scholarly journals Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e045343
Author(s):  
Ray Moynihan ◽  
Sharon Sanders ◽  
Zoe A Michaleff ◽  
Anna Mae Scott ◽  
Justin Clark ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Outcome ◽  
Unmet Need ◽  
Healthcare Utilisation ◽  
Healthcare Services ◽  
Risk Of Bias ◽  
Secondary Outcome ◽  
Severe Illness ◽  
Service Utilisation ◽  
Registration Number

ObjectivesTo determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic.DesignSystematic review.EligibilityEligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics and therapeutics. Studies were excluded if from single centres or studied only patients with COVID-19.Data sourcesPubMed, Embase, Cochrane COVID-19 Study Register and preprints were searched, without language restrictions, until 10 August, using detailed searches with key concepts including COVID-19, health services and impact.Data analysisRisk of bias was assessed by adapting the Risk of Bias in Non-randomised Studies of Interventions tool, and a Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures and narrative synthesis.Outcome measuresPrimary outcome was change in service utilisation between prepandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (eg, triage scores).Results3097 unique references were identified, and 81 studies across 20 countries included, reporting on >11 million services prepandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (IQR −51% to −20%), comprising median reductions for visits of 42% (−53% to −32%), admissions 28% (−40% to −17%), diagnostics 31% (−53% to −24%) and for therapeutics 30% (−57% to −19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27 (45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no difference.ConclusionsHealthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health systems reduce unnecessary care in the postpandemic recovery.PROSPERO registration numberCRD42020203729.

scholarly journals Pandemic impacts on healthcare utilisation: a systematic review

2020 ◽  
Author(s):  
Ray Moynihan ◽  
Sharon Sanders ◽  
Zoe A Michaleff ◽  
Anna Scott ◽  
Justin Clark ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Systems ◽  
Primary Outcome ◽  
Healthcare Utilisation ◽  
Healthcare Services ◽  
Data Sources ◽  
Secondary Outcome ◽  
Severe Illness ◽  
Service Utilisation ◽  
List Type

AbstractObjectivesTo determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic.DesignSystematic reviewEligibilityEligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics, and therapeutics. Studies were excluded if from single-centres or studied only COVID-19 patients.Data sourcesPubMed, Embase, Cochrane COVID-19 Study Register, and pre-prints were searched, without language restrictions, until August 10, using detailed searches with key concepts including COVID-19, health services and impact.Data analysisRisk of bias was assessed by adapting ROBINS-I and Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures, and narrative synthesis.Outcome measuresPrimary outcome was change in service utilisation between pre-pandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (e.g. triage scores).Results3097 unique references were identified, and 81 studies across 20 countries included, reporting on >11 million services pre-pandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (interquartile range −51% to −20%), comprising median reductions for visits of 42%(−53% to −32%), admissions, 28%(−40% to −17%), diagnostics, 31%(−53% to −24%), and for therapeutics, 30%(−57% to −19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27(45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no change.ConclusionsHealthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health-systems prioritise higher-value care in the post-pandemic recovery.Funding, Study registrationNo funding was required. PROSPERO: CRD42020203729Strengths and limitations of this study–The review is the first broad synthesis of global studies of pandemic related changes in utilisation across all categories of healthcare services.–The review provides novel findings informing design of future studies of pandemic-related changes in utilisation and its impacts.–Limitations include the possibility of publication bias and the potential of our eligibility criteria to exclude important data sources such as studies in single-centres and unpublished datasets from health systems.–Heterogenous designs and settings precluding meta-analysis.

scholarly journals How much evidence is there that political factors are related to population health outcomes? An internationally comparative systematic review

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e020886 ◽  
Author(s):  
Max Barnish ◽  
Michelle Tørnes ◽  
Becky Nelson-Horne
Keyword(s):  
Systematic Review ◽  
Welfare State ◽  
Health Outcomes ◽  
Population Health ◽  
Positive Association ◽  
Risk Of Bias ◽  
Secondary Outcome ◽  
Bibliographic Databases ◽  
Previous Systematic Review ◽  
Political Tradition

