scholarly journals Diagnosis and management of transient ischemic attacks in primary care: a systematic review

2017 ◽  
Vol 9 (2) ◽  
pp. 114 ◽  
Author(s):  
Priyanka Bose ◽  
Andrew Wilson ◽  
Amit Mistri
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Data Extraction ◽  
Meta Analysis ◽  
Final Diagnosis ◽  
Future Research ◽  
Stroke Disability ◽  
Referral Behaviour ◽  
Ischaemic Attack ◽  
Specific Symptoms

ABSTRACT INTRODUCTION Many patients who suffer a transient ischaemic attack (TIA) present to their general practitioner (GP). Early identification and treatment reduces the risk of subsequent stroke, disability and mortality. AIM To review the accuracy of TIA diagnosis in primary care, immediate management and interventions to assist GPs with the condition. METHODS This study included the search of Medline, Embase, Web of Science and Scopus databases (1995–2015). Relevant titles and abstracts were obtained using structured criteria (diagnosis, immediate management or intervention of TIAs in primary care), with full review and data extraction for eligible publications. Two reviewers independently assessed quality and extracted information from the 24 eligible studies. The studies had heterogeneous methodology rendering meta-analysis inappropriate, so a narrative synthesis was undertaken. RESULTS Most studies found limitations in GPs’ knowledge and ability to diagnose TIAs to varying extent over time and between countries. GPs tended to over-interpret non-specific symptoms (e.g. isolated vertigo) when considering a TIA diagnosis. Reported referral behaviour varied between countries, with some favouring admission and others preferring outpatient management. Consistent under-referral and under-use of effective medication was reported. However, GPs may refer some patients to exclude rather than confirm a final diagnosis. This, alongside evidence of under-referral, suggests the need for education and decision support tools to enhance referral patterns. Intervention studies suggested that electronic decision support may increase referrals and timely management. CONCLUSION This review revealed deficiencies in knowledge and clinical practice, and identified potential avenues to addressing these. Issues for future research were also identified.

scholarly journals Interventions to Improve Patient Comprehension in Informed Consent for Medical and Surgical Procedures: An Updated Systematic Review

2020 ◽  
Vol 40 (2) ◽  
pp. 119-143 ◽  
Author(s):  
Johanna Glaser ◽  
Sarah Nouri ◽  
Alicia Fernandez ◽  
Rebecca L. Sudore ◽  
Dean Schillinger ◽  
...  
Keyword(s):  
Informed Consent ◽  
Data Extraction ◽  
Meta Analysis ◽  
Size Control ◽  
Group Processes ◽  
Future Research ◽  
Control Group ◽  
Test Feedback ◽  
Patient Comprehension ◽  
Improve Patient

Background. Patient comprehension is fundamental to valid informed consent. Current practices often result in inadequate patient comprehension. Purpose. An updated review to evaluate the characteristics and outcomes of interventions to improve patient comprehension in clinical informed consent. Data Sources. Systematic searches of MEDLINE and EMBASE (2008–2018). Study Selection. We included randomized and nonrandomized controlled trials evaluating interventions to improve patient comprehension in clinical informed consent. Data Extraction. Reviewers independently abstracted data using a standardized form, comparing all results and resolving disagreements by consensus. Data Synthesis. Fifty-two studies of 60 interventions met inclusion criteria. Compared with standard informed consent, a statistically significant improvement in patient comprehension was seen with 43% (6/14) of written interventions, 56% (15/27) of audiovisual interventions, 67% (2/3) of multicomponent interventions, 85% (11/13) of interactive digital interventions, and 100% (3/3) of verbal discussion with test/feedback or teach-back interventions. Eighty-five percent of studies (44/52) evaluated patients’ understanding of risks, 69% (41/52) general knowledge about the procedure, 35% (18/52) understanding of benefits, and 31% (16/52) understanding of alternatives. Participants’ education level was reported heterogeneously, and only 8% (4/52) of studies examined effects according to health literacy. Most studies (79%, 41/52) did not specify participants’ race/ethnicity. Limitations. Variation in interventions and outcome measures precluded conduct of a meta-analysis or calculation of mean effect size. Control group processes were variable and inconsistently characterized. Nearly half of studies (44%, 23/52) had a high risk of bias for the patient comprehension outcome. Conclusions. Interventions to improve patient comprehension in informed consent are heterogeneous. Interactive interventions, particularly with test/feedback or teach-back components, appear superior. Future research should emphasize all key elements of informed consent and explore effects among vulnerable populations.

