scholarly journals Improving palliative care with machine learning and routine data: a rapid review

2019 ◽  
Vol 2 ◽  
pp. 13 ◽  
Author(s):  
Virginia Storick ◽  
Aoife O’Herlihy ◽  
Sarah Abdelhafeez ◽  
Rakesh Ahmed ◽  
Peter May
Keyword(s):  
Machine Learning ◽  
Palliative Care ◽  
Full Text ◽  
Clinical Decision Making ◽  
Grey Literature ◽  
Routine Data ◽  
Adverse Outcomes ◽  
Rapid Review ◽  
Current Evidence ◽  
Cochrane Library

Introduction: Improving palliative care is a priority worldwide as this population experiences poor outcomes and accounts disproportionately for costs. In clinical practice, physician judgement is the core method of identifying palliative care needs but has important limitations. Machine learning (ML) is a subset of artificial intelligence advancing capacity to identify patterns and make predictions using large datasets.  ML has the potential to improve clinical decision-making and policy design, but there has been no systematic assembly of current evidence. Methods: We conducted a rapid review, searching systematically seven databases from inception to December 31st, 2018: EMBASE, MEDLINE, Cochrane Library, PsycINFO, WOS, SCOPUS and ECONLIT.  We included peer-reviewed studies that used ML approaches on routine data to improve palliative care for adults.  Our specified outcomes were survival, quality of life (QoL), place of death, costs, and receipt of high-intensity treatment near end of life.  We did not search grey literature. Results: The database search identified 426 citations. We discarded 162 duplicates and screened 264 unique title/abstracts, of which 22 were forwarded for full text review.  Three papers were included, 18 papers were excluded and one full text was sought but unobtainable.  One paper predicted six-month mortality, one paper predicted 12-month mortality and one paper cross-referenced predicted 12-month mortality with healthcare spending.  ML-informed models outperformed logistic regression in predicting mortality where data inputs were relatively strong, but those using only basic administrative data had limited benefit from ML.  Identifying poor prognosis does not appear effective in tackling high costs associated with serious illness.  Conclusion: While ML can in principle help to identify those at risk of adverse outcomes and inappropriate treatment, applications to policy and practice are formative.  Future research must not only expand scope to other outcomes and longer timeframes, but also engage with individual preferences and ethical challenges.

scholarly journals Improving palliative and end-of-life care with machine learning and routine data: a rapid review

2019 ◽  
Vol 2 ◽  
pp. 13 ◽  
Author(s):  
Virginia Storick ◽  
Aoife O’Herlihy ◽  
Sarah Abdelhafeez ◽  
Rakesh Ahmed ◽  
Peter May
Keyword(s):  
Machine Learning ◽  
End Of Life ◽  
Full Text ◽  
Clinical Decision Making ◽  
Grey Literature ◽  
Routine Data ◽  
Rapid Review ◽  
Current Evidence ◽  
Cochrane Library ◽  
Eol Care

Introduction: Improving end-of-life (EOL) care is a priority worldwide as this population experiences poor outcomes and accounts disproportionately for costs. In clinical practice, physician judgement is the core method of identifying EOL care needs but has important limitations. Machine learning (ML) is a subset of artificial intelligence advancing capacity to identify patterns and make predictions using large datasets.  ML approaches have the potential to improve clinical decision-making and policy design, but there has been no systematic assembly of current evidence. Methods: We conducted a rapid review, searching systematically seven databases from inception to December 31st, 2018: EMBASE, MEDLINE, Cochrane Library, PsycINFO, WOS, SCOPUS and ECONLIT.  We included peer-reviewed studies that used ML approaches on routine data to improve palliative and EOL care for adults.  Our specified outcomes were survival, quality of life (QoL), place of death, costs, and receipt of high-intensity treatment near end of life.  We did not search grey literature and excluded material that was not a peer-reviewed article. Results: The database search identified 426 citations. We discarded 162 duplicates and screened 264 unique title/abstracts, of which 22 were forwarded for full text review.  Three papers were included, 18 papers were excluded and one full text was sought but unobtainable.  One paper predicted six-month mortality, one paper predicted 12-month mortality and one paper cross-referenced predicted 12-month mortality with healthcare spending.  ML-informed models outperformed logistic regression in predicting mortality but poor prognosis is a weak driver of costs.  Models using only routine administrative data had limited benefit from ML methods. Conclusion: While ML can in principle help to identify those at risk of adverse outcomes and inappropriate treatment near EOL, applications to policy and practice are formative.  Future research must not only expand scope to other outcomes and longer timeframes, but also engage with individual preferences and ethical challenges.

