In-hospital stress and patient outcomes: A systematic review and meta-analysis

Daniel M. Ford; Luke Budworth; Rebecca Lawton; Elizabeth A. Teale; Daryl B. O’Connor

doi:10.1371/journal.pone.0282789

Peer Review History

Original SubmissionJuly 12, 2022
25 Jan 2023 Decision Letter - Walid Kamal Abdelbasset, Editor PONE-D-22-19657In-hospital stress and patient outcomes: A systematic review and meta-analysisPLOS ONE Dear Dr. Ford, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== Please submit your revised manuscript by Mar 11 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ******** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Manuscript ID: PONE-D-22-19657 This is a systematic review and meta-analysis of the existing evidence between in-hospital stress and patient outcomes. The topic of this manuscript is interesting. The paper is well written and straightforward. I have some major concerns 1. The authors explained the concept of in-hospital stress and patient outcomes in the introduction, which I appreciated. However, I am not convinced about the relevancy to merge atrial fibrillation in the other outcomes. The atrial fibrillation was the only real medical complication that was included in these studies. Even I understand that comes from a study designed for atrial fibrillation, I found this outcome is really different from the others. 2. The authors said that the post-hospital syndrome was not a potential heading or a keyword for the databases. Did they require the assistance of a librarian? Although there is no specific heading, it should be possible to look for this concept in different databases. For example, in CINAHL, one could use (hospital-associated N3 (decline OR function* OR decondition* OR Deterioration)) OR (post-discharge N3 (decline OR function* OR decondition* OR cognit* OR Deterioration)) I am surprised that there was no studies with the post hospital syndrome. Here are some minor concerns: 1. In the flow-chart, there was three records identified through other sources, please specify what they are. 2. In the first description table of patients, it would be useful to have some basic demographic data. For example: age, sex. Reviewer #2: The authors conducted a systematic review and meta-analysis of 10 studies to determine the association between stress during hospitalization and outcomes. Although the review is based on a limited number of studies, the results are interesting because the psychological stress patients feel during their hospital stay is associated with adverse outcomes, especially in-hospital and subjective outcomes. In addition, the reviewer believes that the article presents a significant finding because such studies still need to be done more. The reviewer also finds the paper well-written, including the strengths and limitations of the study. A minor comment is that the studies included in the systematic review need to indicate which disease treatments. ******** 6. 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Revision 1
6 Feb 2023 Author Response 6th February 2023 Dear Dr. Abdelbasset, Manuscript ID: PONE-D-22-19657 In-hospital stress and patient outcomes: A systematic review and meta-analysis Thank you for providing us with detailed feedback for our paper. We have addressed each of the points raised by Reviewers #1 and #2 and believe that this has added further clarification within the method and results sections. We hope that you feel we have satisfactorily responded to the points raised or have provided sufficient justification where an alternative approach has been taken. We feel that the manuscript is now suitable for publication in PLOS ONE. However, we will be very happy to respond to any additional comments. For your reference, we have addressed each of the reviewers’ comments below, and have provided detail on where and how we have addressed each comment. Reviewer #1: This is a systematic review and meta-analysis of the existing evidence between in-hospital stress and patient outcomes. The topic of this manuscript is interesting. The paper is well written and straightforward. I have some major concerns 1. The authors explained the concept of in-hospital stress and patient outcomes in the introduction, which I appreciated. However, I am not convinced about the relevancy to merge atrial fibrillation in the other outcomes. The atrial fibrillation was the only real medical complication that was included in these studies. Even I understand that comes from a study designed for atrial fibrillation, I found this outcome is really different from the others. Response: We agree with the reviewer and appreciate that incidence of atrial fibrillation is different to the other outcome measures. As a result, we have added a comment on page 21 that acknowledges this issue. Moreover, it is worth noting that this study met the review inclusion criteria and therefore we think it appropriate to leave in the meta-analysis. However, we have conducted a leave-one-out analysis (see page 19) to ensure that inclusion of this study (or any other study) is not having a disproportionate influence on our results. To this end, we have stated that: “Systematically removing one of the 15 correlations at a time, via leave-one-out analysis, indicated that no single effect size was disproportionately contributing to the model. The pooled effect size ranged from: r = 0.173 (-0.018) to r = 0.205 (+0.014), with each model remaining significant (p < 0.001)”. 