scholarly journals Interventions to Enhance Medication Safety in Residential Aged Care Settings: An Umbrella Review

2021 ◽  
Author(s):  
Shadi Alruthea ◽  
Paula Bowman ◽  
Amina Tariq ◽  
Reece Hinchcliff
Keyword(s):  
Health Care ◽  
Systematic Reviews ◽  
Medication Review ◽  
Medication Safety ◽  
Residential Aged Care ◽  
Cochrane Library ◽  
Original Research ◽  
Significant Heterogeneity ◽  
Staff Education ◽  
Umbrella Review

Aim: To conduct the first systematic synthesis of existing evidence reviews on interventions to enhance medication safety in RACS, to establish and compare their effectiveness. Method: This umbrella review included examination of meta-analyses, scoping and systematic reviews. Four electronic databases (MEDLINE, EMBASE, CINAHL, and The Cochrane library database of Systematic Reviews) were explored for eligible reviews. Those meeting the inclusion criteria were critically appraised using the JBI Critical Appraisal Instrument for Systematic reviews and Research Syntheses by two authors. Results: Fourteen reviews covering 166 unique, primary studies were included. Interventions were grouped according to type: medication review (n= 12); staff education (n= 8); multidisciplinary team meetings (n= 6); computerised clinical decision support systems (n= 5); and transferring medicines information between health care settings (n= 1). Most reviews showed mixed evidence to support interventions’ effectiveness, due to the significant heterogeneity between original research studies in respect to sites, samples sizes and intervention periods. However, in all intervention categories, pharmacists’ collaboration with other health care professionals was most beneficial, showing definitive evidence for improving medication safety and quality of prescribing in RACS. The evidence suggests that combining two or more interventions is the most promising approach, despite this presenting implementation barriers in the resource-limited environments of many RACS, and methodological challenges in identifying the precise contribution of individual interventions, when implemented concurrently. Conclusion: Health stakeholders should explore a combination of at least two interventions, such as medication review and staff education, to improve medication safety in RACS.

scholarly journals Association betweenH. pyloriinfection and health Outcomes: an umbrella review of systematic reviews and meta-analyses

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e031951
Author(s):  
Liqun Li ◽  
Jinjing Tan ◽  
Lijian Liu ◽  
Jianfeng Li ◽  
Guangwen Chen ◽  
...  
Keyword(s):  
Irritable Bowel Syndrome ◽  
Health Outcomes ◽  
Systematic Reviews ◽  
Cochrane Library ◽  
Significant Heterogeneity ◽  
Umbrella Review ◽  
Increased Risk ◽  
H Pylori ◽  
Irritable Bowel ◽  
Meta Analyses

ObjectiveSystematic reviews and meta-analyses have revealed the associations betweenH. pyloriinfection and various health outcomes. We aimed to evaluate the strength and breadth of evidence on the associations.DesignUmbrella review of systematic reviews and meta-analyses.SettingNo settings.ParticipantsNo patients involved.Data sourcesEmbase, PubMed, Web of Science, Cochrane Library Databases, CNKI, VIP database and Wangfang database from inception to February 1, 2019.Outcomes measuresDiverse diseases (such as cancer and ischaemic heart disease).ResultsSixty articles reporting 88 unique outcomes met the eligible criteria. 74 unique outcomes had nominal significance (p<0.05). Of the outcomes with significance, 61 had harmful associations and 13 had beneficial associations. Furthermore, 73% (64) of the outcomes exhibited significant heterogeneity . Of the these meta-analyses, 32 had moderate to high heterogeneity (I2=50%–75%) and 24 had high heterogeneity (I2>75%). Moreover, 20% exhibited publication bias (p<0.1). In addition, 97% of the methodological qualities were rated ‘critically low’. 36% of the evidence qualities of outcomes were rated ‘low’, 56% of the evidence qualities were rated ‘very low’ and 8% of the evidence qualities were rated ‘moderate’.H. pyloriinfection may be associated with an increased risk of five diseases and a decreased risk of irritable bowel syndrome.ConclusionAlthough 60 meta-analyses explored 88 unique outcomes, moderate quality evidence only existed for six outcomes with statistical significance.H. pyloriinfection may be associated with a decreased risk of irritable bowel syndrome and an increased risk of hypertriglyceridemia, chronic cholecystitis and cholelithiasis, gestational diabetes mellitus, gastric cancer and systemic sclerosis.Trial registrationCRD42019124680.

