scholarly journals Effectiveness of spatially targeted interventions for control of HIV, tuberculosis, leprosy and malaria: a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e044715
Author(s):  
McEwen Khundi ◽  
James R Carpenter ◽  
Marriott Nliwasa ◽  
Ted Cohen ◽  
Elizabeth L Corbett ◽  
...  
Keyword(s):  
Systematic Review ◽  
Best Practice ◽  
Data Extraction ◽  
Randomised Trial ◽  
Complex Interventions ◽  
Indoor Residual Spraying ◽  
Cluster Randomised Trial ◽  
Community Screening ◽  
Targeted Interventions ◽  
Household Location

BackgroundAs infectious diseases approach global elimination targets, spatial targeting is increasingly important to identify community hotspots of transmission and effectively target interventions. We aimed to synthesise relevant evidence to define best practice approaches and identify policy and research gaps.ObjectiveTo systematically appraise evidence for the effectiveness of spatially targeted community public health interventions for HIV, tuberculosis (TB), leprosy and malaria.DesignSystematic review.Data sourcesWe searched Medline, Embase, Global Health, Web of Science and Cochrane Database of Systematic Reviews between 1 January 1993 and 22 March 2021.Study selectionThe studies had to include HIV or TB or leprosy or malaria and spatial hotspot definition, and community interventions.Data extraction and synthesisA data extraction tool was used. For each study, we summarised approaches to identifying hotpots, intervention design and effectiveness of the intervention.ResultsTen studies, including one cluster randomised trial and nine with alternative designs (before–after, comparator area), satisfied our inclusion criteria. Spatially targeted interventions for HIV (one USA study), TB (three USA) and leprosy (two Brazil, one Federated States of Micronesia) each used household location and disease density to define hotspots followed by community-based screening. Malaria studies (one each from India, Indonesia and Kenya) used household location and disease density for hotspot identification followed by complex interventions typically combining community screening, larviciding of stagnant water bodies, indoor residual spraying and mass drug administration. Evidence of effect was mixed.ConclusionsStudies investigating spatially targeted interventions were few in number, and mostly underpowered or otherwise limited methodologically, affecting interpretation of intervention impact. Applying advanced epidemiological methodologies supporting more robust hotspot identification and larger or more intensive interventions would strengthen the evidence-base for this increasingly important approach.PROSPERO registration numberCRD42019130133.

scholarly journals Health system interventions to integrate genetic testing in routine oncology services: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250379
Author(s):  
Rosie O’Shea ◽  
Natalie Taylor ◽  
Ashley Crook ◽  
Chris Jacobs ◽  
Yoon Jung Kang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Genetic Testing ◽  
Genetic Counselling ◽  
Implementation Research ◽  
Professional Education ◽  
Data Extraction ◽  
Complex Interventions ◽  
Implementation Strategies ◽  
Newcastle Ottawa Scale ◽  
Inner Setting

Background Integration of genetic testing into routine oncology care could improve access to testing. This systematic review investigated interventions and the tailored implementation strategies aimed at increasing access to genetic counselling and testing and identifying hereditary cancer in oncology. Methods The search strategy results were reported using the PRISMA statement and four electronic databases were searched. Eligible studies included routine genetic testing for breast and ovarian cancer or uptake after universal tumour screening for colorectal or endometrial cancer. The titles and abstracts were reviewed and the full text articles screened for eligibility. Data extraction was preformed using a designed template and study appraisal was assessed using an adapted Newcastle Ottawa Scale. Extracted data were mapped to Proctor’s et al outcomes and the Consolidated Framework for Implementation Research and qualitatively synthesised. Results Twenty-seven studies, published up to May 2020, met the inclusion criteria. Twenty-five studies ranged from poor (72%), fair to good (28%) quality. Most interventions identified were complex (multiple components) such as; patient or health professional education, interdisciplinary practice and a documentation or system change. Forty-eight percent of studies with complex interventions demonstrated on average a 35% increase in access to genetic counselling and a 15% increase in testing completion. Mapping of study outcomes showed that 70% and 32% of the studies aligned with either the service and client or the implementation level outcome and 96% to the process or inner setting domains of the Consolidated Framework for Implementation Research. Conclusion Existing evidence suggests that complex interventions have a potentially positive effect towards genetic counselling and testing completion rates in oncology services. Studies of sound methodological quality that explore a greater breadth of pre and post implementation outcomes and informed by theory are needed. Such research could inform future service delivery models for the integration of genetics into oncology services.