scholarly journals Preventing the transmission of COVID-19 and other coronaviruses in older adults aged 60 years and above living in long-term care: a rapid review

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Patricia Rios ◽  
Amruta Radhakrishnan ◽  
Chantal Williams ◽  
Naveeta Ramkissoon ◽  
Ba’ Pham ◽  
...  
Keyword(s):  
Long Term Care ◽  
Grey Literature ◽  
Rapid Review ◽  
Current Evidence ◽  
Cochrane Library ◽  
Infection Prevention And Control ◽  
Term Care ◽  
Environmental Cleaning ◽  
Automated Method

Abstract Background The objective of this review was to examine the current guidelines for infection prevention and control (IPAC) of coronavirus disease-19 (COVID-19) or other coronaviruses in adults 60 years or older living in long-term care facilities (LTCF). Methods EMBASE, MEDLINE, Cochrane library, pre-print servers, clinical trial registries, and relevant grey literature sources were searched until July 31, 2020, using database searching and an automated method called Continuous Active Learning® (CAL®). All search results were processed using CAL® to identify the most likely relevant citations that were then screened by a single human reviewer. Full-text screening, data abstraction, and quality appraisal were completed by a single reviewer and verified by a second. Results Nine clinical practice guidelines (CPGs) were included. The most common recommendation in the CPGs was establishing surveillance and monitoring systems followed by mandating the use of PPE; physically distancing or cohorting residents; environmental cleaning and disinfection; promoting hand and respiratory hygiene among residents, staff, and visitors; and providing sick leave compensation for staff. Conclusions Current evidence suggests robust surveillance and monitoring along with support for IPAC initiatives are key to preventing the spread of COVID-19 in LTCF. However, there are significant gaps in the current recommendations especially with regard to the movement of staff between LTCF and their role as possible transmission vectors. Systematic review registration PROSPERO CRD42020181993

PP66 Hospital Cleaning: Detergent Or Disinfectant-Detergent? A Rapid Review

2018 ◽  
Vol 34 (S1) ◽  
pp. 92-93
Author(s):  
Kathleen Harkin ◽  
Anne Dee
Keyword(s):  
Systematic Reviews ◽  
Adverse Outcomes ◽  
Controlled Vocabulary ◽  
Rapid Review ◽  
Cochrane Library ◽  
Microbial Resistance ◽  
Low Level ◽  
Healthcare Environment ◽  
Environmental Surfaces ◽  
Routine Cleaning

Introduction:Healthcare-associated infections (HAIs) are an important, potentially preventable reason to maintain a clean healthcare environment. However, guidelines from Europe and North America do not concur—European guidelines recommend using neutral detergent (followed by chlorine-based disinfection (CBD) if required), whilst North American guidelines recommend using detergent or hospital-grade disinfectant-detergents for routine cleaning or decontamination of noncritical healthcare environmental surfaces. The objective of this study was to compare the effectiveness on rates of HAIs of: (i) disinfectant-detergents versus detergents; and (ii) the active ingredient of many disinfectant-detergents—quaternary ammonium compounds (QAC)—versus CBD.Methods:A rapid review of systematic reviews was conducted using the following search terms: keywords and controlled vocabulary terms for the concepts of “healthcare environmental surfaces” AND (“QAC-based disinfectants” OR “disinfectant-detergents” OR “decontamination”) AND (“environmental contamination” OR “colonization” OR “HAIs”). The search filters included systematic reviews, guidelines, and technology reports. The following databases were searched: The Cochrane Library; PubMed; and health technology assessment and guideline websites for gray literature. Systematic reviews of studies comparing the effects of disinfectant-detergents with detergent, or comparing QAC with CBD, on rates of HAIs in the healthcare environment were included. Reviews on the cleaning or disinfection of body surfaces or disinfection of invasive medical devices were excluded. Quality assessment was not conducted. Data extraction was performed using a pro forma.Results:The literature search resulted in 356 titles. From ninety-four potentially relevant abstracts, fifty-seven full-texts were evaluated: fifty-one were excluded (eight non-English) and six were included. All review authors cautioned that the evidence was low level, methodologically poor, subject to confounding, and didn't address adverse outcomes. The reviews identified eight relevant primary studies, three of which compared disinfectant-detergents with detergent and found no difference in rates of HAI. Five studies compared QAC with CBD. All five demonstrated that CBD was superior to QAC and reduced Clostridium difficile infection rates in outbreak contexts. Furthermore, QAC may induce sporulation and microbial resistance.Conclusions:Low-level evidence suggested that: there is no advantage in using disinfectant-detergents for routine cleaning of noncritical surfaces; CBD is superior to QAC-based disinfection in reducing clostridial infections; and QAC agents may induce sporulation or microbial resistance.

