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

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

Download Full-text

Barriers to and facilitators of the implementation of multi-disciplinary care pathways in primary care: a systematic review

10.21203/rs.2.22891/v2 ◽

2020 ◽

Author(s):

Eva Seckler ◽

Verena Regauer ◽

Thomas Rotter ◽

Petra Bauer ◽

Martin Müller

Keyword(s):

Systematic Review ◽

Primary Care ◽

Process Evaluation ◽

Data Extraction ◽

Complex Interventions ◽

Implementation Strategies ◽

Barriers And Facilitators ◽

Cochrane Library ◽

Care Pathways ◽

Perfect Agreement

Abstract Background : Care pathways (CPWs) are complex interventions that have the potential to reduce treatment errors and optimize patient outcomes by translating evidence into local practice. To design an optimal implementation strategy, potential barriers to and facilitators of implementation must be considered. The objective of this systematic review is to identify barriers to and facilitators of the implementation of CPWs in primary care (PC). Methods : A systematic search via Cochrane Library, CINAHL, and MEDLINE via PubMed supplemented by hand searches and citation tracing was carried out. We considered articles reporting on CPWs targeting patients at least 65 years of age in outpatient settings that were written in the English or German language and were published between 2007 and 2019. We considered (non-)randomized controlled trials, controlled before-after studies, interrupted time series studies ( main project reports ) as well as associated process evaluation reports of either methodology. Two independent researchers performed the study selection; the data extraction and critical appraisal were duplicated until the point of perfect agreement between the two reviewers. Due to the heterogeneity of the included studies, a narrative synthesis was performed. Results : 14 studies (seven main project reports and seven process evaluation reports) of the identified 8,154 records in the search update were included in the synthesis. The structure and content of the interventions as well as the quality of evidence of the studies varied. The identified barriers and facilitators were classified using the Context and Implementation of Complex Interventions framework . The identified barriers were inadequate staffing, insufficient education, lack of financial compensation, low motivation and lack of time. Adequate skills and knowledge through training activities for health professionals, good multi-disciplinary communication and individual tailored interventions were identified as facilitators. Conclusions : In the implementation of CPWs in PC, a multitude of barriers and facilitators must be considered, and most of them can be modified through the careful design of intervention and implementation strategies. Furthermore, process evaluations must become a standard component of implementing CPWs to enable other projects to build upon previous experience. Trial registration : PROSPERO 2018 CRD42018087689

Download Full-text

Barriers to and facilitators of the implementation of multi-disciplinary care pathways in primary care: a systematic review

10.21203/rs.2.22891/v1 ◽

2020 ◽

Author(s):

Eva Seckler ◽

Verena Regauer ◽

Thomas Rotter ◽

Petra Bauer ◽

Martin Müller

Keyword(s):

Systematic Review ◽

Primary Care ◽

Process Evaluation ◽

Data Extraction ◽

Complex Interventions ◽

Implementation Strategies ◽

Barriers And Facilitators ◽

Cochrane Library ◽

Care Pathways ◽

Perfect Agreement

Abstract Background : Care pathways (CPWs) are complex interventions that have the potential to reduce treatment errors and optimize patient outcomes by translating evidence into local practice. To design an optimal implementation strategy, potential barriers to and facilitators of implementation must be considered. The objective of this systematic review is to identify barriers to and facilitators of the implementation of CPWs in primary care (PC). Methods : A systematic search via Cochrane Library, CINAHL, and MEDLINE via PubMed supplemented by hand searches and citation tracing was carried out. We considered articles reporting on CPWs targeting patients at least 65 years of age in outpatient settings that were written in the English or German language and were published between 2007 and 2019. We considered (non-)randomized controlled trials, controlled before-after studies, interrupted time series studies ( main project reports ) as well as associated process evaluation reports of either methodology. Two independent researchers performed the study selection; the data extraction and critical appraisal were duplicated until the point of perfect agreement between the two reviewers. Due to the heterogeneity of the included studies, a narrative synthesis was performed. Results : 14 studies (seven main project reports and seven process evaluation reports) of the identified 8,154 records in the search update were included in the synthesis. The structure and content of the interventions as well as the quality of evidence of the studies varied. The identified barriers and facilitators were classified using the Context and Implementation of Complex Interventions framework . The identified barriers were inadequate staffing, insufficient education, lack of financial compensation, low motivation and lack of time. Adequate skills and knowledge through training activities for health professionals, good interprofessional communication and individual tailored interventions were identified as facilitators. Conclusions : In the implementation of CPWs in PC, a multitude of barriers and facilitators must be considered, and most of them can be modified through the careful design of intervention and implementation strategies. Furthermore, process evaluations must become a standard component of implementing CPWs to enable other projects to build upon previous experience.