scholarly journals A Systematic Review to Determine Best Practice Reporting Guidelines for AFO Interventions in Studies Involving Children with Cerebral Palsy

2010 ◽  
Vol 34 (2) ◽  
pp. 129-145 ◽  
Author(s):  
Emily Ridgewell ◽  
Fiona Dobson ◽  
Timothy Bach ◽  
Richard Baker
Keyword(s):  
Systematic Review ◽  
Cerebral Palsy ◽  
Best Practice ◽  
Data Extraction ◽  
Evidence Base ◽  
Gait Pattern ◽  
Best Practice Guidelines ◽  
Sufficient Detail ◽  
Children With Cerebral Palsy

Studies which have examined the effects of ankle-foot orthoses (AFOs) on children with cerebral palsy (CP) often report insufficient detail about the participants, devices and testing protocols. The aim of this systematic review was to evaluate the level and quality of detail reported about these factors in order to generate best practice guidelines for reporting of future studies. A systematic search of the literature was conducted to identify studies which examined any outcome measure relating to AFO use in children with CP. A customized checklist was developed for data extraction and quality assessment. There was substantial variability in the level and quality of detail reported across the 41-paper yield. Many papers reported insufficient detail to allow synthesis of outcomes across studies. The findings of this review have been used to generate guidelines for best practice of reporting for AFO intervention studies. It is important to ensure homogeneity of gait pattern in a subject sample or to subdivide a sample to investigate the possibility that heterogeneity affected results. It is also important to describe the orthosis in sufficient detail that the device can be accurately replicated because differences in designs have been shown to affect outcomes. These guidelines will help researchers provide more systematic and detailed reports and thereby permit future reviewers to more accurately assess both the reporting and quality of orthotic interventions, and will facilitate synthesis of literature to enhance the evidence base.

scholarly journals Ketamine for the treatment of prehospital acute pain: a systematic review of benefit and harm

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038134
Author(s):  
Mårten Sandberg ◽  
Per Kristian Hyldmo ◽  
Poul Kongstad ◽  
Kristian Dahl Friesgaard ◽  
Lasse Raatiniemi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Nitrous Oxide ◽  
Acute Pain ◽  
Rating Scale ◽  
Randomised Trial ◽  
Risk Of Bias ◽  
Nausea And Vomiting ◽  
Cochrane Library ◽  
Cluster Randomised Trial ◽  
Analgesic Drugs

BackgroundFew publications have addressed prehospital use of ketamine in analgesic doses. We aimed to assess the effect and safety profile of ketamine compared with other analgesic drugs (or no drug) in adult prehospital patients with acute pain.MethodsA systematic review of clinical trials assessing prehospital administration of ketamine in analgesic doses compared with other analgesic drugs or no analgesic treatment in adults. We searched PubMed, EMBASE, Cochrane Library and Epistemonikos from inception until 15 February 2020, including relevant articles in English and Nordic languages. We used the Cochrane and Grading of Recommendations Assessment, Development and Evaluation methodologies and exclusively assessed patient-centred outcomes. Two independent authors screened trials for eligibility, extracted data and assessed risk of bias.ResultsWe included eight studies (2760 patients). Ketamine was compared with various opioids given alone, and intranasal ketamine given with nitrous oxide was compared with nitrous oxide given alone. Four randomised controlled trials (RCTs) and one cluster randomised trial included 699 patients. One prospective cohort included 27 patients and two retrospective cohorts included 2034 patients. Five of the eight studies had high risks of bias. Pain score with ketamine is probably lower than after opioids as demonstrated in a cluster-RCT (308 patients) and a retrospective cohort (158 patients) study, Δvisual analogue scale −0.4 (−0.8 to 0.0) and Δnumeric pain rating scale −3.0 (−3.86 to −2.14), respectively. Ketamine probably leads to less nausea and vomiting (risk ratio (RR) 0.24 (0.11 to 0.52)) but more agitation (RR 7.81 (1.85 to 33)) than opioids.ConclusionsThis systematic literature review finds that ketamine probably reduces pain more than opioids and with less nausea and vomiting but higher risk of agitation. Risk of bias in included studies is high.OtherScandinavian society of anaesthesiology and intensive care medicine funded meetings and software. The Norwegian Air Ambulance Foundation funded publication. Otherwise this research received no grant from any agency in the public, commercial or not-for-profit sectors.PROSPERO registration numberCRD42018114399.

