scholarly journals Systematic Review Investigating Multi-disciplinary Team Approaches to Screening and Early Diagnosis of Dementia in Primary Care – What are the Positive and Negative Effects and Who Should Deliver It?

2017 ◽  
Vol 15 (1) ◽  
pp. 5-17 ◽  
Author(s):  
Toby Smith ◽  
Jane Cross ◽  
Fiona Poland ◽  
Felix Clay ◽  
Abbey Brookes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Early Diagnosis ◽  
Service Providers ◽  
Care Practice ◽  
Initial Contact ◽  
Negative Effects ◽  
People With Dementia ◽  
Health And Social Care ◽  
Early Diagnostic

Background: Primary care services frequently provide the initial contact between people with dementia and health service providers. Early diagnosis and screening programmes have been suggested as a possible strategy to improve the identification of such individuals and treatment and planning health and social care support. Objective: To determine what early diagnostic and screening programmes have been adopted in primary care practice, to explore who should deliver these and to determine the possible positive and negative effects of an early diagnostic and screening programme for people with dementia in primary care. Methods: A systematic review of the literature was undertaken using published and unpublished research databases. All papers answering our research objectives were included. A narrative analysis of the literature was undertaken, with the CASP tools used appropriately to assess study quality. Results: Thirty-three papers were identified of moderate to high quality. The limited therapeutic options for those diagnosed with dementia means that even if such a programme was instigated, the clinical value remains questionable. Furthermore, accuracy of the diagnosis remains difficult to assess due to poor evidence and this raises questions regarding whether people could be over- or under-diagnosed. Given the negative social and psychological consequences of such a diagnosis, this could be devastating for individuals. Conclusion: Early diagnostic and screening programmes have not been widely adopted into primary care. Until there is rigorous evidence assessing the clinical and cost-effectiveness of such programmes, there remains insufficient evidence to support the adoption of these programmes in practice.

WikiRecs primary care: developing rapid recommendations for primary care through effective collaboration between systematic review and guideline teams

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697085
Author(s):  
Trudy Bekkering ◽  
Bert Aertgeerts ◽  
Ton Kuijpers ◽  
Mieke Vermandere ◽  
Jako Burgers ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Clinical Practice ◽  
Primary Care Physicians ◽  
Urinary Stones ◽  
Care Practice ◽  
Supporting Evidence ◽  
Supervised Exercise ◽  
Review Team ◽  
New Evidence

BackgroundThe WikiRecs evidence summaries and recommendations for clinical practice are developed using trustworthy methods. The process is triggered by studies that may potentially change practice, aiming at implementing new evidence into practice fast.AimTo share our first experiences developing WikiRecs for primary care and to reflect on the possibilities and pitfalls of this method.MethodIn March 2017, we started developing WikiRecs for primary health care to speed up the process of making potentially practice-changing evidence in clinical practice. Based on a well-structured question a systematic review team summarises the evidence using the GRADE approach. Subsequently, an international panel of primary care physicians, methodological experts and patients formulates recommendations for clinical practice. The patient representatives are involved as full guideline panel members. The final recommendations and supporting evidence are disseminated using various platforms, including MAGICapp and scientific journals.ResultsWe are developing WikiRecs on two topics: alpha-blockers for urinary stones and supervised exercise therapy for intermittent claudication. We did not face major problems but will reflect on issues we had to solve so far. We anticipate having the first WikiRecs for primary care available at the end of 2017.ConclusionThe WikiRecs process is a promising method — that is still evolving — to rapidly synthesise and bring new evidence into primary care practice, while adhering to high quality standards.

scholarly journals Refugee-like migrants have similar health needs to refugees: a New Zealand post-settlement cohort study

BJGP Open ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. bjgpopen20X101013
Author(s):  
Jonathan Donald Kennedy ◽  
Serena Moran ◽  
Sue Garrett ◽  
James Stanley ◽  
Jenny Visser ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
New Zealand ◽  
Primary Care Practice ◽  
Social Care ◽  
Hospital Admissions ◽  
Outpatient Service ◽  
Care Practice ◽  
Care Needs ◽  
Health And Social Care