scholarly journals Effect of computerised, knowledge-based, clinical decision support systems on patient-reported and clinical outcomes of patients with chronic disease managed in primary care settings: a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e054659
Author(s):  
Marie line El Asmar ◽  
Kanika I Dharmayat ◽  
Antonio J Vallejo-Vaz ◽  
Ryan Irwin ◽  
Nikolaos Mastellos
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Decision Support ◽  
Chronic Disease ◽  
Clinical Outcomes ◽  
Data Extraction ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Intervention Effect ◽  
Patient Reported

ObjectivesChronic diseases are the leading cause of disability globally. Most chronic disease management occurs in primary care with outcomes varying across primary care providers. Computerised clinical decision support systems (CDSS) have been shown to positively affect clinician behaviour by improving adherence to clinical guidelines. This study provides a summary of the available evidence on the effect of CDSS embedded in electronic health records on patient-reported and clinical outcomes of adult patients with chronic disease managed in primary care.Design and eligibility criteriaSystematic review, including randomised controlled trials (RCTs), cluster RCTs, quasi-RCTs, interrupted time series and controlled before-and-after studies, assessing the effect of CDSS (vs usual care) on patient-reported or clinical outcomes of adult patients with selected common chronic diseases (asthma, chronic obstructive pulmonary disease, heart failure, myocardial ischaemia, hypertension, diabetes mellitus, hyperlipidaemia, arthritis and osteoporosis) managed in primary care.Data sourcesMedline, Embase, CENTRAL, Scopus, Health Management Information Consortium and trial register clinicaltrials.gov were searched from inception to 24 June 2020.Data extraction and synthesisScreening, data extraction and quality assessment were performed by two reviewers independently. The Cochrane risk of bias tool was used for quality appraisal.ResultsFrom 5430 articles, 8 studies met the inclusion criteria. Studies were heterogeneous in population characteristics, intervention components and outcome measurements and focused on diabetes, asthma, hyperlipidaemia and hypertension. Most outcomes were clinical with one study reporting on patient-reported outcomes. Quality of the evidence was impacted by methodological biases of studies.ConclusionsThere is inconclusive evidence in support of CDSS. A firm inference on the intervention effect was not possible due to methodological biases and study heterogeneity. Further research is needed to provide evidence on the intervention effect and the interplay between healthcare setting features, CDSS characteristics and implementation processes.PROSPERO registration numberCRD42020218184.

scholarly journals Determinants of Frequent Attendance in Primary Care. A Systematic Review of Longitudinal Studies

2021 ◽  
Vol 8 ◽  
Author(s):  
André Hajek ◽  
Benedikt Kretzler ◽  
Hans-Helmut König
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Longitudinal Studies ◽  
Data Extraction ◽  
Future Research ◽  
Andersen Model ◽  
Frequent Attendance ◽  
Perform Sensitivity Analysis ◽  
Sample Characteristics ◽  
Longitudinal Observational Studies

Introduction: There is a lack of a systematic review synthesizing longitudinal studies investigating the determinants of frequent attendance in primary care. The goal of our systematic review was to fill this gap in knowledge.Methods: Three electronic databases (Medline, PsycINFO, and CINAHL) were searched. Longitudinal observational studies analyzing the predictors of frequent attendance in primary care were included. Data extraction covered methods, sample characteristics, and main findings. Selection of the studies, extracting the data and evaluation of study quality was performed by two reviewers. In the results section, the determinants of frequent attendance were presented based on the (extended) Andersen model.Results: In total, 11 longitudinal studies have been included in our systematic review. The majority of studies showed that frequent attendance was positively associated with the predisposing characteristics lower age, and unemployment. Moreover, it was mainly not associated with enabling resources. Most of the studies showed that need factors, and in particular worse self-rated health, lower physical functioning and physical illnesses were associated with an increased likelihood of frequent attendance. While most studies were of good quality, several of the included studies did not perform sensitivity analysis or described how they dealt with missing data.Discussion: Our systematic review showed that particularly lower age, unemployment and need factors are associated with the likelihood of becoming a frequent attender. Enabling resources are mainly not associated with the outcome measure. Future research should concentrate on the determinants of persistent frequent attendance due to the high economic burden associated with it.

scholarly journals Are digital technology interventions effective to reduce loneliness in older adults? A systematic review and meta-analysis

2020 ◽  
Author(s):  
Syed Ghulam Sarwar Shah ◽  
David Nogueras ◽  
Hugo Cornelis van Woerden ◽  
Vasiliki Kiparoglou
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Clinical Trials ◽  
English Language ◽  
Data Extraction ◽  
Meta Analysis ◽  
Future Research ◽  
Before And After ◽  
Quasi Experimental

