scholarly journals The Effect of Pharmacist Services on Patient Health Outcomes in a Low Middle-income Country: a Systematic Review

2021 ◽  
Author(s):  
Ali Ahmed ◽  
Muhammad Saqlain ◽  
Maria Tanveer ◽  
Ali Qais Blebil ◽  
Juman Dujaili ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Outcomes ◽  
Cochrane Library ◽  
Middle Income ◽  
Medication Therapy ◽  
Pharmacist Interventions ◽  
Safety Outcomes ◽  
Patient Health ◽  
Pharmacist Services

Abstract Background: The pharmacist's role is shifting from dispensing to bedside care, resulting in better patient health outcomes. However, pharmacist services on healthcare utilization in low- and middle-income countries such as Pakistan are unclear. As a result, we intend to conduct a systematic review of pharmacists' roles in improving Pakistani patients' health outcomes.Methods: We searched PubMed, Scopus, EMBASE, CINAHIL, and Cochrane Library for relevant articles published from inception to February 2021. Original studies investigating the therapeutic, humanistic, safety, and economic impact of pharmacists in Pakistani patients (hospitalized or outpatients) were selected. Two reviewers independently assessed the bias in studies, and mutual consensus resolved discrepancies. Results: The literature search found 751 articles from which ten studies were included; seven were randomized controlled trials (RCTs), and three were observational studies. Three RCTs included were having a low risk of bias (ROB), two RCTs were having an unclear ROB, while two RCTs were having high ROB. Pharmacist interventions comprised one or more components like provision of education about the disease, medication adherence counselling, medication therapy management, and consultation with a physician regarding change of prescription. In most studies, pharmacists provided therapeutic care, followed by humanistic and safety outcomes with significant improvements. Intervention effect on cost-effectiveness and long-term outcomes were unclear.Conclusions: Positive but not always statistically significant pharmacist effects on therapeutic, humanistic, and safety outcomes have been reported. Therefore, the results favour adding on the benefit of pharmacist services but lack evidence of economic feasibility and long-term impact of pharmacist interventions.

scholarly journals The impact of clinical pharmacist services on patient health outcomes in Pakistan: a systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ali Ahmed ◽  
Muhammad Saqlain ◽  
Maria Tanveer ◽  
Ali Qais Blebil ◽  
Juman Abdulelah Dujaili ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Outcomes ◽  
Clinical Pharmacist ◽  
Risk Of Bias ◽  
Economic Outcomes ◽  
Cochrane Library ◽  
Clinical Pharmacists ◽  
Pharmacist Interventions ◽  
Patient Health ◽  
Pharmacist Services

Abstract Background The pharmacist’s role shifts from dispensing to bedside care, resulting in better patient health outcomes. Pharmacists in developed countries ensure rational drug use, improve clinical outcomes, and promote health status by working as part of a multidisciplinary team of healthcare professionals. However, clinical pharmacist services on healthcare utilization in low-and middle-income countries (LMICs) like Pakistan are unclear. As a result, we aim to systematically review pharmacists’ clinical roles in improving Pakistani patients’ therapeutic, safety, humanistic, and economic outcomes. Methods We searched PubMed, Scopus, EMBASE, CINAHL, and Cochrane Library for relevant articles published from inception to 28th February 2021. All authors were involved in the screening and selection of studies. Original studies investigating the therapeutic, humanistic, safety, and economic impact of clinical pharmacists in Pakistani patients (hospitalised or outpatients) were selected. Two reviewers independently assessed the risk of bias in studies, and discrepancies were resolved through mutual consensus. All of the included studies were descriptively synthesised, and PRISMA reporting guidelines were followed. Results The literature search found 751 articles from which nine studies were included; seven were randomized controlled trials (RCTs), and two were observational studies. Three RCTs included were having a low risk of bias (ROB), two RCTs were having an unclear ROB, while two RCTs were having a high ROB. The nature of clinical pharmacist interventions included one or more components such as disease-related education, lifestyle changes, medication adherence counselling, medication therapy management, and discussions with physicians about prescription modification if necessary. Clinical pharmacist interventions reduce medication-related errors, improve therapeutic outcomes such as blood pressure, glycemic control, lipid control, CD4 T lymphocytes, and renal functions, and improve humanistic outcomes such as patient knowledge, adherence, and health-related quality of life. However, no study reported the economic outcomes of interventions. Conclusions The findings of the studies included in this systematic review suggest that clinical pharmacists play important roles in improving patients’ health outcomes in Pakistan; however, it should be noted that the majority of the studies have a high risk of bias, and more research with appropriate study designs is needed.