Download Full-text

What does my neighbourhood have to do with my weight? A protocol for systematic review and meta-analysis of the association between neighbourhood socioeconomic status and body weight

BMJ Open ◽

10.1136/bmjopen-2017-017567 ◽

2017 ◽

Vol 7 (9) ◽

pp. e017567

Author(s):

Shimels Hussien Mohammed ◽

Mulugeta Molla Birhanu ◽

Tesfamichael Awoke Sissay ◽

Tesfa Dejenie Habtewold ◽

Balewgizie Sileshi Tegegn ◽

...

Keyword(s):

Systematic Review ◽

Socioeconomic Status ◽

Data Extraction ◽

Meta Analysis ◽

Cross Sectional ◽

Registration Number ◽

Newcastle Ottawa Scale ◽

Neighbourhood Socioeconomic Status ◽

Using Data

IntroductionIndividuals living in poor neighbourhoods are at a higher risk of overweight/obesity. There is no systematic review and meta-analysis study on the association of neighbourhood socioeconomic status (NSES) with overweight/obesity. We aimed to systematically review and meta-analyse the existing evidence on the association of NSES with overweight/obesity.Methods and analysisCross-sectional, case–control and cohort studies published in English from inception to 15 May 2017 will be systematically searched using the following databases: PubMed, EMBASE, Web of Sciences and Google Scholar. Selection, screening, reviewing and data extraction will be done by two reviewers, independently and in duplicate. The Newcastle–Ottawa Scale (NOS) will be used to assess the quality of evidence. Publication bias will be checked by visual inspection of funnel plots and Egger’s regression test. Heterogeneity will be checked by Higgins’s method (I2statistics). Meta-analysis will be done to estimate the pooled OR. Narrative synthesis will be performed if meta-analysis is not feasible due to high heterogeneity of studies.Ethics and disseminationEthical clearance is not required as we will be using data from published articles. Findings will be communicated through a publication in a peer-reviewed journal and presentations at professional conferences.PROSPERO registration numberCRD42017063889.

Download Full-text

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

10.2196/preprints.13605 ◽

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)

Download Full-text

Reduction of ileocolic intussusception under sedation or anaesthesia: a systematic review of complications

Archives of Disease in Childhood ◽

10.1136/archdischild-2021-322706 ◽

2021 ◽

pp. archdischild-2021-322706

Author(s):

Moran Gal ◽

Shirly Gamsu ◽

Ron Jacob ◽

Daniel M Cohen ◽

Itai Shavit

Keyword(s):

