scholarly journals Use of Apps to Promote Childhood Vaccination: Protocol for a Systematic Review

10.2196/16929 ◽  
2020 ◽  
Vol 9 (2) ◽  
pp. e16929
Author(s):  
Michelle Helena Van Velthoven ◽  
Madison Milne-Ives ◽  
Caroline de Cock ◽  
Mary Mooney ◽  
Edward Meinert
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Health Care Professionals ◽  
English Language ◽  
Search Strategy ◽  
Grey Literature ◽  
Information Storage ◽  
Childhood Vaccination ◽  
Cochrane Central Register ◽  
Technical Standards

Background The decline in the uptake of routine childhood vaccinations has resulted in outbreaks of vaccine-preventable diseases. Vaccination apps can be used as a tool to promote immunization through the provision of reminders, dissemination of information, peer support, and feedback. Objective The aim of this review is to systematically review the evidence on the use of apps to support childhood vaccination uptake, information storage, and record sharing. Methods We will identify relevant papers by searching the following electronic databases: PubMed, Embase by Ovid, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Education Resources Information Center (ERIC). We will review the reference lists of those studies that we include to identify relevant additional papers not initially identified using our search strategy. In addition to the use of electronic databases, we will search for grey literature on the topic. The search strategy will include only terms relating to or describing the intervention, which is app use. As almost all titles and abstracts are in English, 100% of these will be reviewed, but retrieval will be confined to papers written in the English language. We will record the search outcome on a specifically designed record sheet. Two reviewers will select observational and intervention studies, appraise the quality of the studies, and extract the relevant data. All studies will involve the use of apps relating to child vaccinations. The primary outcome is the uptake of vaccinations. Secondary outcomes are as follows: (1) use of app for sharing of information and providing vaccination reminders and (2) use of app for storage of vaccination information; knowledge and decision making by parents regarding vaccination (ie, risks and benefits of vaccination); costs and cost-effectiveness of vaccination apps; use of the app and measures of usability (eg, usefulness, acceptability, and experiences of different users: parents and health care professionals); use of technical standards for development of the app; and adverse events (eg, data leaks and misinformation). We will exclude studies that do not study an app. We anticipate a limited scope for meta-analysis and will provide a narrative overview of findings and tabular summaries of extracted data. Results This project was funded by the Sir David Cooksey Fellowship in Healthcare Translation at the University of Oxford, Oxford, United Kingdom. We will submit the full systematic review for publication in the Journal of Medical Internet Research. Conclusions This review will follow, where possible, the Cochrane Collaboration and the Centre for Review and Dissemination methodologies for conducting systematic reviews. We will report our findings based on guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The review results will be used to inform the development of a vaccination app. International Registered Report Identifier (IRRID) PRR1-10.2196/16929

scholarly journals Use of Apps to Promote Childhood Vaccination: Protocol for a Systematic Review (Preprint)

2019 ◽  
Author(s):  
Michelle Helena Van Velthoven ◽  
Madison Milne-Ives ◽  
Caroline de Cock ◽  
Mary Mooney ◽  
Edward Meinert
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Health Care Professionals ◽  
English Language ◽  
Search Strategy ◽  
Grey Literature ◽  
Information Storage ◽  
Childhood Vaccination ◽  
Cochrane Central Register ◽  
Technical Standards