BackgroundRefugees and asylum seekers have specific health and social care needs on arrival in a resettlement country. A third group — migrants with a refugee-like background (refugee-like migrants) — are less well defined or understood.AimUsing routinely collected data, this study compared demographics, interpreter need, and healthcare utilisation for cohorts of refugee-like migrants and refugees.Design & settingA retrospective cohort study was undertaken in Wellington, New Zealand.MethodData were obtained for refugee-like migrants and refugees accepted under the national quota system (quota refugees), who enrolled in a New Zealand primary care practice between 2011 and 2015. Data from the primary care practice and nationally held hospital and outpatient service databases, were analysed. Age and sex standardisation adjusted for possible differences in cohort demographic profiles.ResultsThe cohorts were similar in age, sex, deprivation, and interpreter need. Refugee-like migrants were found to have similar, but not identical, health and social care utilisation to quota refugees. Primary care nurse utilisation was higher for refugee-like migrants. Clinical entries in the primary care patient record were similar in rate for the cohorts. Emergency department utilisation and hospital admissions were similar. Hospital outpatient utilisation was lower for refugee-like migrants.ConclusionThis research suggests that health, social care, and other resettlement services should be aligned for refugee-like migrants and quota refugees. This would mean that countries accepting quota refugees should plan for health and social care needs of subsequent refugee-like migrant family migration. Further research should investigate matched larger-scale national health and immigration datasets, and qualitatively explore factors influencing health-seeking behaviour of refugee-like migrants.

Supporting people with dementia during the COVID-19 pandemic

2021 ◽  
Vol 32 (2) ◽  
pp. 65-68
Author(s):  
Linda Nazarko
Keyword(s):  
Primary Care Practice ◽  
Social Care ◽  
Practice Nurse ◽  
Informal Support ◽  
Care Practice ◽  
Physical And Mental Health ◽  
Practice Nurses ◽  
People With Dementia ◽  
Care Workers ◽  
Health And Social Care

People with dementia have experienced great disruption to their lives due to the pandemic. Linda Nazarko highlights the way individuals have been affected and how the practice nurse can support them People with dementia and their caregivers have been severely affected by the COVID-19 pandemic. Isolation, a reduction in formal and informal support, and disruption to routine have contributed to feelings of loneliness and anxiety in people with dementia and their caregivers. The pandemic has led to staff shortages in health and social care, changes of care workers and a reduction in the level of support provided. These changes have affected the physical and mental health of people with dementia and increased their reliance on primary care. Practice nurses have a key role to play in supporting affected individuals.

Stability of food insecurity status in paediatric primary care

2020 ◽  
pp. 1-6
Author(s):  
Kelly A Courts ◽  
Rebecca A Hubbard ◽  
Hans B Kersten ◽  
Heather Klusaritz
Keyword(s):  
Primary Care ◽  
Food Insecurity ◽  
Care Practice ◽  
Negative Effects ◽  
Similar Frequency ◽  
American Academy Of Pediatrics ◽  
Paediatric Primary Care ◽  
Race Ethnicity ◽  
The Stability ◽  
Generalised Estimating Equations

Abstract Objective: The American Academy of Pediatrics recommends screening for food insecurity (FI) at all well-child visits due to well-documented negative effects of experiencing FI in childhood. Before age 3, children have twelve recommended primary care visits at which screening could occur. Little is known regarding the stability of FI status at this frequency of screening. Design: Data derived from electronic health records were used to retrospectively examine the stability of household FI status. Age-stratified (infant v. toddler) analyses accounted for age-based differences in visit frequency. Regression models with time since last screening as the predictor of FI transitions were estimated via generalised estimating equations adjusting for age and race/ethnicity. Setting: A paediatric primary care practice in Philadelphia. Participants: 3451 distinct patients were identified whose health record documented two or more household FI screens between April 1, 2012 and July 31, 2018 and were aged 0–3 years at first screen. Results: Overall, 9·5 % of patients had a transition in household FI status, with a similar frequency of transitioning from food insecure to secure (5·0 %) and from food secure to insecure (4·5 %). Families of toddlers whose last screen was more than a year ago were more likely to experience a transition to FI compared with those screened 0–6 months prior (OR 1·91 (95 % CI 1·05, 3·47)). Conclusions: Screening more than annually may not contribute substantially to the identification of transitions to FI.

