The Impact of Narrow and Tiered Networks on Costs, Access, Quality, and Patient Steering: A Systematic Review

Health insurers use narrow and tiered networks to lower costs by contracting with, or favoring, selected providers. Little is known about the contemporary effects of narrow or tiered networks on key metrics. The purpose of this systematic review was to synthesize the evidence on how narrow and tiered networks impact cost, access, quality, and patient steering. We searched PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials databases for articles published from January 2000 to June 2020. Both narrow and tiered networks are associated with reduced overall health care costs for most cost-related measures. Evidence pertaining to access to care and quality measures were more limited to a narrow set of outcomes or were weak in internal validity, but generally concluded no systematic adverse effects on narrow or tiered networks. Narrow and tiered networks appear to reduce costs without affecting some quality measures. More research on quality outcomes is warranted.

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Overweight and obesity as potential prognostic factors for severity and mortality in patients with COVID-19: A living systematic review protocol

10.31219/osf.io/t97ab ◽

2020 ◽

Author(s):

Catherine Bonilla-Untiveros ◽

Saby Camacho-Lopez ◽

Eduard Baladia ◽

Luis E. Ortiz-Muñoz ◽

Gabriel Rada

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Grey Literature ◽

Overweight And Obesity ◽

Cochrane Central Register ◽

Suspected Infection ◽

Central Register ◽

Review Protocol ◽

The Impact ◽

Overweight Or Obesity

ObjectiveThis living systematic review aims to provide a timely, rigorous and continuously updated summary about the impact of overweight or obesity as a prognostic factor for severity and mortality in patients with COVID-19. DesignThis is a protocol of a living systematic review.Data sourcesWe will conduct searches in MEDLINE/PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), grey literature and in a centralized repository in L·OVE (Living OVerview of Evidence). L·OVE is a platform that maps PICO questions to evidence from Epistemonikos database. In response to the COVID-19 emergency, L·OVE was adapted to expand the range of evidence it covers and customised to group all COVID-19 evidence in one place. The search will cover the period until the day before submission to a journal.Eligibility criteria for selecting studies and methods We adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question. We will include all primary studies that assess patients with confirmed or suspected infection with SARS-CoV-2 and inform the relation of overweight or obesity with death or disease severity. Two reviewers will independently screen each study for eligibility, extract data, and assess the risk of bias. We will pool the results using meta-analysis and will apply the GRADE system to assess the certainty of the evidence for each outcome. A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit it every time the conclusions change or whenever there are substantial updates.

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Oxymetazoline for the treatment of rosacea-associated persistent facial erythema. Systematic review and meta-analysis protocol

10.1101/2020.05.25.20111344 ◽

2020 ◽

Author(s):

Geovanna Cárdenas ◽

Francisco Novillo ◽

Shuheng Lai ◽

Héctor Fuenzalida ◽

Francisca Verdugo ◽

...

Keyword(s):

Systematic Review ◽

Data Extraction ◽

Meta Analysis ◽

Grey Literature ◽

Controlled Trials ◽

Cochrane Central Register ◽

Eligibility Criteria ◽

Facial Erythema ◽

Central Register ◽

The Impact

ABSTRACTObjectiveThe objective of this systematic review is to assess the impact of oxymetazoline in patients with moderate to severe rosacea.Data SourcesWe will conduct a comprehensive search in PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Lilacs, the International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, US National Institutes of Health (NIH) and grey literature, to identify all relevant randomized controlled trials regardless of language or publication status (published, unpublished, in press and in progress).Eligibility criteria for selecting studies and methodsWe will include randomized trials evaluating the effect of oxymetazoline in patients with moderate to severe rosacea. Two reviewers will independently screen each study for eligibility, data extraction, and assess the risk of bias. We will pool the results using meta-analysis and will apply the GRADE [1] system to assess the certainty of the evidence for each outcome.Ethics and DisseminationNo ethics approval is considered necessary. The results of this review will be widely disseminated via peer-reviewed publications, social networks and traditional media.Protocol and RegistrationThis protocol was adapted to the specificities of the question assessed in this review and registered to PROSPERO with the ID CRD42020150262.