scholarly journals The barriers and facilitators to screening in emergency departments: a qualitative evidence synthesis (QES) protocol

2020 ◽  
Vol 3 ◽  
pp. 50
Author(s):  
Louise Barry ◽  
Rose Galvin ◽  
Sylvia Murphy Tighe ◽  
Margaret O'Connor ◽  
Damian Ryan ◽  
...  
Keyword(s):  
Conceptual Model ◽  
Evidence Synthesis ◽  
Grey Literature ◽  
Adverse Outcomes ◽  
Barriers And Facilitators ◽  
Screening Tools ◽  
Cochrane Library ◽  
Qualitative Evidence Synthesis ◽  
Clinical Workflow ◽  
Qualitative Evidence

Background: Early detection of adults at risk of adverse outcomes through systematic screening in the emergency department (ED) can serve to identify high risk groups in need of targeted assessment and early intervention in the hospital or community setting. However, issues such as time pressures, inadequate resources, poor integration of tools into clinical workflow and lack of staff training are cited among the barriers to successfully implementing screening tools in the ED. The aim of this qualitative evidence synthesis (QES) is to synthesize evidence pertaining to the barriers and facilitators to implementing screening tools in the ED. Methods: A comprehensive literature search will be completed in the following databases Scopus, CINAHL, Medline, Embase, Pubmed and Cochrane library. Grey literature sources will also be searched. Qualitative or mixed methods studies that include qualitative data on the perspectives and experiences of stakeholders on the implementation of screening tools in the ED will be included. “Best fit” framework synthesis will be utilised to produce a context specific conceptual model to describe and explain how these barriers and facilitators may impact on implementation. An a priori framework of themes, formed from the existing evidence base, will inform the ultimate thematic analysis and assist in the organisation and interpretation of search results, ensuring the QES is built upon current findings. CASP will be utilised to quality appraise articles and GRADE CERQual will assess confidence in the QES findings. Conclusions: This synthesis will offer a new conceptual model for describing the perspectives, perceptions and experiences of barriers and facilitators experienced by patients and key stakeholders involved in the implementation of screening tools in the ED. The results of this review will inform practice and aid the development and implementation of change strategies to support the implementation of screening tools in the ED. Registration: PROSPERO CRD42020188712 05/07/20

scholarly journals Relationship between cricket participation, health and well-being: scoping review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032070
Author(s):  
Garrett Scott Bullock ◽  
Nirmala K Panagodage-Perera ◽  
Andrew Murray ◽  
Nigel K Arden ◽  
Stephanie R Filbay
Keyword(s):  
Scoping Review ◽  
Sport Participation ◽  
Clinical Decision Making ◽  
Grey Literature ◽  
Well Being ◽  
Cochrane Library ◽  
Research Gaps ◽  
Medicine Journal ◽  
The Relationship ◽  
Health And Well Being