Objective: To review the latest literature on the effectiveness of DTIs in reducing loneliness in (older) adults. Data Sources: Electronic searches in PubMed, Medline, CINAHL, EMBASE and Web of Science covering publication period from 1 January 2010 to 31 July 2019. Subjects: Adult men and women Design: Systematic review and meta-analysis Main Outcome Measure: Loneliness. Study Selection: Primary studies that used DTIs for tackling loneliness in adults (aged ≥18 years) with follow-up measurements at least three months or more and publication in the English language. Data Extraction and Synthesis: Two researchers independently screened articles and extracted data on several variables: participants, interventions, comparators and outcomes. Data was extracted on the primary outcome i.e. loneliness measured at the baseline and follow-up measurements at three, four, six and twelve months after the intervention. Results: Six studies were selected from 4939 articles screened. Selected studies included 5 clinical trials (4 RCTs and 1 quasi experimental study) and one before and after study, which enrolled 646 participants (men =154 (24%), women =427 (66%), no gender information =65 (10%) with average age between 73 and 78 years (SD 6-11). Five clinical trials were included in the meta-analysis and standardised mean differences (SMD) were calculated for each trial and pooled across studies using a random effects model. The overall effect estimates were not statistically significant in follow-up measurements at three months (SMD= 0.02, 95% CI= -0.36, 0.40; P=0.92), four months (SMDs= -1.11, 95% CI= -2.60, 0.38; P=0.14) and six months (SMD= -0.11, 95% CI= -0.54, 0.32; P=0.61). The quality of evidence was very low to moderate in these trials. Conclusions: There is insufficient evidence to make conclusions that DTIs are effective in reducing loneliness in older adults. Future research may consider RCTs with larger sample sizes and longer duration of interventions and follow-up.

scholarly journals Mapping Evidence on Global Perceptions of Environmental Sustainability amidst the COVID-19 Pandemic: A Systematic Review Protocol

2021 ◽  
Author(s):  
PETER ANSU-MENSAH ◽  
Monica Ansu-Mensah ◽  
Desmond Kuupiel
Keyword(s):  
Scoping Review ◽  
Environmental Sustainability ◽  
Data Extraction ◽  
Meta Analysis ◽  
World Health ◽  
Future Research ◽  
Regulatory Bodies ◽  
Review Protocol ◽  
Government Websites ◽  
Health Organization

Abstract Background: Identifying and addressing research gaps on environmental sustainability in this striving time of COVID-19, it is imperative to ensure proper waste management disposal, efficient use of energy as well as judicious use of transport in order to achieve the SDGs 2030.Aim: The proposed scoping review is aimed at mapping evidence on global perceptions of environmental sustainability amidst COVID-19 pandemic. Methods: The proposed study will be guided by the enhanced version of Arksey and O’Malley’s scoping review framework, and Levac et al. 2010 recommendations together with the 2015 Joanna Briggs Institute guidelines. A comprehensive keywords search for relevant studies presenting evidence of environmental sustainability during COVID-19 pandemic will be conducted with the following databases: SCOPUS, Google Scholar, EBSCOhost, and PubMed. Literature from university repositories and international organization such as the World Health Organization (WHO) and government websites relevant to the proposed study will also be retrieved. The proposed review will use the Preferred Reporting Items for Systematic Reviews and Meta-analysis: Extension for Scoping Review (PRISMA-ScR) to present the results of the study. For data extraction in a content thematic manner of analysis, NVivo version 11 software package will be used. A mixed methods appraisal tool (MMAT) version 2018 will be employed to appraise the quality of all the included studies. Discussion: We are hopeful that the results of the proposed study will inform future research and unveil evidence-based information to report potential environmental sustainability issues that may arise in this new phase of COVID-19 pandemic. It also anticipated that the proposed study will enable policy and regulatory bodies to implement new strategies to achieve the SDGs inclusive of COVID-19 pandemic.

scholarly journals A living systematic review protocol for COVID-19 clinical trial registrations

2020 ◽  
Vol 5 ◽  
pp. 60 ◽  
Author(s):  
Brittany J. Maguire ◽  
Philippe J. Guérin
Keyword(s):  
Systematic Review ◽  
Clinical Trial ◽  
Clinical Trials ◽  
Data Extraction ◽  
Meta Analysis ◽  
Geographic Location ◽  
Diagnostic Methods ◽  
Future Research ◽  
Strong Response ◽  
Level Of Evidence