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Leisure and Productivity in Older Adults with Cancer: A Systematic Review

Occupational Therapy International ◽

10.1155/2021/8886193 ◽

2021 ◽

Vol 2021 ◽

pp. 1-11

Author(s):

Cynthia Engels ◽

Robin Bairet ◽

Florence Canoui-Poitrine ◽

Marie Laurent

Keyword(s):

Systematic Review ◽

Older Adults ◽

Self Care ◽

Sociodemographic Factors ◽

Cochrane Central Register ◽

Cross Sectional ◽

Level Of Activity ◽

Central Register ◽

Number Of Publications ◽

The Impact

Introduction. Self-care, leisure, and productivity are important occupational domains for older adults’ quality of life, which might be affected by cancer and its treatment. A great number of publications about older adults focus on function or self-care, so we aimed to analyse how cancer and its treatments affect leisure and productivity. Secondary objectives were to identify whether particular clinical and/or sociodemographic factors were associated with occupational disruptions and to assess the impact of rehabilitation approaches on leisure and productivity in this population. Methods. A systematic review of the 2009-2019 literature performed on Medline, Embase, and the Cochrane Central Register of Controlled Trials. Results. 1471 publications were retrieved: 48 full texts were assessed; seven of these (four cross-sectional studies, two cohort studies, and a case report) were reviewed, including data on 16668 people (12649 healthy controls, 3918 cancer survivors, and 101 ill patients). Older adults with comorbidities and a low level of activity before cancer diagnosis may be more at risk of occupational disruptions. However, studies focused more on physical activity than leisure and productivity. Two studies mentioned occupational therapy. Discussion. As cancer can become a chronic disease, it appears important to also offer occupation-centred assessments and follow-up. Conclusion. An occupation-centred approach could be developed; its effectiveness must be assessed.

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A Systematic Review of Clinical Trials Assessing Sexuality in Hysterectomized Patients

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18083994 ◽

2021 ◽

Vol 18 (8) ◽

pp. 3994

Author(s):

Laura Martínez-Cayuelas ◽

Pau Sarrió-Sanz ◽

Antonio Palazón-Bru ◽

Lidia Verdú-Verdú ◽

Ana López-López ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Randomized Clinical Trials ◽

Laparoscopic Approach ◽

Risk Of Bias ◽

Sexual Life ◽

Cochrane Central Register ◽

Central Register ◽

The Impact

In hysterectomized patients, even though there is still controversy, evidence indicates that in the short term, the vaginal approach shows benefits over the laparoscopic approach, as it is less invasive, faster and less costly. However, the quality of sexual life has not been systematically reviewed in terms of the approach adopted. Through a systematic review, we analyzed (CRD42020158465 in PROSPERO) the impact of hysterectomy on sexual quality and whether there are differences according to the surgical procedure (abdominal or vaginal) for noncancer patients. MEDLINE (through PubMed), Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Scopus were reviewed to find randomized clinical trials assessing sexuality in noncancer patients undergoing total hysterectomy, comparing vaginal and abdominal (laparoscopic and/or open) surgery. Three studies that assessed the issue under study were finally included. Two of these had a low risk of bias (Cochrane risk of bias tool); one was unclear. There was significant variability in how sexuality was measured, with no differences between the two approaches considered in the review. In conclusion, no evidence was found to support one procedure (abdominal or vaginal) over another for non-oncological hysterectomized patients regarding benefits in terms of sexuality.