scholarly journals Efficacy of pressure ulcer prevention interventions in adult intensive care units: a protocol for a systematic review and network meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026727 ◽  
Author(s):  
Yixiu Du ◽  
Fangqin Wu ◽  
Sai Lu ◽  
Wei Zheng ◽  
Huiying Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Best Practice ◽  
Data Extraction ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Prevention Measures ◽  
Prevention Intervention ◽  
Prevention Interventions

IntroductionPressure ulcers (PUs) are associated with substantial health burden. Patients in intensive care units (ICUs) are at high risk for developing PU. In the absence of large randomised controlled trials (RCTs) that compare commonly known interventions for preventing PU in ICUs, uncertainty remains around the best practice strategy for PU management in adult ICUs. This study, therefore, aims to identify the most effective interventions and combinations of interventions that prevent PU in adult ICU using systematic review and network meta-analysis (NMA).Methods and analysisWe will search for all published and unpublished RCTs evaluating interventions to prevent PU compared with other PU prevention measures or with usual care in adult ICU. The primary outcomes are the incidence of PUs and PU severity in critically ill patients in ICU. The secondary outcomes include number of PUs per patient and intervention-related harms caused by the prevention intervention or intervention-related harms. All data extraction will be performed by at least two independent reviewers on the basis of a priori developed extraction form. We will evaluate the risk of bias of the included RCTs in accordance with the Cochrane Collaboration’s risk of bias tool, and assess the quality of evidence using Grading of Recommendations Assessment, Development and Evaluation. A standard pairwise meta-analysis and a Bayesian NMA will be conducted to compare the efficacy of different PU prevention interventions. A surface under the cumulative ranking curve will be used to rank the probabilities of each prevention intervention for various outcomes.Ethics and disseminationThis study will not require the ethics approval as it is a review based on published studies. The findings of this study will be submitted to a peer-reviewed journal for publication. We anticipate that the results of the study will provide the evidence to inform clinicians and guideline developers on determining the best interventions for the prevention of PU in ICU patients.PROSPERO registration numberCRD42018085562.

scholarly journals Examining Challenges to Incorporate End Users in the Development of Digital Health Interventions: Protocol for a Systematic Review (Preprint)

2021 ◽  
Author(s):  
Anthony Duffy ◽  
Greg Christie ◽  
Sylvain Moreno
Keyword(s):  
Systematic Review ◽  
Digital Health ◽  
Data Extraction ◽  
Complex Interventions ◽  
Evidence Base ◽  
End Users ◽  
Digital Design ◽  
Health Interventions ◽  
Healthcare Outcomes ◽  
Eligibility Criteria

