scholarly journals Benefits of medication charts provided at transitions of care: a narrative systematic review

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e037668
Author(s):  
Fine Michèle Dietrich ◽  
Kurt E Hersberger ◽  
Isabelle Arnet
Keyword(s):  
Systematic Review ◽  
Study Design ◽  
Healthcare Providers ◽  
Transitions Of Care ◽  
Current Therapy ◽  
Search Term ◽  
Helpful Tool ◽  
Study Results ◽  
Medication Chart

ObjectivesParticularly at transitions of care points information concerning current medication tends to be incomplete. A medication chart that contains all essential information on current therapy is likely to be a helpful tool for patients and healthcare providers. We aimed to investigate any type of benefits associated with medication charts provided at transition points.MethodsA systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. Two databases, two online journals and two association websites dedicated to biomedicine and pharmacy issues were consulted to identify studies for the review using the search term ‘medication chart’ and synonyms. We run our search from database inception up to March 2019. Studies of any study design, intervention and population which examined the effect of paper-based medication charts were included. We extracted study results narratively and coded and classified them by themes and categories inductively by using the ‘framework method’ with content analysis. The methodological quality of the studies was assessed using the Effective Public Health Practice Project (EPHPP) tool.ResultsFrom the 846 retrieved articles, 30 studies met the inclusion criteria, mostly from Germany (18 studies) and the USA (5 studies). Thirteen studies reported a statistically significant result. In the ‘patient theme’, the most obvious benefits were an increase in medication knowledge, a reduction of medication errors and higher medication adherence. In the ‘interdisciplinary theme’, a medication chart represented a helpful tool to increase communication and inter-sectoral cooperation between healthcare providers. In the ‘theme of terms and conditions’, accuracy and currency of data are prerequisites for any positive effect. The quality of the studies was classified predominantly weak mainly due to unmet good quality criteria (no randomised controlled trials study design, no reported dropouts).ConclusionOverall, the reviewed studies suggested some benefits when using medication charts. Healthcare providers could consider using medication charts in their counselling practice. However, it is unknown whether the reported benefits lead to measurable improvement in clinical outcomes.PROSPERO registration number

scholarly journals A Systematic Review on Psychological and Biological Mediators Between Adversity and Psychosis: Potential Targets for Treatment

2019 ◽  
Author(s):  
Luis Alameda ◽  
Victoria Rodriguez ◽  
Ewan Carr ◽  
Monica Aas ◽  
Giulia Trotta ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Samples ◽  
Traditional Treatment ◽  
Affective Dysregulation ◽  
Cognitive Behavioural ◽  
Study Results ◽  
Registration Number ◽  
Meta Analyses ◽  
Competing Pathways

AbstractVarious psychological and biological pathways have been proposed as mediators between childhood adverse events (CA) and psychosis. A systematic review of the evidence in this domain is needed. The aim of this work is to systematically review the evidence on psychological and biological mediators between CA and psychosis across the psychosis spectrum. This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (registration number: CRD42018100846). Articles published between 1979 and July 2019 were identified through a literature search in OVID (PsychINFO; Medline and Embase). The evidence by each analysis and each study results are presented by group of mediator categories found in the review. The percentage of total effect mediated was calculated. 47 studies were included, with a total of 79,668 from general population (GP) and 3,189 from clinical samples. The quality of studies was judged as “fair”. Our results showed (i) solid evidence of mediation between CA and psychosis by negative cognitive schemas about the self, the world, and others (NS); by dissociation and other PTSD symptoms; (ii) evidence of al mediation through an affective pathway (affective dysregulation, anxiety, and depression) in GP; (iii) lack of studies exploring biological mediators. To conclude, we found evidence suggesting that various overlapping and not competing pathways contribute partially to the link between adversity and psychosis. Experiences of adversity, along with relevant mediators such as PTSD and mood related symptoms and NS, should be routinely assessed in patients with psychosis. Targeting such mediators through cognitive behavioural aproaches using trauma-focused therapy and/or pharmacological means could be a useful addition to the traditional treatment of positive symptoms.

scholarly journals Evaluating measures of quality of life in adult scoliosis: a protocol for a systematic review and narrative synthesis

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
James E. Archer ◽  
Charles Baird ◽  
Adrian Gardner ◽  
Alison B. Rushton ◽  
Nicola R. Heneghan
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Outcome Measures ◽  
Study Design ◽  
Systematic Reviews ◽  
Primary Outcome ◽  
Adult Scoliosis ◽  
Measurement Properties ◽  
Narrative Synthesis