scholarly journals Olfactory dysfunction in Alzheimer’s disease Systematic review and meta-analysis

2018 ◽  
Vol 12 (2) ◽  
pp. 123-132 ◽  
Author(s):  
Maren de Moraes e Silva ◽  
Pilar Bueno Siqueira Mercer ◽  
Maria Carolina Zavagna Witt ◽  
Renata Ramina Pessoa
Keyword(s):  
Systematic Review ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Early Diagnosis ◽  
Effect Size ◽  
Meta Analysis ◽  
Olfactory Dysfunction ◽  
Diagnostic Evaluation ◽  
Olfactory Analysis ◽  
Early Diagnostic

Abstract Alzheimer’s disease (AD), a neurodegenerative condition, is one of the most prevalent kinds of dementia, whose frequency doubles for every 5 years of age in elderly. Objective: To determine the correlation between AD and olfactory alterations, identifying the most affected domains and exploring the utility of olfactory tests for complementing early diagnosis. Methods: Databases were searched using the terms “olfactory OR smell OR olfaction AND alzheimer” for articles related to the proposed theme. The selected studies were categorized and evaluated separately depending on the method of analysis of the olfactory tests: identification of odors, discrimination and recognition, and a meta-analysis was carried out. Results: Fifty-one articles were selected for analysis. The effect size for most studies was large, as were the summary values for each category of individualized olfactory analysis. Conclusion: Among the olfactory domains, except memory, identification appears to be the most altered in AD. The possibility of including tests that specifically evaluate the identification of odors as an item in early diagnostic evaluation should be explored. PROSPERO registration: CRD42018089076.

scholarly journals Communicating with library patrons and people with dementia: Tracing an ethic of care in professional communication guidelines

Dementia ◽  
2018 ◽  
Vol 19 (3) ◽  
pp. 899-914
Author(s):  
Nicole K Dalmer ◽  
DG Campbell
Keyword(s):  
Interpersonal Relationships ◽  
Ethic Of Care ◽  
Service Providers ◽  
Information Service ◽  
Dementia Care ◽  
Professional Communication ◽  
Moral Principles ◽  
People With Dementia ◽  
Health And Social Care ◽  
Reference Librarians

In both library reference work and dementia care, communication between personnel and service recipients can be both complex and complicated. Professionals in both fields have therefore developed protocols and standards to assist personnel in handling these interactions. In this article we detail an exploratory comparative study that used an ethic of care framework to compare prominent guidelines for reference librarians (American Library Association’s Reference and User Services Association’s Guidelines for behavioral performance of reference and information service providers) with guidelines for workers in long-term dementia care settings (the National Institute for Health and Care Excellence’s Guideline on supporting people with dementia and their carers in health and social care). We explored how both sets of Guidelines frame the act of communication as a combination of regulated procedure and empathetic discourse to determine how the similarities among and differences between these two guidelines provide useful insights into each other. Our examination was structured using an ethic of care lens, which emphasizes the importance of interpersonal relationships, reciprocity, and empathetic benevolence. Using specific phrases in each set of Guidelines that align with and are evidence of Tronto’s four moral principles of care, we ultimately discovered, in both sets of Guidelines, an underlying ethic of care: a repeated insistence upon embedding procedures within behaviour that manifests attentiveness, responsibility, responsiveness, and competence.

scholarly journals Determinants of regulatory compliance in health and social care services: a systematic review protocol

2021 ◽  
Vol 4 ◽  
pp. 13
Author(s):  
Paul Dunbar ◽  
John P. Browne ◽  
Laura O'Connor
Keyword(s):  
Systematic Review ◽  
Quality Improvement ◽  
Social Care ◽  
Service Providers ◽  
Regulatory Compliance ◽  
Policy Makers ◽  
Care Services ◽  
Health And Social Care ◽  
Wide Range ◽  
Study Designs