ObjectivesTo provide a 7-year update of the most recent systematic review about the relationships between political features and population health outcomes.SettingInternationally comparative scholarly literature.Data sourcesTen scholarly bibliographic databases plus supplementary searches in bibliographies and Google Scholar were used to update a previous systematic review. The final search was conducted in November 2017.Primary and secondary outcome measuresAny population health outcome measure, apart from healthcare spending.Results73 unique publications were identified from the previous systematic review. The database searches to update the literature identified 45 356 raw records with 35 207 remaining following de-duplication. 55 publications were identified from supplementary searches. In total, 258 publications proceeded to full-text review and 176 were included in narrative synthesis. 85 studies were assessed at low risk of bias, 89 at moderate risk of bias and none at high risk of bias. Assessment could not be conducted for two studies that had only book chapters. No meta-analysis was conducted. 102 studies assessed welfare state generosity and 79 found a positive association. Of the 17 studies that assessed political tradition, 15 were found to show a positive association with the left-of-centre tradition. 44 studies assessed democracy and 34 found a positive association. 28 studies assessed globalisation and 14 found a negative association, while seven were positive and seven inconclusive.ConclusionsThis review concludes that welfare state generosity, left-of-centre democratic political tradition and democracy are generally positively associated with population health. Globalisation may be negatively associated with population health, but the results are less conclusive. It is important for the academic public health community to engage with the political evidence base in its research as well as in stakeholder engagement, in order to facilitate positive outcomes for population health.

scholarly journals Pharmacogenetics of Type 2 diabetes mellitus: A Systematic Review Protocol (Preprint)

2019 ◽  
Author(s):  
Hamid Reza Aghaei Meybodi ◽  
Negar Sarhangi ◽  
Anoosh Naghavi ◽  
Marzieh Rahbaran ◽  
Maryam Hassani Doabsari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Data Extraction ◽  
Relevant Information ◽  
Risk Of Bias ◽  
Cochrane Database ◽  
Registration Number ◽  
Newcastle Ottawa Scale ◽  
Review Protocol

UNSTRUCTURED The objective of this systematic review is to determine the effect of genetic variants that associate with antidiabetic medications and their efficacy and toxicity in T2DM patients. The understanding may allow interventions for improving management of T2DM and later systematically evaluated in more in-depth studies. We will have performed a comprehensive search using PubMed, Scopus, EMBASE, Web of Sciences and Cochrane database from 1990 to 2018. Relevant journals and references of all included studies will be hand searched to find the additional studied. Eligible studies such as pharmacogenetics studies in terms of drug response and toxicity in the type 2 diabetes patients and performed just on human will be included. Data extraction and quality assessment will be carried out by two independent reviewers and disagreements will be resolved through third expert reviewer. Risk of bias will be assessed with the Cochrane Risk of Bias tool for randomized studies and Newcastle-Ottawa Scale (NOS) for observational Studies. Narrative synthesis will be conducted by the combination of key findings. The results of this study will be submitted to a peer-reviewed journal for publication and also presented at PROSPERO. We expect this review will provide highly relevant information for clinicians, pharmaceutical industry that will benefit from the summary of the best available data regarding the efficacy of antidiabetic medication in the aspect of pharmacogenetics. PROSPERO Registration number (CRD42018104843)

scholarly journals Effect of dose administration aids on adherence to self-administered medications: a systematic review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e030536
Author(s):  
Kanika Chaudhri ◽  
Madeleine Kearney ◽  
Richard O Day ◽  
Anthony Rodgers ◽  
Emily Atkins
Keyword(s):  
Systematic Review ◽  
Health Outcomes ◽  
Meta Analysis ◽  
Study Participant ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Dose Administration ◽  
Common Solution ◽  
The Impact

IntroductionForgetting to take a medication is the most common reason for non-adherence to self-administered medication. Dose administration aids (DAAs) are a simple and common solution to improve unintentional non-adherence for oral tablets. DAAs can be in the form of compartmentalised pill boxes, automated medication dispensing devices, blister packs and sachets packets. This protocol aims to outline the methods that will be used in a systematic review of the current literature to assess the impact of DAAs on adherence to medications and health outcomes.Methods and analysisRandomised controlled trials will be identified through electronic searches in databases including EMBASE, MEDLINE, CINAHL and the Cochrane Library, from the beginning of each database until January 2020. Two reviewers will independently screen studies and extract data using the standardised forms. Data extracted will include general study information, characteristics of the study, participant characteristics, intervention characteristics and outcomes. Primary outcome is to assess the effects of DAAs on medication adherence. Secondary outcome is to evaluate the changes in health outcomes. The risk of bias will be ascertained by two reviewers in parallel using The Cochrane Risk of Bias Tool. A meta-analysis will be performed if data are homogenous.Ethics and disseminationEthics approval will not be required for this study. The results of the review described within this protocol will be disseminated through publication in a peer-reviewed journal and relevant conference presentations.PROSPERO registration numberCRD42018096087

scholarly journals Should home-based ovulation predictor kits be offered as an additional approach for fertility management for women and couples desiring pregnancy? A systematic review and meta-analysis