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Does Premedication with Mucolytic Agents Improve Mucosal Visualization during Oesophagogastroduodenoscopy: A Systematic Review and Meta-Analysis

Surgery Research and Practice ◽

10.1155/2021/1570121 ◽

2021 ◽

Vol 2021 ◽

pp. 1-12

Author(s):

Eoghan Burke ◽

Patricia Harkins ◽

Frank Moriarty ◽

Ibrahim Ahmed

Keyword(s):

Systematic Review ◽

Adverse Events ◽

Meta Analysis ◽

Mean Difference ◽

Cochrane Central Register ◽

Central Register ◽

The Mean ◽

And Control ◽

The Impact ◽

Mucolytic Agents

Introduction. Gastric Cancer (GC) is the fourth most common malignancy worldwide and the second leading cause of cancer-related mortality for both sexes. The gold standard for diagnosing GC is oesophagogastroduodenoscopy (OGD). Excess mucus on the gastric mucosa impairs the detection of early GC. Aim. To synthesize available evidence of the effect of premedication with a mucolytic agent among adults undergoing elective nontherapeutic OGD, compared to placebo or other mucolytic agents, on mucosal visibility during OGD. Methods. A systematic review was conducted. PubMed, EMBASE, CINAHL, Cochrane central register of controlled trials (CENTRAL), and Web of Science were searched for relevant studies. A random-effects meta-analysis was performed to determine the mean difference in total mucosal visibility score (TMVS) between the pooled mucolytic agents and control. Subgroup analyses were performed to determine the mean TMVS difference for simethicone versus control and the impact of different timings and doses of mucolytic premedication. Results. 13 studies, involving 11,086 patients, including 6178 females (55.7%), with a mean age of 53.4 were identified and 6 of these were brought forward to meta-analysis. This revealed a mean difference of −2.69 (95% CI −3.5, −1.88) in total mucosal visibility scores (TMVS) between the pooled mucolytic agents and control. For simethicone, the mean difference was −2.68 (95% CI −4.94, −0.43). A simethicone dose of 133 mg was most effective with a mean difference of −4.22 (95% CI −5.11, −3.33). Assessing timing of administration across all mucolytic agents revealed a mean difference for the >20 minutes group of −3.68 (95% CI −4.77, −2.59). No adverse events were reported in any included trials. Conclusions. Regular use of premedication with mucolytic agents prior to routine OGD is associated with improved TMVS with no reported adverse events.

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Interventions directed at men for preventing intimate partner violence: a systematic review protocol

Systematic Reviews ◽

10.1186/s13643-021-01712-7 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Dina Idriss-Wheeler ◽

Julia Hajjar ◽

Sanni Yaya

Keyword(s):

Systematic Review ◽

Intimate Partner Violence ◽

Health Outcomes ◽

Partner Violence ◽

Intimate Partner ◽

Cochrane Central Register ◽

Female Partners ◽

Key Characteristics ◽

Unpublished Manuscripts ◽

The Impact

Abstract Background Intimate partner violence (IPV) is a population health problem linked to a myriad of negative psychological, physical, emotional, sexual and reproductive health outcomes for women. The movement towards working with boys and men over the past couple of decades has increased the number of interventions specifically directed at men who perpetrate violence against a female partner. There is little evidence-based research on key characteristics of effective interventions directed at men to reduce or prevent IPV against female partners. The objective of this systematic review is to identify interventions specifically directed at males , as the perpetrators of violence against women, that have proven to be effective in preventing or reducing intimate partner violence. Methods The following electronic databases will be used to search for peer-reviewed studies: MEDLINE (OVID), Embase (OVID), PsycInfo (OVID), CINAHL (EBSCO), Global Health (EBSCO), Gender Watch (ProQuest), Web of Science (Web of Knowledge), PROSPERO, Cochrane Central Register of Controlled Trials Database (Ovid) and SCOPUS. We will include randomized control trials, non-randomized studies of interventions published in peer-reviewed journals and relevant unpublished manuscripts, books/chapters and clinical or programme study reports. Studies have to demonstrate direction of effect (i.e. pre-post intervention/difference between groups) in terms of prevention or reduction in the outlined outcomes. Primary outcomes include change in behaviour and knowledge of male perpetrator regarding the impact of IPV on women as well as women’s experience of IPV. Secondary outcomes include change in behaviours around substance use and social activities, decrease in negative mental health outcomes and interactions with law enforcement. Studies will be screened, appraised and extracted by two reviewers; any conflicts will be resolved through discussion. Narrative synthesis will be used to analyse and present findings. If sufficient and comparable data is available, a meta-analysis will be conducted. Discussion This review will provide synthesized evidence on interventions directed at males to reduce or prevent their perpetration of intimate partner violence against female partners. Implications for practice will include key characteristics of interventions proven to be effective based on evidence synthesis and certainty of findings. Recommendations for further research will also be considered. Systematic review registration This protocol was submitted for registration in the International Prospective Register of Systematic Reviews (PROSPERO) on September 4, 2020.