BACKGROUND The decline in the uptake of routine childhood vaccinations has resulted in outbreaks of vaccine-preventable diseases. Vaccination apps can be used as a tool to promote immunization through the provision of reminders, dissemination of information, peer support, and feedback. OBJECTIVE The aim of this review is to systematically review the evidence on the use of apps to support childhood vaccination uptake, information storage, and record sharing. METHODS We will identify relevant papers by searching the following electronic databases: PubMed, Embase by Ovid, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and Education Resources Information Center (ERIC). We will review the reference lists of those studies that we include to identify relevant additional papers not initially identified using our search strategy. In addition to the use of electronic databases, we will search for grey literature on the topic. The search strategy will include only terms relating to or describing the intervention, which is app use. As almost all titles and abstracts are in English, 100% of these will be reviewed, but retrieval will be confined to papers written in the English language. We will record the search outcome on a specifically designed record sheet. Two reviewers will select observational and intervention studies, appraise the quality of the studies, and extract the relevant data. All studies will involve the use of apps relating to child vaccinations. The primary outcome is the uptake of vaccinations. Secondary outcomes are as follows: (1) use of app for sharing of information and providing vaccination reminders and (2) use of app for storage of vaccination information; knowledge and decision making by parents regarding vaccination (ie, risks and benefits of vaccination); costs and cost-effectiveness of vaccination apps; use of the app and measures of usability (eg, usefulness, acceptability, and experiences of different users: parents and health care professionals); use of technical standards for development of the app; and adverse events (eg, data leaks and misinformation). We will exclude studies that do not study an app. We anticipate a limited scope for meta-analysis and will provide a narrative overview of findings and tabular summaries of extracted data. RESULTS This project was funded by the Sir David Cooksey Fellowship in Healthcare Translation at the University of Oxford, Oxford, United Kingdom. We will submit the full systematic review for publication in the <i>Journal of Medical Internet Research</i>. CONCLUSIONS This review will follow, where possible, the Cochrane Collaboration and the Centre for Review and Dissemination methodologies for conducting systematic reviews. We will report our findings based on guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The review results will be used to inform the development of a vaccination app. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/16929

scholarly journals Cell-based therapies for COVID-19: A living systematic review

2020 ◽  
Author(s):  
Gabriel Rada ◽  
Javiera Corbalán ◽  
Patricio Rojas
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Grey Literature ◽  
Cochrane Central Register ◽  
Randomised Trials ◽  
Eligibility Criteria ◽  
Open Platform ◽  
Link Type ◽  
Central Register ◽  
Registration Number

ABSTRACT Objective This living systematic review aims to provide a timely, rigorous and continuously updated summary of the available evidence on the role of cell-based therapies in the treatment of patients with COVID-19. Data sources We conducted searches in PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), grey literature and in a centralised repository in L-OVE (Living OVerview of Evidence). L-OVE is a platform that maps PICO questions to evidence from Epistemonikos database. In response to the COVID-19 emergency, L-OVE was adapted to expand the range of evidence it covers and customised to group all COVID-19 evidence in one place. All the searches covered the period until April 23, 2020 (one day before submission). Eligibility criteria for selecting studies and methods We adapted an already published common protocol for multiple parallel systematic reviews to the specificities of this question. We searched for randomised trials evaluating the effect of cell-based therapies versus placebo or no treatment in patients with COVID-19. Anticipating the lack of randomised trials directly addressing this question, we also searched for trials evaluating other coronavirus infections, such as MERS-CoV and SARS-CoV, and non-randomised studies in COVID-19. Two reviewers independently screened each study for eligibility. A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit it every time the conclusions change or whenever there are substantial updates. Results We screened 1,043 records but no study was considered eligible. We identified 61 ongoing studies, including 39 randomised trials evaluating different types of cell-based therapies in COVID-19. Conclusions We did not find any studies that met our inclusion criteria and hence there is no evidence to support or refute the use of cell-based therapies in the treatment of patients with COVID-19. A substantial number of ongoing studies should provide valuable evidence to inform researchers and decision makers in the near future. PROSPERO Registration number CRD42020179711 Box 1 Linked resources in this Living Systematic Review Common protocol Common protocol for the systematic reviews and overviews of systematic reviews being conducted by the COVID-19 L·OVE Working Group. Available here Living review Web version of this systematic review, presented in a ‘living systematic review format’. This means it is continuously updated as soon as new evidence emerges. Available here Living OVerview of Evidence - L·OVE An open platform that uses artificial intelligence and a broad network of contributors to identify all of the evidence relevant to this and other healthcare questions, including those related to COVID-19. Available here

scholarly journals Digital Education for the Management of Chronic Wounds in Health Care Professionals: Protocol for a Systematic Review by the Digital Health Education Collaboration (Preprint)