Abstract Background Adult scoliosis represents a distinct subgroup of scoliosis patients for whom the diagnosis can have a large impact on their health-related quality of life (HR-QOL). Therefore, HR-QOL patient-reported outcome measures (PROMs) are essential to assess disease progression and the impact of interventions. The objective of this systematic review is to evaluate the measurement properties of HR-QOL PROMs in adult scoliosis patients. Methods We will conduct a literature search, from their inception onwards, of multiple electronic databases including AMED, CINAHL, EMBASE, Medline, PsychINFO and PubMed. The searches will be performed in two stages. For both stages of the search, participants will be aged 18 and over with a diagnosis of scoliosis. The primary outcome of interest in the stage one searches will be studies which use PROMs to investigate HR-QOL as defined by the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy, the secondary outcome will be to assess the frequency of use of the various PROMs. In stage two, the primary outcome of interest will be studies which assess the measurement properties of the HR-QOL PROMs identified in stage one. No specific measurement property will be given priority. No planned secondary outcomes have been identified but will be reported if discovered. In stage one, the only restriction on study design will be the exclusion of systematic reviews. In Stage two the only restriction on study design will be the exclusion of full-text articles not available in the English language. Two reviewers will independently screen all citations and abstract data. Potential conflicts will be resolved through discussion. The study methodological quality (or risk of bias) will be appraised using the Consensus-based Standards for the selection of Health Measurement Instruments (COSMIN) checklist. The overall strength of the body of evidence will then be assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A narrative synthesis will be provided with information presented in the main text and tables to summarise and explain the characteristics and findings of the included studies. The narrative synthesis will explore the evidence for currently used PROMs in adult scoliosis patients and any areas that require further study. Discussion The review will help clinicians and researchers identify a HR-QOL PROM for use in patients with adult scoliosis. Findings from the review will be published and disseminated through a peer-reviewed journal and conference presentations. Systematic review registration This systematic review has been registered with the International Prospective Register of Systematic Reviews (PROSPERO), reference number: CRD42020219437

scholarly journals Study reporting quality among interventions to reduce antibiotic use is a barrier to evidence-informed policymaking on antimicrobial resistance: systematic review

2020 ◽  
Vol 75 (5) ◽  
pp. 1091-1098 ◽  
Author(s):  
S Rogers Van Katwyk ◽  
J M Grimshaw ◽  
M Nkangu ◽  
M Mendelson ◽  
M Taljaard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Antimicrobial Resistance ◽  
Reporting Quality ◽  
Complete Information ◽  
Antibiotic Use ◽  
System Level ◽  
Policy Interventions ◽  
Sufficient Detail ◽  
Study Results

Abstract Background Countries are currently seeking evidence-informed policy options to address antimicrobial resistance (AMR). While rigorous evaluations of AMR interventions are the ideal, they are far from the current reality. Additionally, poor reporting and documentation of AMR interventions impede efforts to use evidence to inform future evaluations and policy interventions. Objectives To critically evaluate reporting quality gaps in AMR intervention research. Methods To evaluate the reporting quality of studies, we conducted a descriptive synthesis and comparative analysis of studies that were included in a recent systematic review of government policy interventions aiming to reduce human antimicrobial use. Reporting quality was assessed using the SQUIRE 2.0 checklist of 18 items for reporting system-level interventions to improve healthcare. Two reviewers independently applied the checklist to 66 studies identified in the systematic review. Results None of the studies included complete information on all 18 SQUIRE items (median score = 10, IQR = 8–11). Reporting quality varied across SQUIRE items, with 3% to 100% of studies reporting the recommended information for each SQUIRE item. Only 20% of studies reported the elements of the intervention in sufficient detail for replication and only 24% reported the mechanism through which the intervention was expected to work. Conclusions Gaps in the reporting of impact evaluations pose challenges for interpreting and replicating study results. Failure to improve reporting practice of policy evaluations is likely to impede efforts to tackle the growing health, social and economic threats posed by AMR.