Systematic Review ◽

Intestinal Perforation ◽

English Language ◽

Data Extraction ◽

Current Data ◽

Pulmonary Aspiration ◽

Ileocolic Intussusception ◽

Newcastle Ottawa Scale ◽

Permanent Neurological Deficit ◽

Ottawa Scale

BackgroundDespite the increased use of sedation in children undergoing stressful procedures, reduction of ileocolic intussusception (RII) is usually performed on awake children without any form of sedation.ObjectiveTo evaluate the incidence of severe complications of RII under sedation or anaesthesia.DesignA systematic review including English language original articles of any date.PatientsChildren undergoing RII (pneumatic or hydrostatic) under sedation or anaesthesia.Data sourcesOvid Embase, Scopus, PubMed, the Cochrane Database of Systematic Reviews and the internet search engine Google Scholar.Data extractionThree authors independently reviewed each article for eligibility. The Newcastle-Ottawa Scale was used to assess the quality of included studies.Main outcome measuresThe primary outcome was the incidence of intestinal perforation during RII. The secondary outcomes were the incidence of sentinel adverse events defined as death, cardiopulmonary resuscitation, permanent neurological deficit and pulmonary aspiration syndrome.ResultsThe search yielded 368 articles. Nine studies with 1391 cases were included in the analysis. Of the nine studies, six had a score of ≤6 stars in the Newcastle-Ottawa Scale assessment, indicating low-to-moderate quality. Propofol-based sedation was used in 849 (59.2%) cases; 5 (0.6%) had intestinal perforation. Intestinal perforation was not reported in patients who were sedated with other sedatives. One patient had pulmonary aspiration syndrome.ConclusionsAlthough caution remains warranted, current data suggest that the incidence of severe complications due to RII under sedation or anaesthesia is low. Due to the lack of prospective data, it is difficult to ascertain the exact incidence of severe complications.

Download Full-text

Changes in gastric mucosal microbiota in gastric carcinogenesis: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2020-045810 ◽

2021 ◽

Vol 11 (3) ◽

pp. e045810

Author(s):

Ruoyu Ji ◽

Xinyu Zhao ◽

Xinyuan Cao ◽

Yizhen Zhang ◽

Yingyun Yang

Keyword(s):

Systematic Review ◽

Conference Proceedings ◽

Data Extraction ◽

Alpha Diversity ◽

Gastric Carcinogenesis ◽

Ethical Approval ◽

Registration Number ◽

Newcastle Ottawa Scale ◽

Review Protocol ◽

Quantitative Analyses

IntroductionThe human stomach is a complex and diverse microbial ecosystem. Consecutive alternations of gastric microbiota occur in gastric carcinogenesis, while the changing pattern during this process remains controversial across studies. We aim to identify the changes in the diversity and composition of gastric mucosal microbiota in gastric tumorigenesis.Methods and analysisWe will search through PubMed, EMBASE and Cochrane databases, as well as conference proceedings and references of review articles for observational articles reporting either the relative abundance of bacteria at the phylum or genus level or at least one of the alpha diversity indexes respectively and clearly in both gastric cancer and non-cancer groups. Selection of studies and data extraction will be performed independently by two researchers. Disagreements will be resolved through discussion. Risk of bias will be assessed using the modified Newcastle-Ottawa Scale. Quantitative analyses will be performed using a random effects model, where the effect measurement will be expressed as the MD.Ethics and disseminationEthical approval for this systematic review is not required, as the study is based exclusively on published documents and will not include any individual data. Findings of this study are expected to be disseminated through peer-reviewed journals or conference proceedings.PROSPERO registration numberCRD42020206973.

Download Full-text

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 ◽

10.1136/bmjopen-2021-050912 ◽

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.

Download Full-text

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

10.2196/preprints.28083 ◽

2021 ◽

Author(s):

Anthony Duffy ◽

Greg Christie ◽

Sylvain Moreno

Keyword(s):

Systematic Review ◽

Digital Health ◽

Data Extraction ◽

Complex Interventions ◽

Evidence Base ◽

End Users ◽

Digital Design ◽

Health Interventions ◽

Healthcare Outcomes ◽

Eligibility Criteria

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

Download Full-text

Using Consolidated Framework for Implementation Research to investigate facilitators and barriers of implementing alcohol screening and brief intervention among primary care health professionals: a systematic review

Implementation Science ◽

10.1186/s13012-021-01170-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Paul Shing-fong Chan ◽

Yuan Fang ◽

Martin Chi-sang Wong ◽

Junjie Huang ◽

Zixin Wang ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Brief Intervention ◽