2018 ◽  
Author(s):  
Laura Martinengo ◽  
Natalie Jia Ying Yeo ◽  
Zheng Qiang Tang ◽  
Kasturi D/O Markandran ◽  
Bhone Myint Kyaw ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Systematic Reviews ◽  
Health Care Professionals ◽  
Chronic Wounds ◽  
Cochrane Library ◽  
Cochrane Central Register ◽  
Care Providers ◽  
Digital Education ◽  
Wide Range

BACKGROUND Digital education is “the act of teaching and learning by means of digital technologies.” Digital education comprises a wide range of interventions that can be broadly divided into offline digital education, online digital education, digital game-based learning, massive open online courses (MOOCs), psychomotor skills trainers, virtual reality environments, virtual patient simulations, and m-learning. Chronic wounds pose an immense economic and psychosocial burden to patients and the health care system, as caring for them require highly specialized personnel. Current training strategies face significant barriers, such as lack of time due to work commitments, distance from provider centers, and costs. Therefore, there is an increased need to synthesize evidence on the effectiveness of digital education interventions on chronic wounds management in health care professionals. OBJECTIVE Our main objective is to assess the effectiveness of digital education as a stand-alone approach or as part of a blended-learning approach in improving pre- and postregistration health care professionals’ knowledge, attitudes, practical skills, and behavior in the management of chronic wounds, as well as their satisfaction with the intervention. Secondary objectives are to evaluate patient-related outcomes, cost-effectiveness of the interventions, and any unfavorable or undesirable outcomes that may arise. METHODS This systematic review will follow the methodology as described in the Cochrane Handbook for Systematic Reviews of Interventions. As our systematic review is one of a series of reviews on digital education for health professionals’ education, we will use a previously developed search strategy. This search includes the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library), MEDLINE (Ovid), Embase (Ovid), Web of Science, the Educational Resource Information Centre (ERIC) (Ovid), PsycINFO (Ovid), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCO), the ProQuest Dissertation and Theses database, and trial registries. Databases will be searched for studies published from January 1990 to August 2018. Two independent reviewers will screen the library for included studies. We will describe the screening process using a flowchart as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We will extract the data using a previously developed, structured data extraction form. Included studies will be quality-assessed using the Risk of Bias tool from Cochrane. We will narratively summarize the data and, if possible, we will conduct a meta-analysis. We will use Cochrane’s RevMan 5.3 software for data analysis. RESULTS We have completed the screening of titles and abstracts for this systematic review and are currently selecting papers against our inclusion and exclusion criteria through full-text revision. We are expecting to complete our review by the end of April 2019. CONCLUSIONS This systematic review will provide an in-depth analysis of digital education strategies to train health care providers in the management of chronic wounds. We consider this topic particularly relevant given the current challenges facing health care systems worldwide, including shortages of skilled personnel and a steep increase in the population of older adults as a result of a prolonged life expectancy. CLINICALTRIAL PROSPERO CRD42018109971; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=109971 INTERNATIONAL REGISTERED REPOR DERR1-10.2196/12488

Passive-specific immunotherapy with monoclonal antibodies for prostate cancer: A systematic review

2018 ◽  
Vol 25 (4) ◽  
pp. 903-917 ◽  
Author(s):  
Neda Khalili ◽  
Mahsa Keshavarz-Fathi ◽  
Sepideh Shahkarami ◽  
Armin Hirbod-Mobarakeh ◽  
Nima Rezaei
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Monoclonal Antibodies ◽  
Advanced Prostate Cancer ◽  
Search Strategy ◽  
Specific Immunotherapy ◽  
Therapeutic Option ◽  
Grey Literature ◽  
Statistical Heterogeneity ◽  
Specific Antigens