Background: The delivery of high quality health and social care services is a fundamental goal for health systems worldwide. Identifying the determinants of quality is a complex task as there are a myriad of variables to choose from. Researchers in this field have assessed a range of organisational and environmental factors (for example: staff composition, facility ownership, facility size) for an association with various quality metrics. Less attention has been paid to the determinants of compliance with quality regulation. Identifying the determinants of compliance has the potential to improve regulatory processes and can inform quality improvement initiatives undertaken by service providers and policy makers. This protocol describes a systematic review which will review literature from a wide range of study designs and sources to develop an overview of the determinants of regulatory compliance in health and social care services. Methods: A wide range of study designs and grey literature will be sought for this review. Searches will be conducted using PubMed, MEDLINE, PsycInfo, SocINDEX and CINAHL databases. The studies included in the review will be subject to quality appraisal with reference to the collection of tools available from the Joanna Briggs Institute. Data extraction will be informed by the Consolidated Framework for Implementation Research (CFIR). A narrative synthesis will be conducted on the barriers, facilitators and factors associated with compliance, with reference to the concepts mapped onto the CFIR. GRADE-CERQual will be used to grade the overall body of evidence. Conclusion: The findings of this review will be useful to regulators to inform regulatory policy and practice. Service providers and policy makers may also use the findings to inform quality improvement initiatives aimed at improving compliance and quality across a range of health and social care services.

scholarly journals Optimizing The Diagnosis and Management of Dementia Within Primary Care: A Systematic Review of Systematic Reviews

2021 ◽  
Author(s):  
Brooklynn Fernandes ◽  
Zahra Goodarzi ◽  
Jayna Holroyd-Leduc
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Systematic Reviews ◽  
Family Physicians ◽  
Outcome Data ◽  
Screening Tools ◽  
Care Practice ◽  
Cognitive Screening ◽  
Mental Test Score ◽  
Diagnosis And Management

Abstract Background: To understand how best to approach dementia care within primary care and its challenges, we examined the evidence related to diagnosing and managing dementia within primary care.Methods: Databases searched include: MEDLINE, Embase, PsycINFO and The Cochrane Database of Systematic Reviews from inception to 11 May 2020. English-language systematic reviews were included if they described interventions involving the diagnosis, treatment and/or management of dementia within primary care/family medicine and outcome data was available. The risk of bias was assessed using AMSTAR 2. The review followed PRISMA guidelines and is registered with Open Science Framework.Results: Twenty-one articles are included. The Mini-Cog and the MMSE were the most widely studied cognitive screening tools. The Abbreviated Mental Test Score (AMTS) achieved high sensitivity (100%, 95% CI: 70%-100%) and specificity (82%, 95% CI: 72%-90%) within the shortest amount of time (3.16 to 5 minutes) within primary care. Five of six studies found that family physicians had an increased likelihood of suspecting dementia after attending an educational seminar. Case management improved behavioural symptoms, while decreasing hospitalization and emergency visits. The primary care educational intervention, Enhancing Alzheimer's Caregiver Health (Department of Veterans Affairs), was successful at increasing carer ability to manage problem behaviours and improving outcomes for caregivers.Conclusions: There are clear tools to help identify cognitive impairment in primary care, but strategies for management require further research. The findings from this systematic review will inform family physicians on how to improve dementia diagnosis and management within their primary care practice.

scholarly journals Interprofessional collaboration and chronicity management: a systematic review of clinical trials

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Pascucci ◽  
M T Riccardi ◽  
M Sapienza ◽  
M C Nurchis ◽  
W Ricciardi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Interprofessional Education ◽  
Medical Training ◽  
Interprofessional Collaboration ◽  
Future Research ◽  
Care Practice ◽  
Chronic Patients ◽  
Health And Social Care ◽  
The Impact