scholarly journals Efficacy and safety of aliskiren combination therapy: a protocol for an umbrella review

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e043807
Author(s):  
Jiantong Shen ◽  
Wenming Feng ◽  
Yike Wang ◽  
Qiyuan Zhao ◽  
Billong Laura Flavorta ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Systematic Reviews ◽  
Cochrane Library ◽  
Umbrella Review ◽  
Quality Of Reporting ◽  
Ethical Approval ◽  
Registration Number ◽  
Third Person ◽  
Meta Analyses ◽  
The Impact

IntroductionEfficacy of aliskiren combination therapy with other antihypertensive has been evaluated in the treatment of patients with hypertension in recent systematic reviews. However, most previous reviews only focused on one single health outcome or one setting, none of them made a full summary that assessed the impact of aliskiren combination treatment comprehensively. As such, this umbrella review based on systematic reviews and meta-analyses is aimed to synthesise the evidences on efficacy, safety and tolerability of aliskiren-based therapy for hypertension and related comorbid patients.Methods and analysisA comprehensive search of PubMed, EMBASE, Cochrane Library, CNKI published from inception to August 2020 will be conducted. The selected articles are systematic reviews which evaluated efficacy, safety and tolerability of aliskiren combination therapy. Two reviewers will screen eligible articles, extract data and evaluate quality independently. Any disputes will be resolved by discussion or the arbitration of a third person. The quality of reporting evidence will be assessed using the Assessment of Multiple Systematic Reviews V.2 tool tool. We will take a mixed-methods approach to synthesising the review literatures, reporting summary of findings tables and iteratively mapping the results.Ethics and disseminationEthical approval is not required for the study, as we would only collect data from available published materials. This umbrella review will be also submitted to a peer-reviewed journal for publication after completion.PROSPERO registration numberCRD42020192131.

Effects of Exercise in the Treatment of Alzheimer’s Disease: An Umbrella Review of Systematic Reviews and Meta-Analyses

2021 ◽  
pp. 1-17
Author(s):  
Alexandro Andrade ◽  
Thais Cristina Siqueira ◽  
Anderson D’Oliveira ◽  
Fábio Hech Dominski
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Systematic Reviews ◽  
Web Of Science ◽  
Cochrane Library ◽  
Umbrella Review ◽  
Disease Symptoms ◽  
Moderate Quality ◽  
Low Incidence ◽  
Meta Analyses

The authors aimed to provide an overview of the evidence on the effects of exercise in people with Alzheimer’s disease through a comprehensive review of the existing systematic reviews and meta-analyses. A literature search was performed in CINAHL, Cochrane Library, EMBASE, PubMed, SPORTDiscus, Scopus, and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The AMSTAR-2-Tool was used for the quality assessment. Twenty-three reviews fulfilled the criteria. Most of the reviews investigated the effects of aerobic exercise on Alzheimer’s disease symptoms. The largest effects of exercise were seen in terms of improved cognition by multiple exercises. The majority of the reviews were rated as being of moderate quality and none were classified as having high quality. Exercise is an effective way to treat Alzheimer’s disease symptoms and has a low incidence of related adverse events. As most reviews were evaluated as low-moderate quality, caution is needed in the interpretation of the results.

scholarly journals Evidence of Rehabilitative Impact of Progressive Resistance Training (PRT) Programs in Parkinson Disease: An Umbrella Review