Simultaneous compared to interval administration of mifepristone and misoprostol for medical abortion up to 10+0 weeks' gestation: a systematic review with meta-analyses

2020 ◽  
pp. bmjsrh-2019-200448
Author(s):  
Mia Schmidt-Hansen ◽  
Jonathan Lord ◽  
Elise Hasler ◽  
Sharon Cameron
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Medical Abortion ◽  
Cochrane Library ◽  
Published Data ◽  
Study Results ◽  
Randomised Controlled ◽  
Meta Analyses

BackgroundMedical abortion with mifepristone and misoprostol usually involves an interval of 36–48 hours between administering these drugs; however, it is possible that the clinical efficacy at early gestations may be maintained when the drugs are taken simultaneously. The objective of this systematic review was to determine the safety and effectiveness of simultaneous compared with interval administration of mifepristone and misoprostol for abortion up to 10+0 weeks’ gestation.MethodsWe searched Embase Classic, Embase; Ovid MEDLINE(R) including Daily, and Epub Ahead-of-Print, In-Process & Other Non-Indexed Citations; and Cochrane Library on 11 December 2019. We included randomised controlled trials (RCTs), published in English from 1985, comparing simultaneous to interval administration of mifepristone and misoprostol for early abortion. Risk of bias was assessed using the Cochrane Collaboration checklist for RCTs. Meta-analysis of risk ratios (RRs) using the Mantel-Haenszel method were performed. The quality of the evidence was assessed using GRADE.ResultsMeta-analyses of three RCTs (n=1280) showed no differences in ‘ongoing pregnancy’ (RR 1.78, 95% CI 0.38 to 8.36), ‘haemorrhage requiring transfusion or ≥500 mL blood loss’ (RR 0.11, 95% CI 0.01 to 2.03) and ‘incomplete abortion with the need for surgical intervention’ (RR 1.30, 95% CI 0.76 to 2.25) between the interventions. Individual study results showed no difference in patient satisfaction, or ‘need for repeat misoprostol’, although ‘time to onset of bleeding or cramping’ was longer after simultaneous than interval administration. The quality of evidence was very low to moderate.ConclusionThe published data support the use of simultaneous mifepristone and misoprostol for medical abortion up to 9+0 weeks in women who prefer this method of administration.

Weekly (QW) epoetin alfa (EPO) in prostate cancer (PC) patients (pts) with anemia not receiving chemotherapy (CT) or radiation therapy (RT)

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14634-14634
Author(s):  
D. Shasha
Keyword(s):  
Quality Of Life ◽  
Healthcare Providers ◽  
Open Label ◽  
Vascular Events ◽  
Cancer Data ◽  
Early Withdrawal ◽  
Safety Population ◽  
Study Results ◽  
The Many

14634 Background: While EPO is widely used in the management of CT-related anemia, anemia in cancer pts may stem from causes other than CT. Tumor invasion of the bone marrow and cytokine-mediated inhibition of erythropoiesis are among the many disease-related causes of anemia in cancer. Data evaluating the use of EPO in pts not receiving CT or RT, particularly in specific tumor types, would be important information to healthcare providers. Methods: An open-label, prospective, non-randomized, multicenter pilot study was conducted to evaluate the efficacy and safety of EPO 40,000 U QW in anemic (hemoglobin [Hb] ≤ 11 g/dL) cancer pts not receiving CT or RT1. (Blood 2004;104:abstract 4223.) Treatment duration was up to 12 wks with a 4-wk post-treatment observation period. Primary efficacy endpoint was hematopoietic response during the treatment period (% of pts achieving a ≥ 1 or ≥ 2 g/dL Hb increase from baseline [BL]). Secondary endpoints included change from BL in quality of life as measured by the Linear Analog Scale Assessment (LASA). This is a retrospective subset analysis of PC pts (n = 24) enrolled in the prospective study. Results: For the safety population (all pts who received ≥ 1 EPO dose, n = 23), mean age was 71.4 ± 6.8 yrs; 21 (91.3%) had ECOG status of 0 or 1; and mean BL Hb was 10.4 ± 0.8 g/dL. Of 21 pts evaluated for efficacy, 17 (81.0%) achieved Hb increase from BL ≥ 2 g/dL, while 19 (90.5%) achieved ≥ 1 g/dL by wk 17/early withdrawal. EPO dose was increased in 5 (23.8%) pts (to 60,000 U for Hb increase < 1 g/dL after 4 wks) and held in 16 (76.2%) pts (due to Hb > 13 g/dL, with dosing resumed when Hb was ≤12 g/dL, at 30,000 U from 40,000 U or at 40,000 U from 60,000 U). Both Wk 9 and 17 LASA scores increased significantly from BL in all categories (Energy Level, Daily Activities, and Quality of Life; P < 0.001). 15 of 23 pts (65.2%) had at least one adverse event (AE); 4 (17.4%) pts had at least one serious AE. No clinically relevant thrombotic vascular events were noted. No pt received transfusion. 5 pts discontinued: 2 for AEs, 1 at pt request, and 2 at study sponsor request. Conclusions: This retrospective analysis suggests that EPO 40,000 U QW is safe and effective for treating anemia in PC pts not receiving CT or RT. [Table: see text]

scholarly journals Tolerability of Duloxetine in the Elderly and in Young Adults: A Protocol and Preliminary Results of a Systematic Review and Individual Participant Data Meta-Analysis of Randomised Placebo-Controlled Trials.