Introduction Treatment of metastatic castration-resistant prostate cancer with conventional therapies is still not successful. Therefore, application of novel biological approaches such as immunotherapy, which appears to be more effective and less toxic, is necessary. Monoclonal antibodies against cancer specific antigens are a kind of immunotherapy that have been approved for specific types of cancer and are being investigated for prostate cancer as well. The aim of this review was to assess the effectiveness and safety of monoclonal antibodies for treatment of advanced prostate cancer. Method According to the search strategy stated in our systematic review protocol, Scopus, Medline, TRIP, CENTRAL, ProQuest, DART and OpenGrey databases were searched. Data collection and quality assessment were done independently by two authors and any disagreements between the collected data were resolved by a third author. A meta-analysis was not feasible as there was a considerable statistical heterogeneity among the trials. Hence, this review was limited to a narrative analysis of the included studies. Results We found 9756 references by applying search strategy in 4 databases of journal articles and 3 databases of grey literature. We then discarded 3957 duplicate citations using Endnote software and 5143 articles due to obvious irrelevancy of their topics in primary screening. In secondary screening of 656 fulltexts, we excluded 538 articles, and finally included 12 trials in this systematic review, updated on 23 June 2017. The overall quality of the studies was fair. In general, results of this systematic review show promising advances in the treatment of prostate cancer patients with monoclonal antibodies against prostate-specific antigens with regard to PSA/disease response. Some of the studies reported pain relief after treatment as well. Conclusion Currently, the role of immunotherapy in the treatment of advanced prostate cancer still remains debated. Although passive specific immunotherapy could be offered as a novel therapeutic option in the coming years, patients should be informed about the risks and benefits of this therapy. One of the obstacles in this review was the lack of adequate assessment of survival-related endpoints reported in the included studies. Our study provides support for further research in this field.

scholarly journals Current Evidence for Continuous Vital Signs Monitoring by Wearable Wireless Devices in Hospitalized Adults: Systematic Review

10.2196/18636 ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. e18636 ◽  
Author(s):  
Jobbe P L Leenen ◽  
Crista Leerentveld ◽  
Joris D van Dijk ◽  
Henderik L van Westreenen ◽  
Lisette Schoonhoven ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Clinical Outcomes ◽  
Health Care Professionals ◽  
Continuous Monitoring ◽  
Vital Signs ◽  
Current Evidence ◽  
Cochrane Central Register ◽  
Wireless Devices

Background Continuous monitoring of vital signs by using wearable wireless devices may allow for timely detection of clinical deterioration in patients in general wards in comparison to detection by standard intermittent vital signs measurements. A large number of studies on many different wearable devices have been reported in recent years, but a systematic review is not yet available to date. Objective The aim of this study was to provide a systematic review for health care professionals regarding the current evidence about the validation, feasibility, clinical outcomes, and costs of wearable wireless devices for continuous monitoring of vital signs. Methods A systematic and comprehensive search was performed using PubMed/MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials from January 2009 to September 2019 for studies that evaluated wearable wireless devices for continuous monitoring of vital signs in adults. Outcomes were structured by validation, feasibility, clinical outcomes, and costs. Risk of bias was determined by using the Mixed Methods Appraisal Tool, quality assessment of diagnostic accuracy studies 2nd edition, or quality of health economic studies tool. Results In this review, 27 studies evaluating 13 different wearable wireless devices were included. These studies predominantly evaluated the validation or the feasibility outcomes of these devices. Only a few studies reported the clinical outcomes with these devices and they did not report a significantly better clinical outcome than the standard tools used for measuring vital signs. Cost outcomes were not reported in any study. The quality of the included studies was predominantly rated as low or moderate. Conclusions Wearable wireless continuous monitoring devices are mostly still in the clinical validation and feasibility testing phases. To date, there are no high quality large well-controlled studies of wearable wireless devices available that show a significant clinical benefit or cost-effectiveness. Such studies are needed to help health care professionals and administrators in their decision making regarding implementation of these devices on a large scale in clinical practice or in-home monitoring.

