economic hardship for this condition, particularly in low and middle income settings.

Reporting according to the preferred reporting items for systematic reviews and meta-analyses for abstracts (PRISMA-A) depends on abstract length.

OBJECTIVE: To evaluate reporting of abstracts of systematic reviews according to the preferred reporting items for systematic reviews and meta-analyses for abstracts (PRISMA-A) 2013 checklist. STUDY DESIGN AND SETTING: A random sample of 534 systematic reviews on effectiveness indexed in PubMed between 2000 and 2019 was assessed. Adherence of abstracts to PRISMA-A was analysed using descriptive statistics. Results were stratified by number of words, structure, and year of publication. RESULT: The mean score of fully reported PRISMA-A items was 5.4 of 12, with adherence varying widely between items (0% to 98.8%). Cochrane reviews received higher mean total scores than non-Cochrane reviews (6.3 vs. 5.2). Adherence to PRISMA-A increased linearly with increasing word count. In non-Cochrane reviews, authors of structured abstracts more often adhered to PRISMA-A than those of unstructured abstracts. No improvements in reporting of abstracts were found after the implementation of PRISMA-A in 2013. CONCLUSION: Adherence to PRISMA-A shows great potential for improvement. Therefore, authors, editors, and reviewers should be made aware of PRISMA-A by referring to it in the journal submission guidelines. As adherence to PRISMA-A increases with the number of words, journals should consider to increase the word limit to 250-300 words.

Hospitalization of German and Dutch Nursing Home Residents Depend on Different Long-Term Care Structures: A Systematic Review on Periods of Increased Vulnerability.

OBJECTIVE: To investigate proportions of hospitalized nursing home residents during periods of increased vulnerability, ie, the first 6 months after institutionalization and the last 6 months before death, and comparing the figures between Germany and the Netherlands. DESIGN: Systematic review, registered in PROSPERO (CRD42022312506). SETTING AND PARTICIPANTS: Newly admitted or deceased residents. METHODS: We searched MEDLINE via PubMed, EMBASE, and CINAHL from inception through May 3, 2022. We included all observational studies that reported the proportions of all-cause hospitalizations among German or Dutch nursing home residents during these defined vulnerable periods. Study quality was assessed using the Joanna Briggs Institute's tool. We assessed study and resident characteristics and outcome information and descriptively reported them separately for both countries. RESULTS: We screened 1856 records for eligibility and included 9 studies published in 14 articles (Germany: 8; Netherlands: 6). One study for each country investigated the first 6 months after institutionalization. A total of 10.2% of the Dutch and 42.0% of the German nursing home residents were hospitalized during this time. Overall, 7 studies reported on in-hospital deaths, with proportions ranging from 28.9% to 29.5% for Germany and from 1.0% to 16.3% for the Netherlands. Proportions for hospitalization in the last 30 days of life ranged from 8.0% to 15.7% (Netherlands: n = 2) and from 48.6% to 58.0% (Germany: n = 3). Only German studies assessed the differences by age and sex. Although hospitalizations were less common at older ages, they were more frequent in male residents. CONCLUSIONS AND IMPLICATIONS: During the observed periods, the proportion of nursing homes residents being hospitalized differed greatly between Germany and the Netherlands. The higher figures for Germany can probably be explained by differences in the long-term care systems. There is a lack of research, especially for the first months after institutionalization, and future studies should examine the care processes of nursing home residents following acute events in more detail.

Nearly 80 systematic reviews were published each day: Observational study on trends in epidemiology and reporting over the years 2000-2019.

BACKGROUND: Systematic reviews (SRs) are useful tools in synthesising the available evidence, but high numbers of overlapping SRs are also discussed in the context of research waste. Although it is often claimed that the number of SRs being published is increasing steadily, there are no precise data on that. We aimed to assess trends in the epidemiology and reporting of published SRs over the last 20 years. METHODS: A retrospective observational study was conducted to identify potentially eligible SRs indexed in PubMed from 2000 to 2019. From all 572,871 records retrieved, we drew a simple random sample of 4,000. The PRISMA-P definition of SRs was applied to full texts and only SRs published in English were included. Characteristics were extracted by one reviewer, with a 20% sample verified by a second person. RESULTS: A total of 1,132 SRs published in 710 different journals were included. The estimated number of SRs indexed in 2000 was 1,432 (95% CI: 547-2,317), 5,013 (95% CI: 3,375-6,650) in 2010 and 29,073 (95% CI: 25,445-32,702) in 2019. Transparent reporting of key items increased over the years. About 7 out of 10 named their article a SR (2000-2004: 41.9% and 2015-2019: 74.4%). In 2000-2004, 32.3% of SRs were based in the UK (0% in China), in 2015-2019 24.0% were from China and 10.8% from the UK. Nearly all articles from China (94.9%) conducted a meta-analysis (overall: 58.9%). Cochrane reviews (n = 84; 7.4%) less often imposed language restrictions, but often did not report the number of records and full texts screened and did not name their article a SR (22.6% vs. 73.4%). CONCLUSIONS: We observed a more than 20-fold increase in the number of SRs indexed over the last 20 years. In 2019, this is equivalent to 80 SRs per day. Over time, SRs got more diverse in respect to journals, type of review, and country of corresponding authors. The high proportion of meta-analyses from China needs further investigation. STUDY REGISTRATION: Open Science Framework (https://osf.io/pxjrv/).