Since the coronavirus disease 2019 (COVID-19) outbreak was identified in December 2019 in Wuhan, China, a strong response from the research community has been observed with the proliferation of independent clinical trials assessing diagnostic methods, therapeutic and prophylactic strategies. While there is no intervention for the prevention or treatment of COVID-19 with proven clinical efficacy to date, tools to distil the current research landscape by intervention, level of evidence and those studies likely powered to address future research questions is essential. This living systematic review aims to provide an open, accessible and frequently updated resource summarising the characteristics of COVID-19 clinical trial registrations. Weekly search updates of the WHO International Clinical Trials Registry Platform (ICTRP) and source registries will be conducted. Data extraction by two independent reviewers of trial characteristic variables including categorisation of trial design, geographic location, intervention type and targets, level of evidence and intervention adaptability to low resource settings will be completed. Descriptive and thematic synthesis will be conducted. A searchable and interactive visualisation of the results database will be created, and made openly available online. Weekly results from the continued search updates will be published and made available on the Infectious Diseases Data Observatory (IDDO) website (COVID-19 website). This living systematic review will provide a useful resource of COVID-19 clinical trial registrations for researchers in a rapidly evolving context. In the future, this sustained review will allow prioritisation of research targets for individual patient data meta-analysis.

scholarly journals Ultrasound measurement of brain tissue movement in humans: A systematic review

Ultrasound ◽  
2019 ◽  
Vol 28 (2) ◽  
pp. 70-81 ◽  
Author(s):  
Jonathan Ince ◽  
Meshal Alharbi ◽  
Jatinder S Minhas ◽  
Emma ML Chung
Keyword(s):  
Systematic Review ◽  
Brain Tissue ◽  
Data Extraction ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Qualitative Evaluation ◽  
Health Conditions ◽  
Ultrasound Measurement ◽  
Future Research ◽  
Tissue Motion

Introduction It has long been suggested that ultrasound could be used to measure brain tissue pulsations in humans, but potential clinical applications are relatively unexplored. The aim of this systematic review was to explore and synthesise available literature on ultrasound measurement of brain tissue motion in humans. Methods Our systematic review was designed to include predefined study selection criteria, quality evaluation, and a data extraction pro-forma, registered prospectively on PROSPERO (CRD42018114117). The systematic review was conducted by two independent reviewers. Results Ten studies were eligible for the evidence synthesis and qualitative evaluation. All eligible studies confirmed that brain tissue motion over the cardiac cycle could be measured using ultrasound; however, data acquisition, analysis, and outcomes varied. The majority of studies used tissue pulsatility imaging, with the right temporal window as the acquisition point. Currently available literature is largely exploratory, with measurements of brain tissue displacement over a narrow range of health conditions and ages. Explored health conditions include orthostatic hypotension and depression. Conclusion Further studies are needed to assess variability in brain tissue motion estimates across larger cohorts of healthy subjects and in patients with various medical conditions. This would be important for informing sample size estimates to ensure future studies are appropriately powered. Future research would also benefit from a consistent framework for data analysis and reporting, to facilitate comparative research and meta-analysis. Following standardisation and further healthy participant studies, future work should focus on assessing the clinical utility of brain tissue pulsation measurements in cerebrovascular disease states.

scholarly journals Testing the cycle of maltreatment hypothesis: Meta-analytic evidence of the intergenerational transmission of child maltreatment

2019 ◽  
Vol 31 (1) ◽  
pp. 23-51 ◽  
Author(s):  
Sheri Madigan ◽  
Chantal Cyr ◽  
Rachel Eirich ◽  
R. M. Pasco Fearon ◽  
Anh Ly ◽  
...  
Keyword(s):  
Physical Abuse ◽  
Intergenerational Transmission ◽  
Emotional Abuse ◽  
Methodological Quality ◽  
Data Extraction ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Future Research ◽  
Methodological Rigor ◽  
History Of

AbstractIt has long been claimed that “maltreatment begets maltreatment,” that is, a parent's history of maltreatment increases the risk that his or her child will also suffer maltreatment. However, significant methodological concerns have been raised regarding evidence supporting this assertion, with some arguing that the association weakens in samples with higher methodological rigor. In the current study, the intergenerational transmission of maltreatment hypothesis is examined in 142 studies (149 samples; 227,918 dyads) that underwent a methodological quality review, as well as data extraction on a number of potential moderator variables. Results reveal a modest association of intergenerational maltreatment (k= 80;d= 0.45, 95% confidence interval; CI [0.37, 0.54]). Support for the intergenerational transmission of specific maltreatment types was also observed (neglect:k= 13,d= 0.24, 95% CI [0.11, 0.37]; physical abuse:k= 61,d= 0.41, 95% CI [0.33, 0.49]; emotional abuse:k= 18,d= 0.57, 95% CI [0.43, 0.71]; sexual abuse:k= 18,d= 0.39, 95% CI [0.24, 0.55]). Methodological quality only emerged as a significant moderator of the intergenerational transmission of physical abuse, with a weakening of effect sizes as methodological rigor increased. Evidence from this meta-analysis confirms the cycle of maltreatment hypothesis, although effect sizes were modest. Future research should focus on deepening understanding of mechanisms of transmission, as well as identifying protective factors that can effectively break the cycle of maltreatment.