scholarly journals Investigating the use of ultrasonography for the antenatal diagnosis of structural congenital anomalies in low-income and middle-income countries: systematic review protocol

2019 ◽  
Vol 3 (1) ◽  
pp. e000538 ◽  
Author(s):  
Stephanie Michele Goley ◽  
Sidonie Sakula-Barry ◽  
Ann Kelly ◽  
Naomi Wright
Keyword(s):  
Systematic Review ◽  
Health Outcomes ◽  
Low Income ◽  
Congenital Anomalies ◽  
Antenatal Diagnosis ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Middle Income ◽  
Antenatal Ultrasound ◽  
Middle Income Countries

IntroductionCongenital anomalies are the fifth leading cause of mortality in children under 5 years globally. The greatest burden is faced by those in developing countries, where over 95% of deaths occur. Many of these deaths may have been preventable through antenatal diagnosis and early intervention. This study aims to conduct a systematic review that investigates the use of antenatal ultrasound to diagnose congenital anomalies and improve the health outcomes of infants in low-income and middle-income countries (LMICs).Methods and analysisA systematic literature review will be conducted using three search strings: (1) structural congenital anomalies, (2) LMICs and (3) antenatal diagnosis. Four electronic databases will be searched: MEDLINE, Embase, PubMed and the Cochrane Library. Title, abstract and full-text screening will be undertaken in duplicate by two reviewers independently using Covidence. Consensus will be sought from the wider authorship for discrepancies. Data extraction will be undertaken by the principal investigator. The primary analysis will focus on the availability and effectiveness of antenatal ultrasound for structural congenital anomalies. Secondary outcomes will include neonatal morbidity and mortality, termination rates and referral rates for further antenatal care. Descriptive statistics and a narrative synthesis will be included in the final report. The methodological quality of the included studies will be evaluated using the Cochrane-approved Risk of Bias for Non-Randomised Studies of Intervention and Risk of Bias in Randomised Trials V.2.0 tools.Ethics and disseminationEthical approval is not required for conducting the systematic review as there will be no direct collection of data from individuals. The results will be submitted for publication in a scientific journal and presented internationally.ConclusionThis is the first study, to our knowledge, to systematically review current literature on the use of antenatal ultrasound for the detection of congenital anomalies in LMICs. This is vital to define current practice, highlight global disparities and evaluate effects on health outcomes for infants in low-resource settings.PROSPERO registration numberCRD42019105620.

scholarly journals The role of clubfoot training programmes in low- and middle-income countries: a systematic review

2020 ◽  
Vol 50 (4) ◽  
pp. 291-299
Author(s):  
Sharaf Sheik-Ali ◽  
Sergio M Navarro ◽  
Evan Keil ◽  
Chris Lavy
Keyword(s):  
Systematic Review ◽  
Ponseti Method ◽  
Cochrane Library ◽  
Middle Income ◽  
Middle Income Countries ◽  
Talipes Equinovarus ◽  
Training Programmes ◽  
Low And Middle Income

While adoption of the Ponseti method has continued gradually, its use to manage patients with congenital talipes equinovarus (CTEV) has been limited in low- and middle-income countries (LMICs) for a number of reasons including a lack of clinical training on technique and lack of appropriate clinical equipment. There are a frequent number of emerging studies that report on the role of clubfoot training programmes; however, little is known in regard to cumulative benefits. A systematic review was undertaken through Medline, the Cochrane Library and Web of Science for studies analysing clubfoot training programmes. There were no limitations on time, up until the review was commenced on January 2020. The systematic review was registered with PROSPERO as 165657. Ten articles complied with the inclusion criteria and were deemed fit for analysis. Training programmes lasted an average of 2–3 days. There was a reported increase in knowledge of applying the Ponseti method in managing clubfoot by participants (four studies P < 0.05). Skill retention was examined by multiple choice (MCQ) examination style questions before and after the training programme in two studies; both showed an improvement (MCQ answers improved from 59% to 73%). All studies showed an improvement in participants' self-reported understanding of the Ponseti method and confidence in its use in future practice ( P < 0.05). There were improved benefits of knowledge and clinical application of the Ponseti method by participants in the programmes in all studies examined. However, there was a significant lack of follow-up and exploration of long-term effects of these programmes. Implementing training programmes based on perceived benefits rather than actual long-term benefits may have a negative impact on healthcare delivery and patient management in LMICs.