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Functional cortical changes associated with shoulder instability – a systematic review

Shoulder & Elbow ◽

10.1177/17585732211019016 ◽

2021 ◽

pp. 175857322110190

Author(s):

Morissa F Livett ◽

Deborah Williams ◽

Hayley Potter ◽

Melinda Cairns

Keyword(s):

Systematic Review ◽

Joint Instability ◽

Glenohumeral Joint ◽

Controlled Trials ◽

Cochrane Central Register ◽

Cortical Function ◽

High Quality Research ◽

Central Register ◽

Rehabilitative Measures ◽

Randomised Controlled

Background Glenohumeral joint instability is associated with structural deficits and/or alterations in sensory and motor processing; however, a proportion of patients with glenohumeral joint instability fail to respond to surgical and rehabilitative measures. This systematic review aimed to establish if functional cortical changes occur in patients with glenohumeral joint instability. Methods AMED, CINAHL, Cochrane Central Register of Controlled Trials, Embase, Medline, PEDro, Pubmed, PsychINFO and Scopus were searched from inception to 17 March 2021. Randomised controlled trials and non-randomised trials were included and quality was appraised using the Downs and Black tool. Results One thousand two hundred seventy-nine records were identified of which five were included in the review. All studies showed altered cortical function when comparing instability patients with healthy controls and included areas associated with higher cortical functions. Discussion The findings of this systematic review offer some insight as to why interventions addressing peripheral pathoanatomical factors in patients with glenohumeral joint instability may fail in some cases due to functional cortical changes. However, data are of moderate to high risk of bias. Further high-quality research is required to ascertain the degree of functional cortical changes associated with the type and duration of glenohumeral joint instability.

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Abstract NS6: To Rest or Mobilize... When to Start Early Mobilization in Acute Stroke: a Systematic Review

Stroke ◽

10.1161/str.47.suppl_1.ns6 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Michelle Whaley ◽

Wendy Dusenbury ◽

Andrei V Alexandrov ◽

Georgios Tsivgoulis ◽

Anne W Alexandrov

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Acute Stroke ◽

Early Mobilization ◽

Future Research ◽

Cochrane Central Register ◽

Large Artery ◽

Stroke Subtype ◽

Vascular Insufficiency ◽

The Impact

Background: Recent nursing initiatives encourage early mobilization of neurocritical care patients, but whether this intervention can be safely generalized to acute stroke is debatable. We performed a systematic review of findings from recent studies to provide direction for patient management and future research. Methods: An exhaustive literature search was performed in Medline, SCOPUS and the Cochrane Central Register of Controlled Trials to identify published clinical trial research using a very early mobility intervention (within 24 hours) in acute ischemic stroke patients. The primary efficacy outcome supporting the search was neurologic disability reduction or improved functional outcomes, and the primary safety outcome was neurologic deterioration. Studies were critically reviewed for inclusion by 3 separate investigators, findings were synthesized, and an overall recommendation for very early mobilization use in acute stroke was assigned according to GRADE criteria. Results: We initially identified 12 papers focused on early mobilization in acute stroke; of these, 6 observational studies were excluded, 1 study was excluded due to an ambiguous population, and 3 studies were excluded due to first initial mobilization out of bed occurring greater than 24 hours after admission. Two prospective randomized outcome blinded evaluation (PROBE) studies were retained, consisting of a total 2160 patients; ischemic stroke subtype was not disclosed in either study, limiting an understanding of the impact of very early mobilization on small versus large artery occlusion. Slower mobilization occurring beyond the first 24 hours was associated with higher rates of favorable outcome (mRS 0-2) at 90 days, whereas very early mobilization within the first 24 hours was associated with a number needed to harm of 25. Conclusions: In acute stroke, evidence supports a rested approach to care within the first 24 hours of hospitalization (GRADE: Strong recommendation, high quality of evidence). Similar to acute myocardial infarction, vascular insufficiency experienced in stroke likely warrants a more guarded approach to mobility. Additional studies exploring timing beyond 24 hours and dose of mobility interventions are warranted in discreet populations.