IntroductionCricket is a popular sport played by 2.5 billion people of all ages and abilities. However, cricket participation is decreasing in the UK, despite an increased focus of governments on increasing sport participation to enhance public health. Understanding the health benefits and mitigating the health risks of cricket participation may help cricket organisations promote cricket participation while optimising the long-term health of cricket participants. Currently, there is no literature review on the relationship between cricket participation, health and well-being; thus, this relationship remains unclear. Therefore, the aims of this scoping review were (1) to investigate the relationship between cricket participation, health and well-being and (ii) to identify the research gaps related to cricket, health and well-being.Methods and analysisDue to the broad nature of our research question and the large number of health outcomes assessed within the cricket literature and to facilitate identification of research gaps, a scoping review methodology was used. The methodology of this paper was informed by previous scoping review protocols and best practice methodological frameworks. MEDLINE, CINAHL, Embase, Scopus, PsycINFO, SPORTDiscus, Cochrane Library, EBSCO, Web of Science and PEDro and grey literature sources (Google Scholar, ClinicalTrials.gov, ISRCTN Registry and ProQuest) will be systematically searched. Studies that assess a construct related to health and/or well-being in current and/or former cricketers from all ages and standards of play will be eligible. Two reviewers will independently screen full texts of identified studies for eligibility and will perform data extraction. Results will be presented in tabular and graphical forms and will be reported descriptively.Ethics and disseminationThis research is exempt from ethics approval due to the data being available through published and public available resources. Results will be published in a peer-reviewed sports and exercise medicine journal regardless of positive or negative findings. In addition, results will be disseminated through multiple platforms, including conference presentations and social media using multimedia resources (eg, infographics, animations, videos, podcasts and blogs), to engage stakeholder groups, including cricketers, cricket coaches, sporting bodies, sports medicine professionals and policy makers. There findings will inform clinical decision making, policy changes and future research agendas.

Gypsy, Traveller and Roma experiences, views and needs in palliative and end of life care: a systematic literature review and narrative synthesis

2021 ◽  
pp. bmjspcare-2020-002676
Author(s):  
Kathryn Charlotte Dixon ◽  
Rebecca Ferris ◽  
Isla Kuhn ◽  
Anna Spathis ◽  
Stephen Barclay
Keyword(s):  
Palliative Care ◽  
Health Beliefs ◽  
Grey Literature ◽  
Community Diversity ◽  
Weight Of Evidence ◽  
Current Evidence ◽  
Healthcare Provision ◽  
Community Healthcare ◽  
Care Community ◽  
Wide Range

BackgroundGypsy, Traveller and Roma communities are known to experience health inequalities. There has been little focus on palliative care in these communities despite the well-recognised inequalities of access to palliative care in other minority ethnic groups.MethodsSystematic review and thematic analysis of the current evidence concerning palliative care experiences, views and needs of Gypsy, Traveller and Roma communities. Medline, Embase, Emcare, CINAHL, PsycINFO, Web of Science, Scopus, AMED, Global Health, Psychological and Behavioural Sciences Collection and BNI were searched up to November 2020, alongside author and citation searching. NHS England, Hospice UK, National Audit Office and OpenGrey were searched as grey literature sources. Gough’s ‘Weight of Evidence’ framework was used for quality appraisal.ResultsThirteen papers from eight studies were included in the synthesis. Although there was variation between communities, three overarching and inter-related themes were identified. (1) Strong family and community values include a preference for healthcare to be provided from within the community, duty to demonstrate respect by attending the bedside and illness as a community problem with decision-making extending beyond the patient. (2) Distinct health beliefs regarding superstitions around illness, personal care, death rituals and bereavement. (3) Practical barriers to non-community healthcare provision include communication difficulties, limited awareness of and access to services, tensions between patients and healthcare professionals and lack of training in delivering culturally appropriate care.ConclusionA wide range of factors influence Gypsy, Traveller and Roma community access to palliative care. Community diversity requires sensitive and highly individualised approaches to patient care.PROSPERO registration number42019147905.