2019 ◽  
Vol 4 (2) ◽  
pp. e001403 ◽  
Author(s):  
Ping Teresa Yeh ◽  
Caitlin E Kennedy ◽  
Sheryl Van der Poel ◽  
Thabo Matsaseng ◽  
Laura Bernard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Observational Study ◽  
Pregnancy Rate ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Time To Pregnancy ◽  
Fertility Management ◽  
Home Based ◽  
Registration Number

IntroductionTo inform the WHO Guideline on self-care interventions, we conducted a systematic review of the impact of ovulation predictor kits (OPKs) on time-to-pregnancy, pregnancy, live birth, stress/anxiety, social harms/adverse events and values/preferences.MethodsIncluded studies had to compare women desiring pregnancy who managed their fertility with and without OPKs, measure an outcome of interest and be published in a peer-reviewed journal. We searched for studies on PubMed, CINAHL, LILACS and EMBASE through November 2018. We assessed risk of bias assessed using the Cochrane tool for randomised controlled trials (RCTs) and the Evidence Project tool for observational studies, and conducted meta-analysis using random effects models to generate pooled estimates of relative risk (RR).ResultsFour studies (three RCTs and one observational study) including 1487 participants, all in high-income countries, were included. Quality of evidence was low. Two RCTs found no difference in time-to-pregnancy. All studies reported pregnancy rate, with mixed results: one RCT from the 1990s among couples with unexplained or male-factor infertility found no difference in clinical pregnancy rate (RR: 1.09, 95% CI 0.51 to 2.32); two more recent RCTs found higher self-reported pregnancy rates among OPK users (pooled RR: 1.40, 95% CI 1.08 to 1.80). A small observational study found higher rates of pregnancy with lab testing versus OPKs among women using donor insemination services. One RCT found no increase in stress/anxiety after two menstrual cycles using OPKs, besides a decline in positive affect. No studies measured live birth or social harms/adverse events. Six studies presented end-users’ values/preferences, with almost all women reporting feeling satisfied, comfortable and confident using OPKs.ConclusionA small evidence base, from high-income countries and with high risk of bias, suggests that home-based use of OPKs may improve fertility management when attempting to become pregnant with no meaningful increase in stress/anxiety and with high user acceptability.Systematic review registration numberPROSPERO registration number CRD42019119402.

scholarly journals Classifying atopic dermatitis: protocol for a systematic review of subtypes (phenotypes) and associated characteristics

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e023097 ◽  
Author(s):  
Amy R Mulick ◽  
Victoria Allen ◽  
Hywel C Williams ◽  
Douglas J C Grindlay ◽  
Neil Pearce ◽  
...  
Keyword(s):  
Systematic Review ◽  
Atopic Dermatitis ◽  
Complex Disease ◽  
Methodological Approach ◽  
Secondary Outcome ◽  
Cross Sectional ◽  
Ovid Medline ◽  
Clinical Presentations ◽  
Ethical Approval ◽  
Registration Number

IntroductionAtopic dermatitis is a complex disease with differing clinical presentations. Many attempts have been made to identify uniform subtypes, or phenotypes, of atopic dermatitis in order to identify different aetiologies, improve diagnosis, estimate more accurate clinical prognoses, inform treatment andmanagement or predict treatment efficacy andeffectiveness. However, no consensus yet exists on exactly what defines these phenotypes or how many there are and whether they are genuine or statistical artefacts. This review aims to identify previously reported phenotypes of atopic dermatitis, the features used to define them and any characteristics or clinical outcomes significantly associated with them.Methods and analysisWe will search Ovid Embase, Ovid MEDLINE and Web of Science from inception to the latest available date at the time of the search for studies attempting to classify atopic dermatitis in humans using any cross-sectional or longitudinal epidemiological or interventional design. Primary outcomes are atopic dermatitis phenotypes, features used to define them and characteristics associated with them in subsequent analyses. A secondary outcome is the methodological approach used to derive them. Two reviewers will independently screen titles and abstracts for inclusion, extract data and assess study quality. We will present the results of this review descriptively and with frequencies where possible.Ethics and disseminationEthical approval is not required for this study as it is a systematic review. We will report results from this systematic review in a peer-reviewed journal. The main value of this study will be to inform further research.PROSPERO registration numberCRD42018087500

scholarly journals The use of triclosan-coated sutures to prevent surgical site infections: a systematic review and meta-analysis of the literature