scholarly journals The impacts of health systems financing fragmentation in low- and middle-income countries: a systematic review protocol

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Marina Siqueira ◽  
Maíra Coube ◽  
Christopher Millett ◽  
Rudi Rocha ◽  
Thomas Hone
Keyword(s):  
Systematic Review ◽  
Health Outcomes ◽  
Health System ◽  
Health Systems ◽  
Cochrane Library ◽  
Financial Risk Protection ◽  
Middle Income ◽  
Middle Income Countries ◽  
Patient Reported ◽  
Low And Middle Income

Abstract Background Health systems are often fragmented in low- and middle-income countries (LMICs). This can increase inefficiencies and restrict progress towards universal health coverage. The objective of the systematic review described in this protocol will be to evaluate and synthesize the evidence concerning the impacts of health systems financing fragmentation in LMICs. Methods Literature searches will be conducted in multiple electronic databases, from their inception onwards, including MEDLINE, EMBASE, LILACS, CINAHL, Scopus, ScienceDirect, Scielo, Cochrane Library, EconLit, and JSTOR. Gray literature will be also targeted through searching OpenSIGLE, Google Scholar, and institutional websites (e.g., HMIC, The World Bank, WHO, PAHO, OECD). The search strings will include keywords related to LMICs, health system financing fragmentation, and health system goals. Experimental, quasi-experimental, and observational studies conducted in LMICs and examining health financing fragmentation across any relevant metric (e.g., the presence of different health funders/insurers, risk pooling mechanisms, eligibility categories, benefits packages, premiums) will be included. Studies will be eligible if they compare financing fragmentation in alternative settings or at least two-time points. The primary outcomes will be health system-related goals such as health outcomes (e.g., mortality, morbidity, patient-reported outcome measures) and indicators of access, services utilization, equity, and financial risk protection. Additional outcomes will include intermediate health system objectives (e.g., indicators of efficiency and quality). Two reviewers will independently screen all citations, abstract data, and full-text articles. Potential conflicts will be resolved through discussion and, when necessary, resolved by a third reviewer. The methodological quality (or risk of bias) of selected studies will be appraised using established checklists. Data extraction categories will include the studies’ objective and design, the fragmentation measurement and domains, and health outcomes linked to the fragmentation. A narrative synthesis will be used to describe the results and characteristics of all included studies and to explore relationships and findings both within and between the studies. Discussion Evidence on the impacts of health system fragmentation in LMICs is key for identifying evidence gaps and priority areas for intervention. This knowledge will be valuable to health system policymakers aiming to strengthen health systems in LMICs. Systematic review registration PROSPERO CRD42020201467

Taxing sugar-sweetened beverages as a policy to reduce overweight and obesity in countries of different income classifications: a systematic review

2021 ◽  
pp. 1-27
Author(s):  
Alexander Itria ◽  
Stéfani S. Borges ◽  
Ana Elisa M. Rinaldi ◽  
Luciana Bertoldi Nucci ◽  
Carla Cristina Enes
Keyword(s):  
Systematic Review ◽  
Price Change ◽  
Overweight And Obesity ◽  
Cochrane Library ◽  
Obesity Prevalence ◽  
Middle Income ◽  
Sugar Sweetened Beverage ◽  
Middle Income Countries ◽  
Sweetened Beverages ◽  
Prevalence Of Obesity