scholarly journals Radiology artificial intelligence, a systematic evaluation of methods (RAISE): a systematic review protocol

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Brendan Kelly ◽  
Conor Judge ◽  
Stephanie M. Bollard ◽  
Simon M. Clifford ◽  
Gerard M. Healy ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Systematic Review ◽  
Data Extraction ◽  
Meta Analysis ◽  
Group Analysis ◽  
Cochrane Collaboration ◽  
Systematic Evaluation ◽  
Future Research ◽  
Ethical Approval ◽  
Registration Number

Abstract Introduction There has been a recent explosion of research into the field of artificial intelligence as applied to clinical radiology with the advent of highly accurate computer vision technology. These studies, however, vary significantly in design and quality. While recent guidelines have been established to advise on ethics, data management and the potential directions of future research, systematic reviews of the entire field are lacking. We aim to investigate the use of artificial intelligence as applied to radiology, to identify the clinical questions being asked, which methodological approaches are applied to these questions and trends in use over time. Methods and analysis We will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and by the Cochrane Collaboration Handbook. We will perform a literature search through MEDLINE (Pubmed), and EMBASE, a detailed data extraction of trial characteristics and a narrative synthesis of the data. There will be no language restrictions. We will take a task-centred approach rather than focusing on modality or clinical subspecialty. Sub-group analysis will be performed by segmentation tasks, identification tasks, classification tasks, pegression/prediction tasks as well as a sub-analysis for paediatric patients. Ethics and dissemination Ethical approval will not be required for this study, as data will be obtained from publicly available clinical trials. We will disseminate our results in a peer-reviewed publication. Registration number PROSPERO: CRD42020154790

scholarly journals Mapping evidence on the burden and distribution of childhood obesity in sub-Saharan Africa: a scoping review protocol

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Frederick I. Danquah ◽  
Matilda Yeboah ◽  
Vitalis Bawontuo ◽  
Desmond Kuupiel
Keyword(s):  
Childhood Obesity ◽  
Scoping Review ◽  
Data Extraction ◽  
Meta Analysis ◽  
Research Direction ◽  
Sub Saharan Africa ◽  
Future Research ◽  
Adverse Health Outcomes ◽  
Unpublished Studies ◽  
Sub Saharan

Abstract Background Obesity in childhood is associated with adverse health outcomes and complications throughout the life-span of a child. Available evidence suggests a dramatic increase in childhood obesity in sub-Saharan Africa (SSA) over the past two decades. The health risks associated with obesity/overweight are particularly problematic in children due to the potential for long-term health concerns. The researchers propose to conduct a systematic scoping review to map evidence on the burden and distribution of childhood obesity in SSA. Methods The study will be guided by the scoping review framework proposed by Arksey and O’Malley. A comprehensive literature search will be performed in the following electronic databases: PubMed, Web of Science, African Index Medicus, and CINAHL with full text via EBSCOhost platform. Primary studies both published in peer-reviewed journals and gray literature such as unpublished studies, thesis, and studies in press addressing the research topic will be included. One reviewer will conduct title screening, and the results will be exported to Mendeley Desktop library. Two independent reviewers will perform both abstract and full article screening in parallel as well as data extraction from eligible studies. The Preferred Reporting Items for Systematic Reviews and Meta-analysis: Extension for Scoping Review (PRISMA-ScR) will be utilized to present the study findings of the proposed scoping review. NVivo version 11.0 will be used to extract the relevant outcomes from the included studies, a content thematic analysis performed, and the results reported using a narrative approach. The Mixed Method Quality Appraisal Tool Version 2018 will be used to assess the methodological quality of all included studies. Discussion We anticipate that the proposed study will contribute to the existing body of knowledge on childhood obesity, identify gaps in knowledge on the topic, inform future research direction, and provide evidence-based information to strengthen health systems and policies on childhood obesity towards achieving the WHO global target of halting the rise in obesity by 2025.

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