Abstract 210: Implementation of Appropriate Use Criteria for Cardiology Tests and Procedures: A Systematic Review and Meta-analysis

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
David E Winchester ◽  
Justin Merritt ◽  
Nida Waheed ◽  
Hannah Norton ◽  
Veena Manja ◽  
...  
Keyword(s):  
Implementation Strategy ◽  
Data Extraction ◽  
Meta Analysis ◽  
A Priori ◽  
Intervention Strategy ◽  
Implementation Strategies ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Appropriate Care ◽  
Specific Implementation

Background: The American College of Cardiology appropriate use criteria (AUC) provide clinicians with evidence-informed recommendations for cardiac care. Adopting AUC into clinical workflows may present challenges, and there may be specific implementation strategies that are effective in promoting effective use of AUC. We sought to assess the effect of implementing AUC in clinical practice. Methods: We conducted a meta-analysis of studies found through a systematic search of the MEDLINE, Web of Science, Cochrane, or CINAHL databases. Peer-reviewed manuscripts published after 2005 that reported on the implementation of AUC for a cardiovascular test or procedure were included. The analysis protocol was submitted a priori to the PROSPERO international prospective register of systematic reviews. We used a structured data extraction spreadsheet for elements such as study design, implementation strategy, and primary outcome. Results: We included 18 studies, the majority used pre/post cohort designs; few (n=3) were randomized trials. Most studies used multiple strategies (n=12, 66.7%). Education was the most common individual intervention strategy (n=13, 72.2%), followed by audit & feedback (n=8, 44.4%) and computerized physician order entry (CPOE) (n=6, 33.3%). No studies reported on formal use of stakeholder engagement or “nudges”. In meta-analysis, AUC implementation was associated with a reduction in inappropriate/rarely appropriate care (odds ratio 0.62, 95 % confidence interval 0.49-0.78). Funnel plot suggests the possibility of publication bias. Conclusions: We found most published efforts to implement AUC succeeded at reducing inappropriate/rarely appropriate care. Studies rarely explored how or why the implementation strategy was effective. Because interventions were infrequently tested in isolation, it is difficult to make observations about their effectiveness as stand-alone strategies.

scholarly journals Implementation of appropriate use criteria for cardiology tests and procedures: a systematic review and meta-analysis

2020 ◽  
Author(s):  
David E Winchester ◽  
Justin Merritt ◽  
Nida Waheed ◽  
Hannah Norton ◽  
Veena Manja ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Intervention Strategy ◽  
Implementation Strategies ◽  
Audit And Feedback ◽  
Appropriate Use Criteria ◽  
Appropriate Use ◽  
Appropriate Care ◽  
Specific Implementation ◽  
Effective Use ◽  
Physician Order Entry

Abstract Aims The American College of Cardiology appropriate use criteria (AUC) provide clinicians with evidence-informed recommendations for cardiac care. Adopting AUC into clinical workflows may present challenges, and there may be specific implementation strategies that are effective in promoting effective use of AUC. We sought to assess the effect of implementing AUC in clinical practice. Methods and results We conducted a meta-analysis of studies found through a systematic search of the MEDLINE, Web of Science, Cochrane, or CINAHL databases. Peer-reviewed manuscripts published after 2005 that reported on the implementation of AUC for a cardiovascular test or procedure were included. The main outcome was to determine if AUC implementation was associated with a reduction in inappropriate/rarely appropriate care. Of the 18 included studies, the majority used pre/post-cohort designs; few (n = 3) were randomized trials. Most studies used multiple strategies (n = 12, 66.7%). Education was the most common individual intervention strategy (n = 13, 72.2%), followed by audit and feedback (n = 8, 44.4%) and computerized physician order entry (n = 6, 33.3%). No studies reported on formal use of stakeholder engagement or ‘nudges’. In meta-analysis, AUC implementation was associated with a reduction in inappropriate/rarely appropriate care (odds ratio 0.62, 95% confidence interval 0.49–0.78). Funnel plot suggests the possibility of publication bias. Conclusion We found most published efforts to implement AUC observed reductions in inappropriate/rarely appropriate care. Studies rarely explored how or why the implementation strategy was effective. Because interventions were infrequently tested in isolation, it is difficult to make observations about their effectiveness as stand-alone strategies. Study registration PROSPERO 2018 CRD42018091602. Available from https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018091602.