Measuring integrated care at the interface between primary care and secondary care: a scoping review

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Aimee O'Farrell ◽  
Geoff McCombe ◽  
John Broughan ◽  
Áine Carroll ◽  
Mary Casey ◽  
...  
Keyword(s):  
Primary Care ◽  
Scoping Review ◽  
Full Text ◽  
Secondary Care ◽  
Research Question ◽  
Grey Literature ◽  
Problem Area ◽  
Cochrane Library ◽  
Comprehensive Overview ◽  
Content Type

PurposeIn many healthcare systems, health policy has committed to delivering an integrated model of care to address the increasing burden of disease. The interface between primary and secondary care has been identified as a problem area. This paper aims to undertake a scoping review to gain a deeper understanding of the markers of integration across the primary–secondary interface.Design/methodology/approachA search was conducted of PubMed, SCOPUS, Cochrane Library and the grey literature for papers published in English using the framework described by Arksey and O'Malley. The search process was guided by the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA).FindingsThe initial database search identified 112 articles, which were screened by title and abstract. A total of 26 articles were selected for full-text review, after which nine articles were excluded as they were not relevant to the research question or the full text was not available. In total, 17 studies were included in the review. A range of study designs were identified including a systematic review (n = 3), mixed methods study (n = 5), qualitative (n = 6) and quantitative (n = 3). The included studies documented integration across the primary–secondary interface; integration measurement and factors affecting care coordination.Originality/valueMany studies examine individual aspects of integration. However, this study is unique as it provides a comprehensive overview of the many perspectives and methodological approaches involved with evaluating integration within the primary–secondary care interface and primary care itself. Further research is required to establish valid reliable tools for measurement and implementation.

Abstract P126: Risk Factors For Hypertensive Emergencies: A Systematic Review And Meta-analysis

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Irina Benenson ◽  
Frederick Waldron
Keyword(s):  
Risk Factors ◽  
Full Text ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Target Organ Damage ◽  
Grey Literature ◽  
Hypertensive Crisis ◽  
Kidney Injury ◽  
Clinical Decision ◽  
Hypertensive Urgency

Background: Hypertensive emergency (HTNE) is a subtype of hypertensive crisis. In contrast to hypertensive urgency (HTNU), which is a severely elevated BP without acute target organ damage (TOD), HTNE presents with the equally high BP in the presence of potentially life-threatening acute TOD such as myocardial infarction, stroke, pulmonary edema and acute kidney injury. Knowledge on risk factors of HTNE may be used in clinical decision-making to differentiate between HTNE and HTNU in patients presenting with markedly high BP. Method: A search of 4 databases (MEDLINE, Cochrane Database of Systematic Reviews, Web of Science, and CINAHL), 7 grey literature sites and relevant organizational websites revealed 11,387 titles. After duplicates were removed, 9,183 studies were screened by the title and abstract for eligibility. Forty full-text articles were retrieved, and each was assessed for eligibility. Fourteen full-text studies that included 10,376 participants were critically appraised and included in this review. The extracted data were pooled to meta-analysis, where HTNU patients (BP ≥180/110 mmHg without acute TOD) were compared to HTNE patients (BP ≥180/110 mmHg with acute TOD) based on several modifiable and non-modifiable risk factors. Results: Patients with HTNE had higher mean systolic (MD 2.413, 95% CI 0.477,4.350) and diastolic BP (MD 2.043, 95% CI 0.624,3.461) compared to patients with HTNU. HTNE were more common in men (OR 1.390, 95% CI 1.207,1.601), older patients (mean diff 5.282, 95% CI 3.229, 7.335). Diabetes (OR 1.723, 95% CI 1.485, 2.000), hyperlipidemia (OR 2.028, 95% CI 1.642, 2.505), and chronic kidney disease (OR 2.448, 95% CI 1.169, 5.124) increased the risk of HTNE. Non-adherence to antihypertensives (OR 0.939, 95% CI 0.647,1.363) and HTN diagnosis unawareness (OR 0.807, 95% CI 0.564, 1.154) did not change the odds of HTNE. Conclusion: Systolic and diastolic BP are marginally higher in patients with HTNE compared to patients with HTNU. Since these differences are small and not clinically significant, clinicians should rely on other symptoms and signs to differentiate between HTNU and HTNE. Measures to prevent and treat cardiometabolic comorbidities should be implemented in order to mitigate the risk of HTNE.

scholarly journals Access to Psychotherapy in the Era of Web 2.0 – New Media, Old Inequalities? / Zugang zur Psychotherapie in der Ära des Web 2.0 – Neue Medien, Alte Ungleichheiten?