Abstract The increasing prevalence of chronic disease generates significant financial, social and psychosocial burden for patients, families and healthcare system. Interprofessional collaboration (IPC) is becoming recognized as a discipline among health and social care professionals and medical training institutions worldwide. Literature research suggests that following interventions could be particularly useful in the management of chronic patients. The objective of this systematic review was to assess the impact of IPC on chronic patients compared to standard health-care practice. The PICO model was adopted and three electronic databases (Medline, EMBASE, Web of Science) were searched using appropriate keywords. Selected trials were assessed for quality and risk of bias using the National Institutes of Health Quality Assessment of Controlled Intervention Studies. Data were analyzed using descriptive statistic, and comparison of outcomes among teams with or without pharmacist was performed using t-Student test (p < 0,05). Out of 11.128, 24 studies met the inclusion criteria and 58 indicators were identified: 62% improved significantly, 38% did not show any variation, no indicator worsened after intervention. In particular, systolic blood pressure (SBP) showed a statistically significant improvement in 70.0 % of trials in which was considered while did not show any difference in the rest. The presence of a pharmacist in the team show a statistically significant improvement on SBP (p = 0,002) in patients with hypertension while no statistically significant effect is observed on glycated hemoglobin (p = 0,193) in diabetics. The results support that IPC contributes to positive patient, provider and institutional level outcomes, in particular for chronic conditions. Future research should focus on the inclusion of patient/caregivers in the collaborative team, and on the role of interprofessional education (IPE) on collaborative practice in the management of the patient with chronicity. Key messages IPC is an innovative strategy to address the complex health needs of chronic populations. Further studies are needed to evaluate the role of IPE in achieving better IPC and improving chronic patients’ outcomes.

scholarly journals Effectiveness of Educational Interventions to Increase Knowledge of Evidence-Based Practice Among Nurses and Physiotherapists in Primary Health Care: Protocol for a Systematic Review

10.2196/17621 ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. e17621
Author(s):  
Henk Verloo ◽  
Pauline Melly ◽  
Roger Hilfiker ◽  
Filipa Pereira
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Health Care ◽  
Systematic Reviews ◽  
Evidence Based Practice ◽  
Daily Practice ◽  
Educational Interventions ◽  
Care Practice ◽  
Evidence Based ◽  
Cochrane Central Register

Background The implementation of evidence-based practice (EBP) in daily health care practice is strongly encouraged; it is widely recognized as a means to improve the quality and safety of health care for patients and reduce avoidable costs. Primary care nurses and physiotherapists face numerous challenges in trying to ensure that they deliver effective daily care. Broadly promoted educational interventions aim to increase the integration and implementation of EBP in their daily practice. Objective This systematic review will retrieve and evaluate publications examining the effectiveness of educational interventions to increase the integration and implementation of EBP among nurses, nurse practitioners, and physiotherapists active in primary care. Methods We will conduct a systematic review of published articles in relevant professional, scientific journals (from their start dates) and in the following electronic databases, from inception until October 31, 2020: Medline Ovid SP (from 1946), PubMed (NOT Medline[sb]; from 1996), Embase.com (from 1947), CINAHL Ebesco (from 1937), the Cochrane Central Register of Controlled Trials Wiley (from 1992), PsycINFO Ovid SP (from 1806), Web of Science Core collection (from 1900), PEDro (from 1999), the JBI Database of Systematic Reviews and Implementation Reports (from 1998), and the Trip Database (from 1997). We will use the predefined search terms of “evidence-based practice,” “nurses,” or “physiotherapists” and combinations with other terms, such as “educational interventions.” We will also conduct a hand search of the bibliographies of all the relevant articles and a search for unpublished studies using Google Scholar, the ProQuest Dissertations and Theses dissemination, Mednar, WorldCat, OpenGrey, and Grey Literature Report. We will consider publications in English, French, German, and Portuguese. Results The electronic database searches were completed in October 2020. Retrieved articles are currently being screened, and the entire study is expected to be completed by March 2021. Conclusions This systematic review will provide specific knowledge about the effectiveness of educational interventions to increase the implementation and integration of EBP in the daily practice of nurses and physiotherapists providing primary care services. Its findings will inform us about the types and frequencies of the most successful educational interventions. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42017077309; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=77309 International Registered Report Identifier (IRRID) DERR1-10.2196/17621

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