scholarly journals Safety and efficiency of gasless laparoscopy: a systematic review protocol

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Haitham Shoman ◽  
Simone Sandler ◽  
Alexander Peters ◽  
Ameer Farooq ◽  
Magdalen Gruendl ◽  
...  
Keyword(s):  
Systematic Review ◽  
Assessment Tool ◽  
Data Extraction ◽  
Meta Analysis ◽  
A Priori ◽  
Risk Of Bias ◽  
Conventional Laparoscopy ◽  
Eligibility Criteria ◽  
Gasless Laparoscopy ◽  
Resource Setting

Abstract Background Gasless laparoscopy, developed in the early 1990s, was a means to minimize the clinical and financial challenges of pneumoperitoneum and general anaesthesia. It has been used in a variety of procedures such as in general surgery and gynecology procedures including diagnostic laparoscopy. There has been increasing evidence of the utility of gasless laparoscopy in resource limited settings where diagnostic imaging is not available. In addition, it may help save costs for hospitals. The aim of this study is to conduct a systematic review of the available evidence surrounding the safety and efficiency of gasless laparoscopy compared to conventional laparoscopy and open techniques and to analyze the benefits that gasless laparoscopy has for low resource setting hospitals. Methods This protocol is developed by following the Preferred Reporting Items for Systematic review and Meta-Analysis–Protocols (PRISMA-P). The PRISMA statement guidelines and flowchart will be used to conduct the study itself. MEDLINE (Ovid), Embase, Web of Science, Cochrane Central, and Global Index Medicus (WHO) will be searched and the National Institutes of Health Clinical Trials database. The articles that will be found will be pooled into Covidence article manager software where all the records will be screened for eligibility and duplicates removed. A data extraction spreadsheet will be developed based on variables of interest set a priori. Reviewers will then screen all included studies based on the eligibility criteria. The GRADE tool will be used to assess the quality of the studies and the risk of bias in all the studies will be assessed using the Cochrane Risk assessment tool. The RoB II tool will assed the risk of bias in randomized control studies and the ROBINS I will be used for the non-randomized studies. Discussion This study will be a comprehensive review on all published articles found using this search strategy on the safety and efficiency of the use of gasless laparoscopy. The systematic review outcomes will include safety and efficiency of gasless laparoscopy compared to the use of conventional laparoscopy or laparotomy. Trial registration The study has been registered in PROSPERO under registration number: CRD42017078338

scholarly journals Condition-Based Maintenance—An Extensive Literature Review

Machines ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 31 ◽  
Author(s):  
Elena Quatrini ◽  
Francesco Costantino ◽  
Giulio Di Gravio ◽  
Riccardo Patriarca
Keyword(s):  
Literature Review ◽  
Meta Analysis ◽  
Implementation Strategies ◽  
Research Field ◽  
Condition Based Maintenance ◽  
Future Research ◽  
Extensive Literature ◽  
Main Research ◽  
Extensive Literature Review ◽  
Specific Implementation

This paper presents an extensive literature review on the field of condition-based maintenance (CBM). The paper encompasses over 4000 contributions, analysed through bibliometric indicators and meta-analysis techniques. The review adopts Factor Analysis as a dimensionality reduction, concerning the metric of the co-citations of the papers. Four main research areas have been identified, able to delineate the research field synthetically, from theoretical foundations of CBM; (i) towards more specific implementation strategies (ii) and then specifically focusing on operational aspects related to (iii) inspection and replacement and (iv) prognosis. The data-driven bibliometric results have been combined with an interpretative research to extract both core and detailed concepts related to CBM. This combined analysis allows a critical reflection on the field and the extraction of potential future research directions.