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029727 ◽  
Author(s):  
Imran Ahmed ◽  
Adam Jonathan Boulton ◽  
Sana Rizvi ◽  
William Carlos ◽  
Edward Dickenson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Fixed Effects ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Surgical Site Infections ◽  
Causative Factor ◽  
Fixed Effects Model ◽  
Surgical Interventions ◽  
Registration Number ◽  
Randomised Controlled

Introduction and objectivesSurgical site infections (SSIs) represent a common and serious complication of all surgical interventions. Microorganisms are able to colonise sutures that are implanted in the skin, which is a causative factor of SSIs. Triclosan-coated sutures are antibacterial sutures aimed at reducing SSIs. Our objective is to update the existing literature by systematically reviewing available evidence to assess the effectiveness of triclosan-coated sutures in the prevention of SSIs.MethodsA systematic review of EMBASE, MEDLINE, AMED (Allied and complementary medicine database) and CENTRAL was performed to identify full text randomised controlled trials (RCTs) on 31 May 2019.InterventionTriclosan-coated sutures versus non-triclosan-coated sutures.Primary outcomeOur primary outcome was the development of SSIs at 30 days postoperatively. A meta-analysis was performed using a fixed-effects model.ResultsTwenty-five RCTs were included involving 11 957 participants. Triclosan-coated sutures were used in 6008 participants and non triclosan-coated sutures were used in 5949. Triclosan-coated sutures significantly reduced the risk of SSIs at 30 days (relative risk 0.73, 95% CI 0.65 to 0.82). Further sensitivity analysis demonstrated that triclosan-coated sutures significantly reduced the risk of SSIs in both clean and contaminated surgery.ConclusionTriclosan-coated sutures have been shown to significantly reduced the risk of SSIs when compared with standard sutures. This is in agreement with previous work in this area. This study represented the largest review to date in this area. This moderate quality evidence recommends the use of triclosan-coated sutures in order to reduce the risk of SSIs particularly in clean and contaminated surgical procedures.PROSPERO registration numberCRD42014014856

scholarly journals Comparison of two bedside evaluation methods of dysphagia in patients with acute stroke

2018 ◽  
Vol 3 (4) ◽  
pp. 237-244 ◽  
Author(s):  
Ting Ye ◽  
Shengyan Huang ◽  
Yi Dong ◽  
Qiang Dong
Keyword(s):  
Acute Stroke ◽  
Prospective Observational Study ◽  
Primary Outcome ◽  
Tube Feeding ◽  
Predictive Ability ◽  
Secondary Outcome ◽  
Test Results ◽  
Volume Viscosity ◽  
Registration Number ◽  
Positive Results

BackgroundDysphagia is a common complication after stroke. Water swallowing test (WST) is a recognised but limited tool in providing details about dysphagia, including severity and how to adjust the diet based on the test results.MethodsWe performed a prospective observational study of comparing WST and volume–viscosity swallow test (V-VST) in patients with acute stroke within 14 days. All patients had WST and if failed would have a V-VST. The primary outcome was to compare the dysphagia levels assessed by these two test tools. The secondary outcome was to explore the predictive capability in patients who were at high risk of pneumonia by these two swallowing tests.ResultsConsecutively 276 patients with stroke were enrolled in our study, and 197 had normal WST. Among 79 patients who had both WST and V-VST, 20 showed swallowing safety and effectiveness by V-VST. The chance of being on tube feeding was strongly related to the positive results of failed WST (p<0.001). Both tests showed good predictive ability in patients with stroke for pneumonia even some of them were placed on tube feeding (p=0.001 in WST and p<0.001 in V-VST).ConclusionsV-VST performed better as a clinical screening test for dysphagia in patients with acute stroke at the bedside.Trial registration numberChiCTR1800016442.

scholarly journals Effectiveness of physical activity interventions for overweight and obesity during pregnancy: a systematic review of the content of behaviour change interventions

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Caragh Flannery ◽  
Milou Fredrix ◽  
Ellinor K. Olander ◽  
Fionnuala M. McAuliffe ◽  
Molly Byrne ◽  
...  
Keyword(s):  
Systematic Review ◽  
Physical Fitness ◽  
Pregnant Women ◽  
Behaviour Change ◽  
Meta Analysis ◽  
Intervention Group ◽  
Overweight And Obesity ◽  
Risk Of Bias ◽  
The Other ◽  
Secondary Outcome