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Use of opioids in patients with cancer with hepatic impairment—a systematic review

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2021-003065 ◽

2021 ◽

pp. bmjspcare-2021-003065

Author(s):

Lewis Thomas Hughes ◽

David Raftery ◽

Paul Coulter ◽

Barry Laird ◽

Marie Fallon

Keyword(s):

Systematic Review ◽

Cancer Pain ◽

Hepatic Impairment ◽

Evaluation System ◽

Meta Analysis ◽

Hepatic Function ◽

Cochrane Central Register ◽

Assessment Development ◽

Patients With Cancer ◽

Central Register

PurposeOpioids are recommended for moderate-to-severe cancer pain; however, in patients with cancer, impaired hepatic function can affect opioid metabolism. The aim of this systematic review was to evaluate the evidence for the use of opioids in patients with cancer with hepatic impairment.MethodsA systematic review was conducted and the following databases searched: AMED (−2021), MEDLINE (−2021), EMBASECLASSIC + EMBASE (−2021) and Cochrane Central Register of Controlled Trials (−2021). Eligible studies met the following criteria: patients with cancer-related pain, taking an opioid (as defined by the WHO Guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents); >18 years of age; patients with hepatic impairment defined using recognised or study-defined definitions; clinical outcome hepatic impairment related; and primary studies. All eligible studies were appraised using the Grading of Recommendations Assessment, Development and Evaluation system.ResultsThree studies (n=95) were eligible but heterogeneity meant meta-analysis was not possible. Each individual study focused on only one each of oxycodone±hydrocotarnine, oxycodone/naloxone and morphine. No recommendations could be formulated on the preferred opioid in patients with hepatic impairment.ConclusionsMorphine is the preferred opioid in hepatic impairment owing to clinical experience and pharmacokinetics. This review, however, found little clinical evidence to support this. Dose adjustments of morphine and the oxycodone formulations reviewed remain necessary in the absence of quality evidence. Overall, the quality of existing evidence on opioid treatments in cancer pain and hepatic impairment is low and there remains a need for high-quality clinical studies examining this.

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Dynamic compared to rigid fixation in lumbar spine: a systematic review

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.60.02.013 ◽

2014 ◽

Vol 60 (2) ◽

pp. 151-155 ◽

Cited By ~ 1

Author(s):

Ricardo Vieira Botelho ◽

Rafael Bastianello Junior ◽

Luciana DiniGianini de Albuquerque ◽

Wanderley Marques Bernardo

Keyword(s):

Systematic Review ◽

Lumbar Spine ◽

Randomized Trials ◽

Published Data ◽

Rigid Fixation ◽

Cochrane Central Register ◽

Pedicle Fixation ◽

Central Register ◽

Spine Fixation

Objective: The objective of this review is to reveal the quality of published data and the effect size of DPFs compared to rigid fixation in lumbar spine. Summary of background data: since 2002, several dynamic pedicle fixation (DPF) systems have been developed with the aim to stabilize the spine without the undesirable effects of rigid lumbar spine fixation. Nearly ten years later, there are several studies on these dynamic systems. Methods: A systematic review was done in MEDLINE/PubMED, Embase, Cochrane Central Register of Randomized Trials and Google Scholar to assess the quality of published literature and the available studied outcomes in randomized controlled trials of DPF. Results: Only three papers described randomized trials studying DPF. One of them focused on protection of adjacent level disease provided by DPF. Conclusion: It was not possible to reveal any evidence for benefits using DPF compared to rigid fixation in surgery for lumbar spine.

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