2021 ◽  
Author(s):  
Jean-Charles Roy ◽  
Chloé Rousseau ◽  
Alexis Jutel ◽  
Florian Naudet ◽  
Gabriel Robert
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Elderly Population ◽  
Meta Analysis ◽  
The Elderly ◽  
Search Term ◽  
Individual Participant Data ◽  
Younger Adults ◽  
Individual Participant

Abstract BackgroundDuloxetine is an antidepressant that benefits from a wide range of approval in the elderly population, while its safety for use in the elderly population, compared to younger adults, is not clearly assessed. This protocol outlines a systematic review and individual participant data meta-analysis comparing the tolerability of duloxetine between elderly and younger adults. MethodsOnly randomised controlled clinical trials, comparing duloxetine to placebo, will be included in this meta-analysis. The studies will be selected if participants were adults of less and more than 65 years old, in conditions of use of duloxetine approved by the European Medical Agency (EMA) and the Food and Drug Administration (FDA). The primary outcome will be the rate ratio of serious adverse events under duloxetine compared to placebo, between participants at least 65 years old and younger adults. Second, the number of any adverse events, clinical efficacy and quality of life will be compared between elderly and younger adults under both interventions. The quality of evidence in the tolerability of duloxetine will be assessed using the GRADE system. A two-step random effect meta-analysis will be conducted. Preliminary searches and formal screening of search results against eligibility criteria on have been completed using predefined search term on electronic databases. DiscussionThis study represents the first meta-analysis investigating the safety of duloxetine in the elderly population across all conditions approved by European and American regulatory authorities. The results from this meta-analysis are intended to help prescribers to provide better care for the elderly population.Systematic review registrationThe protocol has been registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42019130488).

scholarly journals Perceived Consequences of Healthcare Service Decentralization on Access, Affordability and Quality of Care in Khartoum Locality, Sudan

2020 ◽  
Author(s):  
Bandar Noory ◽  
Sara Hassanein ◽  
Jeffrey Edwards ◽  
Benedikte Victoria Lindskog
Keyword(s):  
Quality Of Care ◽  
Healthcare Providers ◽  
Quality Of Healthcare ◽  
Healthcare Services ◽  
System Capacity ◽  
Cross Sectional ◽  
Study Results ◽  
Catchment Areas ◽  
The Impact

Abstract Background: Decentralization of healthcare services have been widely utilized, especially in developing countries, to improve the performance of healthcare systems by increasing the access and efficiency of service delivery. Experiences have been variable secondary to disparities in financial and human resources, system capacity and community engagement. Sudan is no exception and understanding the perceived effect of decentralization on access, affordability, and quality of care among stakeholders is crucial.Methods: This was a mixed method, cross-sectional, explorative study that involved 418 household members among catchment areas and 40 healthcare providers of Ibrahim Malik Hospital (IBMH) and Khartoum Teaching Hospital (KTH). Data were collected through a structured survey and in-depth interviews from July-December 2015.Results: Access, affordability and quality of healthcare services were all perceived as worse, compared to before decentralization was implemented. Reported affordability was found to be 53% and 55% before decentralization compared to 24% to 16% after decentralization, within KTH and IBMH catchment areas respectively, (p= 0.01). The quality of healthcare services were reported to have declined from 47% and 38% before decentralization to 38% and 28% after, in KTH and IBMH respectively (p=0.02). Accessibility was found to be more limited, with services being accessible before decentralization approximately 59% and 52% of the time, compared to 41% and 30% after, in KTH and IBMH catchment areas respectively, (p=0.01).Accessibility to healthcare was reported to have decreased secondary to facility closures, reverse transference of services, and low capacity of devolved facilities. Lastly, privatized services were reported as strengthened in response to this decentralization of healthcare. Conclusions: The deterioration of access, affordability and quality of health services was experienced as the predominant perception among stakeholders after decentralization implementation. Our study results suggest there is an urgent need for a review of the current healthcare policies, structure and management within Sudan in order to provide evidence and insights regarding the impact of decentralization.