scholarly journals Development of an efficient search filter to retrieve systematic reviews from PubMed

2021 ◽  
Vol 109 (4) ◽  
Author(s):  
José Antonio Salvador-Oliván ◽  
Gonzalo Marco-Cuenca ◽  
Rosario Arquero-Avilés
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Systematic Reviews ◽  
Search Strategy ◽  
Average Precision ◽  
Search Filter ◽  
Search Terms ◽  
Mesh Terms ◽  
Cochrane Database ◽  
Relevant Publication

Objective: Locating systematic reviews is essential for clinicians and researchers when creating or updating reviews and for decision-making in health care. This study aimed to develop a search filter for retrieving systematic reviews that improves upon the performance of the PubMed systematic review search filter.Methods: Search terms were identified from abstracts of reviews published in Cochrane Database of Systematic Reviews and the titles of articles indexed as systematic reviews in PubMed. Both the precision of the candidate terms and the number of systematic reviews retrieved from PubMed were evaluated after excluding the subset of articles retrieved by the PubMed systematic review filter. Terms that achieved a precision greater than 70% and relevant publication types indexed with MeSH terms were included in the filter search strategy.Results: The search strategy used in our filter added specific terms not included in PubMed’s systematic review filter and achieved a 61.3% increase in the number of retrieved articles that are potential systematic reviews. Moreover, it achieved an average precision that is likely greater than 80%.Conclusions: The developed search filter will enable users to identify more systematic reviews from PubMed than the PubMed systematic review filter with high precision.

scholarly journals Clinical Efficacy of Repeated Applications of Local Drug Delivery and Adjunctive Agents in Nonsurgical Periodontal Therapy: A Systematic Review

Antibiotics ◽  
2021 ◽  
Vol 10 (10) ◽  
pp. 1178
Author(s):  
Oi Leng Tan ◽  
Syarida Hasnur Safii ◽  
Masfueh Razali
Keyword(s):  
Systematic Review ◽  
Drug Delivery ◽  
Clinical Efficacy ◽  
Grey Literature ◽  
Periodontal Therapy ◽  
Local Drug Delivery ◽  
Control Group ◽  
Cochrane Central Register ◽  
Nonsurgical Periodontal Therapy ◽  
Repeated Applications

The aim of this systematic review is to compare the clinical efficacy of repeated applications of local drug delivery and adjunctive agents (LDAs) in nonsurgical periodontal therapy (NSPT) compared to subgingival mechanical debridement (SMD) alone. The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, EMBASE, Web of Science, hand-searched literature and grey literature databases were searched for randomized controlled clinical trials (RCTs) with a minimum of 6-month follow-up. The outcomes of interest were changes in probing pocket depth and clinical attachment level as well as patient-centred outcomes. Of 1094 studies identified, 16 RCTs were included in the qualitative analysis. Across 11 different adjuncts analysed, only two studies utilizing minocycline gel/ointment and antimicrobial photodynamic therapy (aPDT) with indocyanine green photosensitizer had statistically significant differences in primary outcomes when compared to their control groups. Only one study on aPDT methylene blue 0.005% had compared single versus multiple applications against its control group. A mean range of 0.27–3.82 mm PD reduction and −0.09–2.82 mm CAL gain were observed with repeated LDA application. Considerable clinical heterogeneity and methodological flaws in the included studies preclude any definitive conclusions regarding the clinical efficacy of repeated LDA applications. Future RCTs with a direct comparison between single and repeated applications should be conducted to confirm or refute the clinical advantages of repeated LDA application in the nonsurgical management of periodontitis.