Abstract Objective: To evaluate the potential impact of sugar-sweetened beverage (SSB) taxes on overweight and obesity prevalence in countries of different income classifications. Design: Systematic review following PRISMA guidelines (PROSPERO number CRD42020161612). Five databases (Cochrane Library, Embase, LILACS (via Virtual Health Library) and MEDLINE (via PubMed), and Web of Science were searched, from January 2009 up to December 2019. Articles that reported changes in purchases, sales, intake, body weight, BMI, overweight and/or obesity prevalence due to a tax on, or price change in SSBs were included. Setting: Studies conducted in countries of different income classifications. Participants: The search yielded 8,349 articles of which twenty-one met inclusion criteria. Results: Among the 16 studies selected, only 2 did not show that consumption, sales and purchase decreased as the price of SSBs increased. In 8 of the 13 studies selected, a positive effect of an SSB tax on decreasing overweight and obesity prevalence was expected. It is estimated that a 20% taxation on SSBs would result in a greater decrease in the prevalence of overweight and obesity compared to a 10% rate. Studies with no significant effect of taxing on sales, purchases, consumption and prevalence of obesity were from high-income countries, while significant effects of taxing on reducing purchase, consumption and/or obesity prevalence were found in studies from upper-middle and middle-income countries. Conclusion: A high SSB tax might be an effective fiscal policy to decrease purchase and consumption of SSBs and reduce overweight/obesity prevalence, especially if the tax were specific for beverage volume.

scholarly journals Effect of Non-Thermal Atmospheric Plasma on Micro-Tensile Bond Strength at Adhesive/Dentin Interface: A Systematic Review

Materials ◽  
2021 ◽  
Vol 14 (4) ◽  
pp. 1026
Author(s):  
Mohamed M. Awad ◽  
Feras Alhalabi ◽  
Abdullah Alshehri ◽  
Zaid Aljeaidi ◽  
Ali Alrahlah ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bond Strength ◽  
Atmospheric Plasma ◽  
Tensile Bond Strength ◽  
Cochrane Library ◽  
Limited Information ◽  
Short Term ◽  
Etch And Rinse ◽  
Medium Risk

Objective: The objective of this review was to evaluate the effect of non-thermal atmospheric plasma (NTAP) on adhesives resin–dentin micro-tensile bond strength (μTBS) in previously published studies. Methods: Electronic search was conducted using the Medline, Cochrane library, and Scopus databases. The included studies were laboratory studies that investigated the effect of NTAP on adhesives μTBS to coronal dentin. Studies that evaluated the effect of NTAP on bond strength to indirect substrates, enamel or root dentin, were excluded. The methodological quality of included studies was assessed. Results: Thirteen studies were included in this systematic review. All the included studies were considered to have a medium risk of bias. NTAP significantly improved μTBS at 24 h or after short-term aging in five studies (38.5%) and both immediate and after long-term aging in 5 studies (38.5%). In two studies (15.4%), NTAP resulted in a short-term material-dependent effect that was not stable after long-term aging. Interestingly, in one study (7.7%), NTAP had a positive effect only in the etch-and-rinse (ER) mode after long-term aging. Conclusion: Within the limitations of this systematic review, NTAP application could enhance resin–dentin μTBS of ER adhesives or universal adhesives (UAs) applied in the ER mode. In the ER mode, the rewetting step after NTAP seems to be unnecessary. Because of the limited information currently available in the literature, further studies are required to evaluate the effect of the NTAP application on self-etch (SE) adhesives or UAs applied in the SE mode.

scholarly journals Ageing, limb-loss and military veterans: a systematic review of the literature

2018 ◽  
Vol 39 (8) ◽  
pp. 1582-1610 ◽  
Author(s):  
NICK CADDICK ◽  
HELEN CULLEN ◽  
AMANDA CLARKE ◽  
MATT FOSSEY ◽  
MICHAEL HILL ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Military Service ◽  
Military Veterans ◽  
Limb Loss ◽  
Cochrane Library ◽  
Term Care ◽  
Long Term Impact ◽  
The Impact

ABSTRACTThe impact of losing a limb in military service extends well beyond initial recovery and rehabilitation, with long-term consequences and challenges requiring health-care commitments across the lifecourse. This paper presents a systematic review of the current state of knowledge regarding the long-term impact of ageing and limb-loss in military veterans. Key databases were systematically searched including: ASSIA, CINAHL, Cochrane Library, Medline, Web of Science, PsycArticles/PsychInfo, ProQuest Psychology and ProQuest Sociology Journals, and SPORTSDiscus. Empirical studies which focused on the long-term impact of limb-loss and/or health-care requirements in veterans were included. The search process revealed 30 papers relevant for inclusion. These papers focused broadly on four themes: (a) long-term health outcomes, prosthetics use and quality of life; (b) long-term psycho-social adaptation and coping with limb-loss; (c) disability and identity; and (d) estimating the long-term costs of care and prosthetic provision. Findings present a compelling case for ensuring the long-term care needs and costs of rehabilitation for older limbless veterans are met. A dearth of information on the lived experience of limb-loss and the needs of veterans’ families calls for further research to address these important issues.