BACKGROUND Digital Health Interventions (DHIs) are rapidly evolving the landscape of healthcare. Multiple studies have shown their propensity to extend both the quality and reach of interventions. However, failure to improve DHI development is linked to failed uptake and health outcomes. This dilemma is further conflicted by the colliding backdrops of the digital and health industries respectively, which approach, understand and involve end users differently in the framing of a DHI. OBJECTIVE The objective of this systematic review is to assess the challenges to incorporate end users in the development of digital health interventions, to identify emerging hybridised solutions, and to identify limitations and gaps for areas of future investigation. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) will be used to structure this protocol. A systematic search of the PsycInfo, PubMed (Medline), Web of Science, CINAHL and IEEE Xplore databases will be conducted. Additionally, the PerSPEcTiF guidelines for complex interventions will be consulted. Two reviewers will independently screen the titles and abstracts of the identified references and select studies according to the eligibility criteria. Any discrepancies will then be discussed and resolved. Two reviewers will independently extract and validate data from the included studies into a standardised form and conduct quality appraisal. RESULTS As of February 2020, we have completed a preliminary literature search examining challenges to incorporate end users in the development of DHI. Systematic searches, data extraction and analysis, and writing of the systematic review are expected to be completed by August 2021. CONCLUSIONS This systematic review aims to provide an effective summary of challenges to incorporate end users in the development of DHIs. Results from this review will provide an evidence base for a more harmonised approach to end users that satisfies the needs of healthcare outcomes and digital design and development respectively.

scholarly journals Process evaluations of primary care interventions addressing chronic disease: a systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e025127 ◽  
Author(s):  
Hueiming Liu ◽  
Alim Mohammed ◽  
Janani Shanthosh ◽  
Madeline News ◽  
Tracey-Lea Laba ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Randomised Controlled Trials ◽  
Data Extraction ◽  
Complex Interventions ◽  
Controlled Trials ◽  
Theoretical Frameworks ◽  
Intervention Theory ◽  
Randomised Controlled ◽  
Process Evaluations

ObjectiveProcess evaluations (PEs) alongside randomised controlled trials of complex interventions are valuable because they address questions of for whom, how and why interventions had an impact. We synthesised the methods used in PEs of primary care interventions, and their main findings on implementation barriers and facilitators.DesignSystematic review using the UK Medical Research Council guidance for PE as a guide.Data sourcesAcademic databases (MEDLINE, SCOPUS, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, EMBASE and Global Health) were searched from 1998 until June 2018.Eligibility criteriaWe included PE alongside randomised controlled trials of primary care interventions which aimed to improve outcomes for patients with non-communicable diseases.Data extraction and synthesisTwo independent reviewers screened and conducted the data extraction and synthesis, with a third reviewer checking a sample for quality assurance.Results69 studies were included. There was an overall lack of consistency in how PEs were conducted and reported. The main weakness is that only 30 studies were underpinned by a clear intervention theory often facilitated by the use of existing theoretical frameworks. The main strengths were robust sampling strategies, and the triangulation of qualitative and quantitative data to understand an intervention’s mechanisms. Findings were synthesised into three key themes: (1) a fundamental mismatch between what the intervention was designed to achieve and local needs; (2) the required roles and responsibilities of key actors were often not clearly understood; and (3) the health system context—factors such as governance, financing structures and workforce—if unanticipated could adversely impact implementation.ConclusionGreater consistency is needed in the reporting and the methods of PEs, in particular greater use of theoretical frameworks to inform intervention theory. More emphasis on formative research in designing interventions is needed to align the intervention with the needs of local stakeholders, and to minimise unanticipated consequences due to context-specific barriers.PROSPERO registration numberCRD42016035572.

scholarly journals Prehospital randomised assessment of a mechanical compression device in out-of-hospital cardiac arrest (PARAMEDIC): a pragmatic, cluster randomised trial and economic evaluation

2017 ◽  
Vol 21 (11) ◽  
pp. 1-176 ◽  
Author(s):  
Simon Gates ◽  
Ranjit Lall ◽  
Tom Quinn ◽  
Charles D Deakin ◽  
Matthew W Cooke ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Economic ◽  
Cardiac Arrest ◽  
Chest Compression ◽  
Randomised Trial ◽  
Health Technology ◽  
Cluster Randomised Trial ◽  
Cluster Randomised ◽  
Mechanical Chest Compression ◽  
Hospital Cardiac Arrest