scholarly journals Menstrual Hygiene Preparedness Among Schools in India: A Systematic Review and Meta-Analysis of System-and Policy-Level Actions

2020 ◽  
Vol 17 (2) ◽  
pp. 647 ◽  
Author(s):  
Shantanu Sharma ◽  
Devika Mehra ◽  
Nele Brusselaers ◽  
Sunil Mehra
Keyword(s):  
Systematic Review ◽  
Data Extraction ◽  
Meta Analysis ◽  
A Priori ◽  
Common Source ◽  
Menstrual Hygiene ◽  
Pooled Prevalence ◽  
Data Extraction Form ◽  
School Preparedness ◽  
The Government

With increasing girls’ enrolment in schools, school preparedness to ensure a menstrual friendly environment is crucial. The study aimed to conduct a systematic review regarding the existing evidence on menstrual hygiene management (MHM) across schools in India. It further aimed to highlight the actions that have been taken by the government to improve the MHM situation in India. We conducted the systematic literature search using PubMed, EMBASE, and Web of Science for searching the peer-reviewed articles and Google Scholar for anecdotal reports published from inception until 30 October 2019. Of 1125 publications retrieved through the search, 183 papers were included in this review, using a priori created data-extraction form. Meta-analysis was used to estimate the pooled prevalence (PP) of MHM practices in schools. Less than half of the girls were aware of menstruation before menarche (PP 0.45, 0.39 to 0.51, I2 = 100.0%, n = 122). Teachers were a less common source of information about menstruation to girls (PP 0.07, 0.05 to 0.08, I2 = 100.0%, n = 86). Separate toilets for girls were present in around half of the schools (PP 0.56, 0.42 to 0.75, I2 100.0%, n = 11). MHM in schools should be strengthened with convergence between various departments for explicit implementation of guidelines.

scholarly journals Adherence to clinical practice guidelines (CPGs) for the treatment of cancers in Australia and the factors associated with adherence: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e050912
Author(s):  
Mia Bierbaum ◽  
Frances Rapport ◽  
Gaston Arnolda ◽  
Yvonne Tran ◽  
Bróna Nic Giolla Easpaig ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Cancer Treatment ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Data Extraction ◽  
Meta Analysis ◽  
Survival Rates ◽  
Implementation Strategies ◽  
Factors Associated

IntroductionClinical practice guidelines (CPGs) synthesise the latest evidence to support clinical and patient decision-making. CPG adherent care is associated with improved patient survival outcomes; however, adherence rates are low across some cancer streams in Australia. Greater understanding of specific barriers to cancer treatment CPG adherence is warranted to inform future implementation strategies.This paper presents the protocol for a systematic review that aims to determine cancer treatment CPG adherence rates in Australia across a variety of common cancers, and to identify any factors associated with adherence to those CPGs, as well as any associations between CPG adherence and patient outcomes.Methods and analysisFive databases will be searched, Ovid Medline, PsychInfo, Embase, Scopus and Web of Science, for eligible studies evaluating adherence rates to cancer treatment CPGs in Australia. A team of reviewers will screen the abstracts in pairs according to predetermined inclusion criteria and then review the full text of eligible studies. All included studies will be assessed for quality and risk of bias. Data will be extracted using a predefined data extraction template. The frequency or rate of adherence to CPGs, factors associated with adherence to those CPGs and any reported patient outcome rates (eg, relative risk ratios or 5-year survival rates) associated with adherence to CPGs will be described. If applicable, a pooled estimate of the rate of adherence will be calculated by conducting a random-effects meta-analysis. The systematic review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Ethics and disseminationEthics approval will not be required, as this review will present anonymised data from other published studies. Results from this study will form part of a doctoral dissertation (MB), will be published in a journal, presented at conferences, and other academic presentations.PROSPERO registration numberCRD42020222962.