Abstract Background Behaviour change techniques (BCTs) employed within PA intervention for pregnant women with a healthy body mass index (BMI) have been previously identified, however, these BCTS may differ for other weight profiles during pregnancy. The aim of this current review was to identify and summarise the evidence for effectiveness of PA interventions on PA levels for pregnant women with overweight and obesity, with an emphasis on the BCTs employed. Methods A systematic review and meta-analysis of PA intervention studies using the PRISMA statement was conducted. Searches were conducted of eight databases in January 2019. Strict inclusion/exclusion criteria were employed. The validity of each included study was assessed using the Cochrane Collaboration’s tool for assessing risk of bias. The primary outcome measure was change in PA levels, subjectively or objectively measured, with physical fitness as a secondary outcome. All intervention descriptions were double coded by two authors using Michie’s et al’s BCT taxonomy V1. Meta-analyses using random effect models assessed the intervention effects on PA. Other PA outcomes were summarised in a narrative synthesis. Results From 8389 studies, 19 met the inclusion criteria 13 of which were suitable for inclusion in a meta-analysis. The remaining 6 studies were described narratively due to insufficient data and different outcome measures reported. In the meta-analysis, comparing interventions to a control group, significant increases were found in the intervention group for metabolic equivalent (SMD 0.39 [0.14, 0.64], Z = 3.08 P = 0.002) and physical fitness (VO2 max) (SMD 0.55 [0.34, 0.75], Z = 5.20 P = < 0.001). Of the other six, five studies reported an increase in PA for the intervention group versus the control with the other study reporting a significant decrease for women in their 3rd trimester (p = 0.002). ‘Self-monitoring of behaviour’ was the most frequently used BCTs (76.5%), with ‘social support’ being newly identified for this pregnant population with overweight or obesity. Conclusions This review identified a slight increase in PA for pregnant women with overweight and obesity participating in interventions. However, due to the high risk of bias of the included studies, the results should be interpreted with caution. PA measures should be carefully selected so that studies can be meaningfully compared and standardised taxonomies should be used so that BCTs can be accurately assessed.

scholarly journals Increased fluid intake to prevent urinary tract infections: systematic review and meta-analysis

2020 ◽  
Vol 70 (692) ◽  
pp. e200-e207 ◽  
Author(s):  
Anna Mae Scott ◽  
Justin Clark ◽  
Chris Del Mar ◽  
Paul Glasziou
Keyword(s):  
Systematic Review ◽  
At Risk ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Primary Outcome ◽  
Fluid Intake ◽  
Risk Of Bias ◽  
Antimicrobial Use ◽  
Recurrent Utis ◽  
Tract Infections

BackgroundApproximately 15% of community-prescribed antibiotics are used in treating urinary tract infections (UTIs). Increase in antibiotic resistance necessitates considering alternatives.AimTo assess the impact of increased fluid intake in individuals at risk for UTIs, for impact on UTI recurrence (primary outcome), antimicrobial use, and UTI symptoms (secondary outcomes).Design and settingA systematic review.MethodThe authors searched PubMed, Cochrane CENTRAL, EMBASE, two trial registries, and conducted forward and backward citation searches of included studies in January 2019. Randomised controlled trials of individuals at risk for UTIs were included; comparisons with antimicrobials were excluded. Different time-points (≤6 months and 12 months) were compared for the primary outcome. Risk of bias was assessed using Cochrane Risk of Bias tool. Meta-analyses were undertaken where ≥3 studies reported the same outcome.ResultsEight studies were included; seven were meta-analysed. There was a statistically non-significant reduction in the number of patients with any UTI recurrence in the increased fluid intake group compared with control after 12 months (odds ratio [OR] 0.39, 95% confidence interval [CI] = 0.15 to 1.03, P = 0.06); reduction was significant at ≤6 months (OR 0.13, 95% CI = 0.07 to 0.25, P<0.001). Excluding studies with low volume of fluid (<200 ml) significantly favoured increased fluid intake (OR 0.25, 95% CI = 0.11 to 0.59, P = 0.001). Increased fluid intake reduced the overall rate of all recurrent UTIs (rate ratio [RR] 0.46, 95% CI = 0.40 to 0.54, P<0.001); there was no difference in antimicrobial use (OR 0.52, 95% CI = 0.25 to 1.07, P = 0.08). Paucity of data precluded meta-analysing symptoms.ConclusionGiven the minimal potential for harm, patients with recurrent UTIs could be advised to drink more fluids to reduce recurrent UTIs. Further research is warranted to establish the optimal volume and type of increased fluid.

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