BackgroundMechanical chest compression devices may help to maintain high-quality cardiopulmonary resuscitation (CPR), but little evidence exists for their effectiveness. We evaluated whether or not the introduction of Lund University Cardiopulmonary Assistance System-2 (LUCAS-2; Jolife AB, Lund, Sweden) mechanical CPR into front-line emergency response vehicles would improve survival from out-of-hospital cardiac arrest (OHCA).ObjectiveEvaluation of the LUCAS-2 device as a routine ambulance service treatment for OHCA.DesignPragmatic, cluster randomised trial including adults with non-traumatic OHCA. Ambulance dispatch staff and those collecting the primary outcome were blind to treatment allocation. Blinding of the ambulance staff who delivered the interventions and reported initial response to treatment was not possible. We also conducted a health economic evaluation and a systematic review of all trials of out-of-hospital mechanical chest compression.SettingFour UK ambulance services (West Midlands, North East England, Wales and South Central), comprising 91 urban and semiurban ambulance stations. Clusters were ambulance service vehicles, which were randomly assigned (approximately 1 : 2) to the LUCAS-2 device or manual CPR.ParticipantsPatients were included if they were in cardiac arrest in the out-of-hospital environment. Exclusions were patients with cardiac arrest as a result of trauma, with known or clinically apparent pregnancy, or aged < 18 years.InterventionsPatients received LUCAS-2 mechanical chest compression or manual chest compressions according to the first trial vehicle to arrive on scene.Main outcome measuresSurvival at 30 days following cardiac arrest; survival without significant neurological impairment [Cerebral Performance Category (CPC) score of 1 or 2].ResultsWe enrolled 4471 eligible patients (1652 assigned to the LUCAS-2 device and 2819 assigned to control) between 15 April 2010 and 10 June 2013. A total of 985 (60%) patients in the LUCAS-2 group received mechanical chest compression and 11 (< 1%) patients in the control group received LUCAS-2. In the intention-to-treat analysis, 30-day survival was similar in the LUCAS-2 (104/1652, 6.3%) and manual CPR groups [193/2819, 6.8%; adjusted odds ratio (OR) 0.86, 95% confidence interval (CI) 0.64 to 1.15]. Survival with a CPC score of 1 or 2 may have been worse in the LUCAS-2 group (adjusted OR 0.72, 95% CI 0.52 to 0.99). No serious adverse events were noted. The systematic review found no evidence of a survival advantage if mechanical chest compression was used. The health economic analysis showed that LUCAS-2 was dominated by manual chest compression.LimitationsThere was substantial non-compliance in the LUCAS-2 arm. For 272 out of 1652 patients (16.5%), mechanical chest compression was not used for reasons that would not occur in clinical practice. We addressed this issue by using complier average causal effect analyses. We attempted to measure CPR quality during the resuscitation attempts of trial participants, but were unable to do so.ConclusionsThere was no evidence of improvement in 30-day survival with LUCAS-2 compared with manual compressions. Our systematic review of recent randomised trials did not suggest that survival or survival without significant disability may be improved by the use of mechanical chest compression.Future workThe use of mechanical chest compression for in-hospital cardiac arrest, and in specific circumstances (e.g. transport), has not yet been evaluated.TriaI registrationCurrent Controlled Trials ISRCTN08233942.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 11. See the NIHR Journals Library website for further project information.

scholarly journals Process evaluation protocol of a cluster randomised trial for a scalable solution for delivery of Diabetes Self-Management Education in Thailand (DSME-T)

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e056141
Author(s):  
Iliatha Papachristou Nadal ◽  
Chanchanok Aramrat ◽  
Wichuda Jiraporncharoen ◽  
Kanokporn Pinyopornpanish ◽  
Nutchar Wiwatkunupakarn ◽  
...  
Keyword(s):  
Process Evaluation ◽  
Repeated Measures ◽  
Management Education ◽  
Health Workers ◽  
Randomised Trial ◽  
Complex Interventions ◽  
Self Management ◽  
Cluster Randomised Trial ◽  
London School ◽  
Successful Implementation