scholarly journals Protocol for a systematic review of research on HPV and cervical cancer in Ghana, up until the year 2017: informing research and policy direction on cervical cancer prevention in Ghana

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e020183
Author(s):  
Adolf Kofi Awua ◽  
Edna Dzifa Doe
Keyword(s):  
Systematic Review ◽  
Cervical Cancer ◽  
Meta Analysis ◽  
Grey Literature ◽  
Cervical Cancer Prevention ◽  
Specific Information ◽  
Cochrane Central Register ◽  
Eligibility Criteria ◽  
Digital Collections ◽  
The Status

IntroductionFor a country that lacks a national cervical cancer screening/prevention programme, there is the need to assess the volume of country-specific information, and the status of research on HPV and cervical cancer, in order to provide evidence that will inform policy and further research. The aim of this protocol is to plan an intended systematic review, which is to identify research gaps, prevent unnecessary duplication of work and enable collaboration.Methods and analysisThis protocol, developed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement and registered by PROSPERO (CRD42017075583), will apply a 13-point eligibility criteria to screening and selecting peer-reviewed research articles and grey literature. These will be obtained from searches in databases, including, among others, those of the National Centre for Biotechnology Information, Cochrane Central Register of Controlled Trials, Google Scholar and the digital collections database of research publications of Universities in Ghana. Collected data will be aggregated and summarised according to emerging themes and simple descriptive statistics.Ethics and disseminationThe study will use publicly available data and will not identify authors of the publication by name. In light of these and as has been indicted, research ethics clearance is not required for evidence syntheses in such reviews. The review will be published in peer-reviewed scientific journals and presented at local and internal conferences as the opportunity becomes available.PROSPERO registration numberCRD42017075583.

The effects of non-clinician guidance on effectiveness and process outcomes of digital mental health interventions: A systematic review and meta-analysis. (Preprint)

2021 ◽  
Author(s):  
Calista Leung ◽  
Julia Pei ◽  
Kristen Hudec ◽  
Farhud Shams ◽  
Richard Munthali ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Psychosocial Support ◽  
Meta Analysis ◽  
Grey Literature ◽  
Risk Of Bias ◽  
Health Interventions ◽  
Cochrane Central Register ◽  
Process Outcomes ◽  
Mental Health Interventions

BACKGROUND Digital mental health interventions are increasingly prevalent in the current context of rapidly evolving technology, and research indicates that they yield effectiveness outcomes comparable to in-person treatment. Integrating professionals (i.e. psychologists, physicians) into digital mental health interventions has been common, and the inclusion of guidance within programs can increase adherence to interventions. However, employing professionals to enhance mental health programs may undermine the scalability of digital interventions. Therefore, delegating guidance tasks to paraprofessionals (peer supporters, technicians, lay counsellors, or other non-clinicians) can help reduce costs and increase accessibility. OBJECTIVE This systematic review and meta-analysis evaluates the effectiveness, adherence, and other process outcomes of non-clinician guided digital mental health interventions. METHODS Four databases (MEDLINE, EMBASE, CINAHL, and PSYCInfo) were searched for randomized controlled trials published between 2010 and 2020 examining digital mental health interventions. Three journals focused on digital intervention were also hand searched and grey literature was searched using ProQuest and the Cochrane Central Register of Control Trials (CENTRAL). Two researchers independently assessed risk of bias using the Cochrane Risk of Bias Tool 2. Data were collected on effectiveness, adherence, and other process outcomes, and meta-analyses were conducted for effectiveness and adherence outcomes. Non-clinician guided interventions were compared with treatment as usual, clinician-guided interventions, and unguided interventions. RESULTS Thirteen studies qualified for inclusion. Results indicate that non-clinician guided interventions yielded higher post-treatment effectiveness outcomes when compared to conditions involving control programs (e.g. online psychoeducation, monitored attention control) or waitlist controls (k=7, Hedges g=-0.73 (95% CI -1.08 to -0.38)). There are significant differences between non-clinician guided interventions and unguided interventions as well (k=6, Hedges g=-0.17 (95% CI -0.23 to -0.11)). In addition, non-clinician guided interventions did not differ in effectiveness from clinician-guided interventions (k=3, Hedges g=0.08 (95% CI -0.01 to 0.17)). These results suggest that guided digital mental health interventions are helpful to improve mental health outcomes regardless of the qualification, and that the presence of a non-clinician guide improves effectiveness outcomes more than no guidance. Non-clinician guided interventions did not yield significantly different effects on adherence outcomes when compared with unguided interventions (k=3, OR 1.58 (95% CI 0.51 to 4.92)), although a general trend of improved adherence was observed within non-clinician guided interventions. CONCLUSIONS Integrating paraprofessionals and non-clinicians appear to improve outcomes of digital mental health interventions, and may also enhance adherence outcomes (though the trend was nonsignificant). Further research should focus on the specific types of tasks these paraprofessionals can successfully provide (i.e. psychosocial support, therapeutic alliance, technical augmentation) and their associated outcomes. CLINICALTRIAL The protocol is preregistered on PROSPERO (CRD42020191226).