The Effect of Intimate Partner Violence on the Physical Health and Health-Related Behaviors of Women: A Systematic Review of the Literature

2021 ◽  
pp. 152483802098554
Author(s):  
Anita Stubbs ◽  
Cassandra Szoeke
Keyword(s):  
Systematic Review ◽  
Intimate Partner Violence ◽  
Health Outcomes ◽  
Physical Health ◽  
Partner Violence ◽  
Intimate Partner ◽  
Physical Health Outcomes ◽  
Health Related Behaviors ◽  
Health Related

Aim: The long-term effects of intimate partner violence (IPV) on physical health outcomes and health-related behaviors are underresearched in comparison to the effects on mental health and pregnancy. This systematic review examines the recent research in this area from 2012 through 2019. Methods: SCOPUS, PubMed, EBSCOhost, and gray literature were searched using the key words “intimate partner violence” and “health.” To meet inclusion criteria, studies needed to be original research and focus on IPV during adulthood and its effects on the physical health or health-related behaviors of women. Fifty-two studies were qualitatively analyzed, with results grouped into broad categories of effects, including cardiovascular, endocrine, infectious diseases, and health screening. Results: IPV was shown to have negative effects on physical health outcomes for women, including worsening the symptoms of menopause and increasing the risk of developing diabetes, contracting sexually transmitted infections, engaging in risk-taking behaviors including the abuse of drugs and alcohol, and developing chronic diseases and pain. It also has significant effects on human immunodeficiency virus outcomes, worsening CD4+ cell depletion. Results varied regarding the effects of IPV on cardiovascular health outcomes. Conclusion: The result of this review demonstrates that women who have experienced violence and abuse are at significantly increased risk of poor health outcomes in a variety of areas and so require specialized and tailored primary care. This review highlights significant gaps in this field of research, particularly in relation to cardiovascular disease, endocrine dysfunction, and neurological symptoms and conditions. It demonstrates a need for additional long-term studies in this field to better inform the health care of women who have experienced IPV and to establish the physiological mediators of these outcomes.

scholarly journals Relationship between exclusive breast feeding and cardiorespiratory fitness in children and adolescents: a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e023223 ◽  
Author(s):  
Carlos Berlanga-Macías ◽  
Diana P. Pozuelo-Carrascosa ◽  
Celia Álvarez-Bueno ◽  
Jose Alberto Martínez-Hortelano ◽  
Miriam Garrido-Miguel ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quality Assessment ◽  
Children And Adolescents ◽  
Cardiorespiratory Fitness ◽  
Breast Feeding ◽  
Exclusive Breastfeeding ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Exclusive Breast Feeding

IntroductionBreast feeding has been considered important due to its short-term and long-term benefits on infant and maternal health. Regarding the long-term benefits, the influence of exclusive breastfeeding on cardiorespiratory fitness (CRF) during childhood and adolescence has been studied, although with controversial conclusions. This study protocol aims to provide a clear and standardised procedure for systematically reviewing the relationship between breast feeding, in terms of duration and exclusivity, and CRF in children and adolescents.Methods and analysisThis systematic review and meta-analysis protocol is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. A literature search will be conducted in MEDLINE, EMBASE, Web of Science and Cochrane Library. Observational studies regarding the association between breast feeding and CRF in children and adolescents written in English or Spanish will be included. A Critical Appraisal Checklist for Analytical Cross Sectional Studies and The Newcastle-Ottawa Quality Assessment Scale for longitudinal studies will be used for quality assessment of included studies. Standardised mean differences of CRF by exclusive breastfeeding categories will be calculated as the primary outcome. Subgroup analyses and meta-regression will be performed based on the sources of heterogeneity.Ethics and disseminationThis evidence-based systematic review will summarise the relevant information on the association of exclusive breast feeding and CRF in children and adolescents. The results will be disseminated by publication in a peer-reviewed journal. Given that the data used for this systematic review will be exclusively extracted from published studies, ethical approval will not be required.PROSPERO registration numberCRD42018082642.

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