A Systematic Review of Definitions for Dysphagia and Dysphonia in Patients Treated Surgically for Degenerative Cervical Myelopathy

2021 ◽  
pp. 219256822110357
Author(s):  
Lindsay Tetreault ◽  
Stefan F. Lange ◽  
Silky Chotai ◽  
Mercedes Lupo ◽  
Michael T. Kryshtalskyj ◽  
...  
Keyword(s):  
Systematic Review ◽  
Study Design ◽  
Cervical Myelopathy ◽  
Sound Production ◽  
Rating Scale ◽  
Perioperative Complications ◽  
Life Questionnaire ◽  
Patient Reported ◽  
Degenerative Cervical Myelopathy

Study Design: Systematic review. Surgical decompression for degenerative cervical myelopathy (DCM) is associated with perioperative complications, including difficulty or discomfort with swallowing (dysphagia) as well as changes in sound production (dysphonia). This systematic review aims to (1) outline how dysphagia and dysphonia are defined in the literature and (2) assess the quality of definitions using a novel 4-point rating system. Methods: An electronic database search was conducted for studies that reported on dysphagia, dysphonia or other related complications of DCM surgery. Data extracted included study design, surgical details, as well as definitions and rates of surgical complications. A 4-point rating scale was developed to assess the quality of definitions for each complication. Results: Our search yielded 2,673 unique citations, 11 of which met eligibility criteria and were summarized in this review. Defined complications included odynophagia (n = 1), dysphagia (n = 11), dysphonia (n = 2), perioperative swelling complications (n = 2), and soft tissue swelling (n = 3). Rates of dysphagia varied substantially (0.0%-50.0%) depending on whether this complication was patient-reported (4.4%); patient-reported using a modified Swallowing Quality of Life questionnaire (43.1%) or the Bazaz criteria (8.8%-50.0%); or diagnosed using an extensive protocol consisting of clinical assessment, a bedside swallowing test, evaluation by a speech and language pathologist and a modified barium swallowing test/fiberoptic endoscopy (42.9%). The reported incidences of dysphonia also ranged significantly from 0.6% to 38.0%. Conclusion: There is substantial variability in reported rates of dysphagia and dysphonia due to differences in data collection methods, diagnostic strategies, and definitions. Consolidation of nomenclature will improve evaluation of the overall safety of surgery.

scholarly journals The quality of and women’s satisfaction with maternal referral practices in Sub-Saharan African low and lower-middle income countries: A systematic review

2020 ◽  
Author(s):  
Edward Kwabena Ameyaw ◽  
Carolyne Njue ◽  
Nguyen Toan Tran ◽  
Angela Dawson
Keyword(s):  
Systematic Review ◽  
Low Cost ◽  
Healthcare Providers ◽  
Neonatal Morbidity ◽  
Primary Data ◽  
Middle Income ◽  
Middle Income Countries ◽  
Referral Practices ◽  
Sub Saharan

Abstract Background: Sub-Saharan African Low and Lower-Middle Income Countries (SSA LLMICs have the highest burden of maternal and neonatal morbidity and mortality in the world. Timely and appropriate obstetric referral to a suitable health facility is a sign of effective health system. This paper presents the findings of a systematic review that aimed to identify what referral practices are delivered according to accepted standards for pregnant women and newborns in SSA LLMICs by competent healthcare providers and in line with the need and wishes of women. Methods: Six electronic databases were systematically searched for primary data studies (2009-2018) in English reporting on maternal referral practices and their effectiveness. We conducted a content analysis guided by a framework for assessing the quality of maternal referral. The articles defined quality referral as: the timely identification of signal functions, established guidelines or standards, adequate documentation, staff accompaniment and prompt care by competent healthcare providers at the receiving facility. Results: Seventeen articles were included in the study. Most studies were quantitative (n=11). Two studies reported that women were dissatisfied due to delays in referral processes that affected their health. Most of the articles (10) reported that women were not accompanied to higher levels of healthcare, delays in referral processes, transportation challenges and poor referral documentation. Some healthcare providers administered essential drugs such as misoprostol prior to referral. Conclusions: Efforts to improve maternal health in LLMICs should aim to enhance maternal healthcare providers’ ability to identify conditions that demand referral. Low cost transport is needed to mitigate transportation barriers of referral. To ensure quality maternal referral, mechanisms should be instituted for health managers at the district level to monitor and evaluate referral documentation, quality and efficiency of maternal referrals on regular basis.

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