2015 ◽  
Vol 2 (2) ◽  
pp. 119-129 ◽  
Author(s):  
Jennifer Anette Apolinario-Hagen ◽  
Siegfried Tasseit
Keyword(s):  
Clinical Trials ◽  
Anxiety Disorders ◽  
Web 2.0 ◽  
Grey Literature ◽  
Rapid Review ◽  
Cochrane Library ◽  
Neue Medien ◽  
Hand Search ◽  
Online Psychotherapy ◽  
Online Therapies

Abstract Background: Currently, the debate on regional and socio-structurally related treatment gaps in psychotherapeutic care increases the interest in e-mental health interventions such as the Internet-based psychotherapy, online self-help and new approaches for self-empowerment. Thus, health professionals could support informed decision-making by knowing the latest developments. However, if the ‘digital revolution’ fails to reach patients not familiar with Web 2.0, access to psychotherapies is unlikely to improve. Therefore, the objective of this review is to clarify whether online therapies should be recommended as an effective alternative to conventional psychotherapy in primary care.Methods: To investigate the research evidence of online therapies in adults within the last decade (2004-2014), a rapid review of literature was conducted by using electronic databases (i.e. Medline/PubMed, PubMed Central, Cochrane Library) to find systematic reviews, meta-analysis and clinical trials. Furthermore, a hand search in journals and grey literature was undertaken.Results: A search in PubMed for clinical trials on ‘online psychotherapy’ resulted in a total number of 245 publications. So, eight reviews and several clinical trials were chosen. Overall, mostly positive findings on the effectiveness and acceptance of online psychotherapy, primarily in the treatment of depression and anxiety disorders, were identified.Discussion: In sum, Internet-based psychotherapies have been effective in reducing symptoms of mood and anxiety disorders in clinical trials. However, due to the limited range of treatable disorders and non-representative samples (young female college graduates), external validity remains insufficient. Thus, further research is needed to determine if online therapies will be capable of improving access to psychotherapy.

scholarly journals The current leadership development opportunities provided for student paramedics by Higher Education Institutions: a literature review

2020 ◽  
Vol 5 (2) ◽  
pp. 26-33
Author(s):  
Alison Rae ◽  
Simon Robinson
Keyword(s):  
Higher Education ◽  
Leadership Development ◽  
Literature Review ◽  
Full Text ◽  
Higher Education Institutions ◽  
Grey Literature ◽  
Current Evidence ◽  
Leadership Potential ◽  
Current Leadership ◽  
Leadership Opportunities

Introduction: The development of safe, competent and capable paramedics is one of the key concerns of education providers or Higher Education Institutions (HEIs). To achieve this, paramedic programmes need to focus on teaching leadership to students. The aim of this literature review was to identify the current leadership development opportunities for paramedic students during their undergraduate training across the United Kingdom, in order to identify current gaps and make suggestions on how HEIs could increase leadership opportunities for student paramedics.Methods: During August 2018, the Scopus, Medline, CINAHL and Academic Search Premier databases were searched (the last three accessed via EBSCOhost). Grey literature was also manually reviewed. Both authors screened the title and abstract and agreed on final papers eligible for full-text review. CASP and COREQ checklists were used to assist in critically appraising the quality of the research and to help decide on the papers chosen for inclusion.Results: The search yielded 511 results (455 after duplicates were removed). The grey literature search also yielded one additional document that incorporated a framework based on primary research integrated within the paper itself. After title and abstract review, seven papers were included for full text critical review. Two papers were then excluded, resulting in a total of five papers being included in the review.Conclusion: Current evidence, although limited, demonstrates the benefit of educational programmes in developing educational and non-educational leadership opportunities for paramedic students. Moreover, there is value to individuals being provided or seeking extra-curricular activities, and students should be encouraged to engage in societies, the College of Paramedics, events and conferences, and to work or volunteer in healthcare or emergency service-related sectors to further enhance their leadership potential and skills.

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