scholarly journals We have the program, what now? Development of an implementation strategy to bridge the research-practice gap prevalent in exercise oncology

2020 ◽  
Author(s):  
Mary Ann Kennedy ◽  
Sara Bayes ◽  
Robert U. Newton ◽  
Yvonne Zissiadis ◽  
Nigel A. Spry ◽  
...  
Keyword(s):  
Implementation Strategy ◽  
Implementation Strategies ◽  
Study Data ◽  
Treatment Center ◽  
Advisory Group ◽  
Science Literature ◽  
Implementation Barriers ◽  
Oncology Research ◽  
Specific Implementation ◽  
Exercise Oncology

Abstract Background Exercise has emerged as a promising therapy for people with cancer. Novel programs have been developed to translate this research into practice; however, implementation barriers have limited their success. The aim of this study was to employ the implementation mapping protocol to develop an implementation strategy to effectively support programming of a co-located exercise clinic and cancer treatment center. Methods The Implementation Mapping protocol, which consists of five specific, iterative tasks, was employed for this study. Data from interviews, surveys, clinic records, and implementation science literature was used to develop a comprehensive implementation strategy for the co-located exercise clinic. A stakeholder advisory group advised throughout the process. Results The organization’s general manager was identified as the program adopter; oncologists, center leaders, and various administrative staff as program implementers; and the operations manager as the program maintainer. Twenty performance objectives were identified and used to inform the development of a comprehensive theory-based implementation plan consisting of seven implementation strategies across the individual and organizational levels, including use of program champions and an implementation advisor, and revision of professional roles. Finally, an evaluation plan was developed to measure the success of the implementation strategy. Conclusion Successful translation of exercise oncology research into practice requires context-specific implementation plans. The Implementation Mapping protocol provided a roadmap to guide development of a robust implementation strategy that considered all ecological domains, was informed by theory, and demonstrated an extensive understanding of the implementation context. Strong research-practitioner partnerships and effective stakeholder engagement were critical to successful execution of the protocol.

Abstract MP040: Comparative-Effectiveness of Implementation Strategies on Blood Pressure Control among Hypertensive Patients: a Meta-Analysis

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Katherine T Mills ◽  
Katherine M Obst ◽  
Wei Shen ◽  
Sandra Molina ◽  
Huijie Zhang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Comparative Effectiveness ◽  
Meta Analysis ◽  
Intervention Strategy ◽  
Implementation Strategies ◽  
Clinical Decision Support Systems ◽  
Health Coaching ◽  
Audit And Feedback ◽  
Hypertension Control ◽  
Eligibility Criteria

Introduction: Globally, only 13.8% of adults with hypertension have controlled blood pressure (BP). Effective strategies are needed to overcome barriers to BP control. The overall objective is to determine the comparative-effectiveness of implementation strategies to reduce BP in adults with hypertension. Methods: We searched Medline and Embase (through November 2015) for randomized controlled trials of implementation strategies targeting barriers to hypertension control compared to usual care. One hundred trials with 48,070 hypertensive participants met our eligibility criteria and were included in this analysis. These trials were grouped by intervention strategy, and the effects of the intervention on BP change were combined using random effects models. Results: Multi-component team-based care with and without non-physician providers titrating medications had the greatest reduction in systolic and diastolic BP. Health coaching, home BP monitoring, and a combination of the two also resulted in significant reductions in BP. Few studies of BP audit and feedback and clinical decision support systems were available, and they did not result in significant reductions in systolic BP. Provider training did not significantly reduce BP. Conclusions: Team-based collaborative care is the most effective strategy for BP control among patients with hypertension. In addition, health coaching and home BP monitoring are useful patient-level strategies for hypertension control. These strategies should be prioritized in future BP control efforts.