IntroductionType 2 diabetes mellitus is a major global challenge, including for Thai policy-makers, as an estimated 4 million people in Thailand (population 68 million) have this condition. Premature death and disability due to diabetes are primarily due to complications which can be prevented by good risk factor control. Diabetes Self-Management Education (DSME) programmes provide patients with diabetes with the necessary knowledge and skills to effectively manage their disease. Currently, a trial is being conducted in Thailand to evaluate the effectiveness, defined as HbA1c<7 at 12 months after enrolment, of a culturally tailored DSME in Thailand. A process evaluation can provide further interpretation of the results from complex interventions as well as insight into the success of applying the programme into a broader context.Methods and analysisThe aim of the process evaluation is to understand how and why the intervention was effective or ineffective and to identify contextually relevant strategies for future successful implementation. For the process evaluation, the design will be a mixed-method study collecting data from nurse providers, and village health volunteers (community health workers) as well as patients. This will be conducted using observations, interviews and focus groups from the three purposively selected groups at the beginning and end of trial. Quantitative data will be collected through surveys conducted at the beginning, during 6-month follow-up, and at the end of trial. The mixed-methods analysis will be triangulated to assess differences and similarities across the various data sources. The overall effectiveness of the intervention will be examined using multilevel analysis of repeated measures.Ethics and disseminationStudy approved by the Chiang Mai University Research Ethics Committee (326/2018) and the London School of Hygiene & Tropical Medicine (16113/RR/12850). Results will be published in open access, peer-reviewed scientific journals.Trial registration numberNCT03938233.

scholarly journals Effect of intra-partum Oxytocin on neonatal encephalopathy: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Constance Burgod ◽  
Stuti Pant ◽  
Maria Moreno Morales ◽  
Paolo Montaldo ◽  
Phoebe Ivain ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Meta Analysis ◽  
Randomised Trial ◽  
Risk Of Bias ◽  
Cluster Randomised Trial ◽  
Analysis Model ◽  
Neonatal Encephalopathy ◽  
Case Control Studies ◽  
Middle Income

Abstract Background Oxytocin is widely used for induction and augmentation of labour, particularly in low- and middle-income countries (LMICs). In this systematic review and meta-analysis, we examined the effect of intra-partum Oxytocin use on neonatal encephalopathy. Methods The protocol for this study was registered with PROSPERO (ID: CRD42020165049). We searched Medline, Embase and Web of Science Core Collection databases for papers published between January 1970 and May 2021. We considered all studies involving term and near-term (≥36 weeks’ gestation) primigravidae and multiparous women. We included all randomised, quasi-randomised clinical trials, retrospective studies and non-randomised prospective studies reporting intra-partum Oxytocin administration for induction and/or augmentation of labour. Our primary outcome was neonatal encephalopathy. Risk of bias was assessed in non-randomised studies using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. The RoB 2.0 tool was used for randomised studies. A Mantel-Haenszel statistical method and random effects analysis model were used for meta-analysis. Odds ratios were used to determine effect measure and reported with 95% confidence intervals. Results We included data from seven studies (6 Case-control studies, 1 cluster-randomised trial) of which 3 took place in high-income countries (HICs) and 4 in LMICs. The pooled data included a total of 24,208 women giving birth at or after 36 weeks; 7642 had intra-partum Oxytocin for induction and/or augmentation of labour, and 16,566 did not receive intra-partum Oxytocin. Oxytocin use was associated with an increased prevalence of neonatal encephalopathy (Odds Ratio 2.19, 95% CI 1.58 to 3.04; p < 0.00001). Conclusions Intra-partum Oxytocin may increase the risk of neonatal encephalopathy. Future clinical trials of uterotonics should include neonatal encephalopathy as a key outcome.

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