Implementation Research ◽

Health Professionals ◽

Alcohol Screening ◽

Screening And Brief Intervention ◽

Primary Care Settings ◽

Facilitators And Barriers ◽

Inner Setting

Abstract Background Alcohol screening and brief intervention (SBI) is recommended to be implemented in primary care settings to intervene against hazardous/harmful drinking. However, studies showed that the uptake rate was low in many regions/countries. This systematic review presented current findings on the facilitators and barriers of SBI implemented by health professionals in primary care settings using the Consolidated Framework for Implementation Research (CFIR). Methods We included qualitative, quantitative, and mixed-method studies identified through four electronic databases (PubMed, MEDLINE, PsycInfo, and Web of Science) from inception to June 2020. Included articles had to address barriers and facilitators of SBI implementation and provide sufficient details that the CFIR domains could be identified and data were abstracted using a standardized extraction form. Results A total of 74 studies published from 1985 to 2019 were finally analysed and summarized. The most common facilitators were knowledge and positive beliefs about SBI (characteristics of the individuals) and available resources (inner setting). In contrast, the most common barriers were cost related to implementing SBI (intervention characteristics), negative beliefs about SBI (characteristics of the individuals), and lack of self-efficacy in implementing SBI (characteristics of the individuals). It could be observed that factors related to the inner setting and characteristics of individuals were extensively studied whilst the process received the least attention. Conclusions Most of the facilitators and barriers are modifiable. Additionally, most literature focused on various kinds of available assets to implement SBI. To promote the spread of SBI implementation, more high-quality studies on the implementation process are needed. This systematic review could serve as a reference framework for health authorities to devise strategies for improving the implementation of SBI in primary care settings. Trial registration This systematic review was registered in PROSPERO (CRD42021258833).

Download Full-text

A systematic review protocol of quantitative instruments of income inequality in studies of children and adolescents

HRB Open Research ◽

10.12688/hrbopenres.13456.1 ◽

2021 ◽

Vol 4 ◽

pp. 132

Author(s):

David O Driscoll ◽

Elizabeth Kiely ◽

Linda O Keeffe ◽

Ali Khashan

Keyword(s):

Systematic Review ◽

Income Inequality ◽

Health Outcomes ◽

Children And Adolescents ◽

Socioeconomic Inequality ◽

Data Extraction ◽

Theil Index ◽

Important Indicator ◽

Data Extraction Form ◽

Newcastle Ottawa Scale

Background: Income inequality is an important indicator of socioeconomic position which is a determinant of social, psychological, and physical health outcomes from childhood to adulthood. Different income inequality instruments (metrics) are used to investigate associations between income inequality and health outcomes (e.g. Gini coefficient, Theil Index). Income inequality instruments provide unique information on the construct of socioeconomic inequality. Albeit there is variation in studies as to the type and rationale for using a particular quantitative instrument of income inequality. The aim of this systematic review will investigate and identify the most used quantitative income inequality instrument in studies of children and adolescents Methods: The PRISMA-P framework will be applied to identify high quality articles (PROSPERO: CRD42021259114). A search will be conducted in PubMed, Embase, and PsycINFO. The search will include studies concerned with income inequality and/or socioeconomic inequality in children and adolescents. All articles will be independently reviewed, data extracted, and quality appraised by two reviewers and a third to arbitrate disputes. Articles will be initially reviewed by title and abstract using inclusion criteria. A data extraction form will be used. Three questions will be answered on the quality of the rationale for using a particular income inequality instrument and the Newcastle-Ottawa Scale will be used to assess bias and quality. The primary outcome of interest is the type and frequency of quantitative income inequality instrument used and the study outcome associated with that income inequality instrument. Conclusions: This systematic review will aim to explore and provide a summary of the different types of quantitative income inequality instruments used in studies of child and adolescent populations. This will help to guide researchers and policy makers on the inclusion and use of income inequality metrics in future studies aimed at understanding associations with health and social outcomes in children and adolescents.

Download Full-text