scholarly journals Metformin in Pregnancy Study (MiPS): protocol for a systematic review with individual patient data meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e036981
Author(s):  
Aya Mousa ◽  
Tone Løvvik ◽  
Ijäs Hilkka ◽  
Sven M Carlsen ◽  
Laure Morin-Papunen ◽  
...  
Keyword(s):  
Individual Patient Data ◽  
Data Extraction ◽  
Meta Analysis ◽  
A Priori ◽  
Patient Data ◽  
Sensitivity Analyses ◽  
Efficacy And Safety ◽  
Adverse Pregnancy ◽  
The Impact ◽  
In Pregnancy

IntroductionGestational diabetes mellitus (GDM) is a common disorder of pregnancy and contributes to adverse pregnancy outcomes. Metformin is often used for the prevention and management of GDM; however, its use in pregnancy continues to be debated. The Metformin in Pregnancy Study aims to use individual patient data (IPD) meta-analysis to clarify the efficacy and safety of metformin use in pregnancy and to identify relevant knowledge gaps.Methods and analysisMEDLINE, EMBASE and all Evidence-Based Medicine will be systematically searched for randomised controlled trials (RCT) testing the efficacy of metformin compared with placebo, usual care or other interventions in pregnant women. Two independent reviewers will assess eligibility using prespecified criteria and will conduct data extraction and quality appraisal of eligible studies. Authors of included trials will be contacted and asked to contribute IPD. Primary outcomes include maternal glycaemic parameters and GDM, as well as neonatal hypoglycaemia, anthropometry and gestational age at delivery. Other adverse maternal, birth and neonatal outcomes will be assessed as secondary outcomes. IPD from these RCTs will be harmonised and a two-step meta-analytic approach will be used to determine the efficacy and safety of metformin in pregnancy, with a priori adjustment for covariates and subgroups to examine effect moderators of treatment outcomes. Sensitivity analyses will assess heterogeneity, risk of bias and the impact of trials which have not provided IPD.Ethics and disseminationAll IPD will be deidentified and studies contributing IPD will have ethical approval from their respective local ethics committees. This study will provide robust evidence regarding the efficacy and safety of metformin use in pregnancy, and may identify subgroups of patients who may benefit most from this treatment modality. Findings will be published in peer-reviewed journals and disseminated at scientific meetings, providing much needed evidence to inform clinical and public health actions in this area.

Measuring Implementation Strategy Fidelity in HealthyHearts NYC: A Complex Intervention Using Practice Facilitation in Primary Care

2020 ◽  
pp. 106286062095945
Author(s):  
Carolyn A. Berry ◽  
Ann M. Nguyen ◽  
Allison M. Cuthel ◽  
Charles M. Cleland ◽  
Nina Siman ◽  
...  
Keyword(s):  
Primary Care ◽  
Conceptual Framework ◽  
Implementation Strategy ◽  
Tracking System ◽  
A Priori ◽  
Implementation Strategies ◽  
Implementation Fidelity ◽  
Practice Facilitation ◽  
Task List ◽  
Fidelity Assessment

Few studies have assessed the fidelity of practice facilitation (PF) as an implementation strategy, and none have used an a priori definition or conceptual framework of fidelity to guide fidelity assessment. The authors adapted the Conceptual Framework for Implementation Fidelity to guide fidelity assessment in HealthyHearts NYC, an intervention that used PF to improve adoption of cardiovascular disease evidence-based guidelines in primary care practices. Data from a web-based tracking system of 257 practices measured fidelity using 4 categories: frequency, duration, content, and coverage. Almost all (94.2%) practices received at least the required 13 PF visits. Facilitators spent on average 26.3 hours at each site. Most practices (95.7%) completed all Task List items, and 71.2% were educated on all Chronic Care Model strategies. The majority (65.8%) received full coverage. This study provides a model that practice managers and implementers can use to evaluate fidelity of PF, and potentially other implementation strategies.

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