2. The authors said that the post-hospital syndrome was not a potential heading or a keyword for the databases. Did they require the assistance of a librarian? Although there is no specific heading, it should be possible to look for this concept in different databases. For example, in CINAHL, one could use (hospital-associated N3 (decline OR function* OR decondition* OR Deterioration)) OR (post-discharge N3 (decline OR function* OR decondition* OR cognit* OR Deterioration)) I am surprised that there was no studies with the post hospital syndrome. Response: We have re-run the searches including ‘post-hospital syndrome’ and ‘posthospital syndrome’ as keywords (see S1_Appendices.docx). This also allowed us to update the search from July 2022 to February 2023. This yielded 113 further papers to screen (after de-duplication), but no additional studies were eligible for inclusion in the systematic review and meta-analysis. We have updated search result numbers in-text (pages 2 & 11) and within the PRISMA flow diagram (page 12). We have also updated the search term justification (page 8) to include the new keyword. The reason for this absence of additional studies is due to the post-hospital syndrome (PHS) literature typically measuring PHS exposure as a hospital admission [30 days / 90 days / one year] prior to the current hospital admission (e.g. Hart et al., 2020; Kirshenbaum et al., 2019; Lim et al., 2020; Sharoky et al., 2017). In our review, we wished to look more specifically at the level of stress experienced in hospital, rather than the mere presence of a hospital admission (which would be a different review entirely). Additionally, we thank the reviewer for their elegant solution to include the effects of post-hospital syndrome in the search without the specific heading. However, re-running the CINAHL search with the two examples yielded no additional papers. Hart, S. T., Nelson, M., Kirshenbaum, E., Chen, Y., Mueller, E. R., & Gupta, G. (2020). Post-hospital syndrome predicts poor postoperative outcomes and increased cost following transvaginal midurethral sling placement. International Urogynecology Journal, 31, 1417-1422. Kirshenbaum, E. J., Nelson, M., Hehemann, M. C., Kothari, A. N., Eguia, E., Farooq, A., ... & Santos, G. D. (2019). Impact of post-hospital syndrome on penile prosthesis outcomes: a period of global health risk. The Journal of Urology, 201(1), 154-159. Lim, S., Alarhayem, A. Q., Farivar, B., Smolock, C. J., Kirksey, L., Caputo, F. J., ... & Hardy, D. M. (2020). Impact of posthospital syndrome on outcomes of elective endovascular repair of abdominal aortic aneurysm. Journal of Vascular Surgery, 72(5), 1618-1625. Sharoky, C. E., Collier, K. T., Wirtalla, C. J., Sinnamon, A. J., Neuwirth, M. G., Kuo, L. E., ... & Kelz, R. R. (2017). Hospitalization in the year preceding major oncologic surgery increases risk for adverse postoperative events. Annals of Surgical Oncology, 24, 3477-3485. Here are some minor concerns: 1. In the flow-chart, there was three records identified through other sources, please specify what they are. Response: the three articles were identified in Google Scholar during the scoping review and feasibility stage before the formal database search commenced. This has now been clarified on page 11. 2. In the first description table of patients, it would be useful to have some basic demographic data. For example: age, sex. Response: participants’ age and sex have been added to Table 2 (pages 13-15). Reviewer #2: The authors conducted a systematic review and meta-analysis of 10 studies to determine the association between stress during hospitalization and outcomes. Although the review is based on a limited number of studies, the results are interesting because the psychological stress patients feel during their hospital stay is associated with adverse outcomes, especially in-hospital and subjective outcomes. In addition, the reviewer believes that the article presents a significant finding because such studies still need to be done more. The reviewer also finds the paper well-written, including the strengths and limitations of the study. A minor comment is that the studies included in the systematic review need to indicate which disease treatments. Response: participants’ condition/treatment have been added to Table 2 (pages 13-15). Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0282789.r002
23 Feb 2023 Decision Letter - Walid Kamal Abdelbasset, Editor In-hospital stress and patient outcomes: A systematic review and meta-analysis PONE-D-22-19657R1 Dear Dr. Ford, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. 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If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: (No Response) ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: (No Response) ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: (No Response) ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: (No Response) ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Dear authors, Thank you for this revised version. I feel my comments have been fairly addressed. I don't have further comments. Reviewer #2: The authors revised the manuscript for each comment that I have pointed out, and the revised version is satisfactory. Therefore, I think that the revised version is now suitable for publication. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Yaohua CHEN Reviewer #2: No ******** https://doi.org/10.1371/journal.pone.0282789.r003
Formally Accepted
27 Feb 2023 Acceptance Letter - Walid Kamal Abdelbasset, Editor PONE-D-22-19657R1 In-hospital stress and patient outcomes: A systematic review and meta-analysis Dear Dr. Ford: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Walid Kamal Abdelbasset Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0282789.r004

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