Ten-year trends in end-of-life hospitalizations of nursing home residents in Germany, 2006-2015.

OBJECTIVES: We investigated trends in end-of-life hospitalizations among nursing home residents (NHR) over 10 years and looked at differences between age groups and sexes as well as the length of terminal hospital stays. STUDY DESIGN: Retrospective cohort study based on health insurance claims data of the AOK Bremen/Bremerhaven. All NHR aged 65 years or more who died between 2006 and 2015 were included. MAIN OUTCOME MEASURES: We assessed the proportions of decedents who were in hospital on the day of death and during the last 3, 7, 14 and 30 days of life, stratified by two-year periods. Multiple logistic regressions were conducted to study changes over time, adjusting for covariates. RESULTS: A total of 10,781 decedents were included (mean age 86.1 years, 72.1 % females). Overall, 29.2 % died in hospital, with a slight decrease from 30.3 % in 2006-2007 to 28.3 % in 2014-2015 (OR 0.86; 95 % CI 0.75-0.98). Of the 3150 terminal hospitalizations, 35.5 % lasted up to 3 days and the mean length of stay decreased from 9.0 (2006-2007) to 7.5 days (2014-2015). When looking at the last 7, 14 and 30 days of life, no changes over time were found. Male sex and younger age were associated with a higher chance of end-of-life hospitalization in almost all analyses. CONCLUSIONS: End-of-life hospitalizations of NHR are common in Germany. There has been a small decrease during recent years in the proportion of in-hospital deaths, but not of hospitalizations during the last 7, 14 and 30 days of life. This might be explained by shorter durations of hospital stays.

More systematic reviews were registered in PROSPERO each year, but few records' status was up-to-date.

OBJECTIVES: To determine the proportion of systematic reviews (SRs) registered in PROSPERO and explore differences between publication years, review focus, and country. Secondary objectives were (1) to compare the characteristics of registered and nonregistered SRs and (2) to assess the up-to-dateness of the PROSPERO records' status. STUDY DESIGN AND SETTING: In November 2018, we searched PubMed for SRs that were eligible for registration in PROSPERO. We included a random sample of n = 500 SRs. Data were analyzed descriptively. RESULTS: Overall, 76 (15.2%) of the included SRs had been registered in PROSPERO. This proportion has increased with each year, up to 31.6% (36/114) in 2018. It did not notably differ depending on the reviews' focus. SRs from the United States or China were generally registered less frequently and SRs from Australia or Canada more frequently. Registered and nonregistered SRs did not differ regarding the number of authors or the time from submission to publication or from search to submission and publication. We could analyze 75 PROSPERO records, of which 63 (84.0%) were not up-to-date. Most SRs (49/75; 65.3%) were still listed as "ongoing." CONCLUSION: More SRs were registered in PROSPERO each year, but only few records' status was up-to-date.

End-of-life care of nursing home residents: A survey among general practitioners in northwestern Germany.

AIM: To describe general practitioners' (GPs) perspectives on end-of-life care of nursing home residents. METHODS: We carried out a cross-sectional study. A questionnaire was sent to a random sample of 1121 GPs in the German federal states of Bremen and Lower Saxony in 2018. Data were compared between GPs with a qualification in palliative medicine and those without such qualifications, and multivariable logistic regression was performed. RESULTS: Overall, 375 questionnaires were returned (response rate 34%). The majority of GPs (71%) agreed that nursing home residents are treated too often in hospitals at the end of life, and more than half rated end-of-life care in nursing homes as "rather poor" (54%). For both questions, GPs with a qualification in palliative medicine showed higher agreements. In the multivariable analysis, a prior qualification in palliative medicine was also strongly associated with rating end-of-life care as "rather poor" (OR 1.89, 95% CI 1.10-3.23). Respondents cited higher staffing ratios and better trained nursing staff as the most important measures to improve end-of-life care. Furthermore, it was estimated that just 37% of residents have an advance directive, with only one-third including valid information on end-of-life hospitalizations. CONCLUSIONS: This study showed that GPs tend to be critical regarding end-of-life care in nursing homes. To improve end-of-life care, better training in palliative care for nursing staff and GPs might be warranted. In addition, advance care planning can help to ensure that residents' wishes are respected. Geriatr Gerontol Int 2020; 20: 25-30.