scholarly journals Pre-arrest and intra-arrest prognostic factors associated with survival after in-hospital cardiac arrest: systematic review and meta-analysis

BMJ ◽  
2019 ◽  
pp. l6373 ◽  
Author(s):  
Shannon M Fernando ◽  
Alexandre Tran ◽  
Wei Cheng ◽  
Bram Rochwerg ◽  
Monica Taljaard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Prognostic Factors ◽  
Systematic Reviews ◽  
English Language ◽  
Data Extraction ◽  
Meta Analysis ◽  
Research Strategy ◽  
Primary Analysis ◽  
Hospital Cardiac Arrest

Abstract Objective To determine associations between important pre-arrest and intra-arrest prognostic factors and survival after in-hospital cardiac arrest. Design Systematic review and meta-analysis. Data sources Medline, PubMed, Embase, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews from inception to 4 February 2019. Primary, unpublished data from the United Kingdom National Cardiac Arrest Audit database. Study selection criteria English language studies that investigated pre-arrest and intra-arrest prognostic factors and survival after in-hospital cardiac arrest. Data extraction PROGRESS (prognosis research strategy group) recommendations and the CHARMS (critical appraisal and data extraction for systematic reviews of prediction modelling studies) checklist were followed. Risk of bias was assessed by using the QUIPS tool (quality in prognosis studies). The primary analysis pooled associations only if they were adjusted for relevant confounders. The GRADE approach (grading of recommendations assessment, development, and evaluation) was used to rate certainty in the evidence. Results The primary analysis included 23 cohort studies. Of the pre-arrest factors, male sex (odds ratio 0.84, 95% confidence interval 0.73 to 0.95, moderate certainty), age 60 or older (0.50, 0.40 to 0.62, low certainty), active malignancy (0.57, 0.45 to 0.71, high certainty), and history of chronic kidney disease (0.56, 0.40 to 0.78, high certainty) were associated with reduced odds of survival after in-hospital cardiac arrest. Of the intra-arrest factors, witnessed arrest (2.71, 2.17 to 3.38, high certainty), monitored arrest (2.23, 1.41 to 3.52, high certainty), arrest during daytime hours (1.41, 1.20 to 1.66, high certainty), and initial shockable rhythm (5.28, 3.78 to 7.39, high certainty) were associated with increased odds of survival. Intubation during arrest (0.54, 0.42 to 0.70, moderate certainty) and duration of resuscitation of at least 15 minutes (0.12, 0.07 to 0.19, high certainty) were associated with reduced odds of survival. Conclusion Moderate to high certainty evidence was found for associations of pre-arrest and intra-arrest prognostic factors with survival after in-hospital cardiac arrest. Systematic review registration PROSPERO CRD42018104795

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