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
T. Paolucci ◽  
S. Sbardella ◽  
C. La Russa ◽  
F. Agostini ◽  
M. Mangone ◽  
...  
Keyword(s):  
Resistance Training ◽  
Muscle Strength ◽  
Parkinson Disease ◽  
Systematic Reviews ◽  
Cochrane Library ◽  
Progressive Resistance Training ◽  
Umbrella Review ◽  
Positive Effects ◽  
Meta Analyses ◽  
Progressive Resistance

Parkinson disease (PD) is a chronic neurodegenerative condition that leads to progressive disability. PD-related reductions in muscle strength have been reported to be associated with lower functional performance and balance confidence with an increased risk of falls. Progressive resistance training (PRT) improves strength, balance, and functional abilities. This umbrella review examines the efficacy of PRT regarding muscular strength in PD patients. The PubMed, PEDro, Scopus, and Cochrane Library databases were searched from January 2009 to August 2019 for systematic reviews and meta-analyses conducted in English. The populations included had diagnoses of PD and consisted of males and females aged >18 years old. Outcomes measured were muscle strength and enhanced physical function. Eight papers (six systematic reviews and meta-analyses and two systematic reviews) were considered relevant for qualitative analysis. In six of the eight studies, the reported severity of PD was mild to moderate. Each study analyzed how PRT elicited positive effects on muscle strength in PD patients, suggesting 10 weeks on average of progressive resistance exercises for the upper and lower limbs two to three times per week. However, none of the studies considered the postworkout follow-up, and there was no detailed evidence about the value of PRT in preventing falls. The possibility of PRT exercises being effective for increasing muscle strength in patients with PD, but without comorbidities or severe disability, is discussed. Overall, this review suggests that PRT should be included in rehabilitation programs for PD patients, in combination with balance training for postural control and other types of exercise, in order to preserve cardiorespiratory fitness and improve endurance in daily life activities.

scholarly journals Management of haemorrhoids: protocol of an umbrella review of systematic reviews and meta-analyses

BMJ Open ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. e035287
Author(s):  
Min Chen ◽  
Tai-Chun Tang ◽  
Tao-Hong He ◽  
Yong-Jun Du ◽  
Di Qin ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Current Evidence ◽  
Cochrane Library ◽  
Final Report ◽  
Umbrella Review ◽  
Effect Model ◽  
Meta Analyses ◽  
The Impact

IntroductionThe prevalence of haemorrhoidal diseases was high in general population, and many treatments are proposed for the management of haemorrhoids. The treatments include conservative and surgical interventions; the credibility and strength of current evidence of their effectiveness are not comprehensively evaluated. We aim to evaluate the credibility of systematic reviews and meta-analyses that assess the effectiveness of the treatments for haemorrhoidal diseases through an umbrella review.Methods and analysisWe will search Ovid Medline, Embase, Cochrane library and Web of Science from inception to March 2020 without any language restriction. We will include meta-analyses that examine the effectiveness of treatments in the management of haemorrhoids. Two reviewers will independently screen the titles and abstracts of retrieved articles, and they will extract data from the included meta-analyses. For each meta-analysis, we will estimate the effect size of a treatment through the random-effect model and the fixed-effect model, and we will evaluate between-study heterogeneity (Cochrane’s Q and I2statistics) and small-study effect (Egger’s test); we will also estimate the evidence of excess significance bias. Evidence of each treatment will be graded according to prespecified criteria. Methodological quality of each meta-analysis will be evaluated by using Assessment of Multiple Systematic Reviews 2. The corrected cover area method will be used to assess the impact of overlap in reviews on the findings of the umbrella review.Ethics and disseminationWe will present the results of the umbrella review at conferences and publish the final report in a peer-reviewed journal. The umbrella review does not require ethical approval.PROSPERO registration numberCRD42019140702.

Refugee health in Europe: mapping review of research literature (2015–2019)

2020 ◽  
Vol 25 (4) ◽  
pp. 349-369
Author(s):  
Irina Ibragimova ◽  
Martina Žužak
Keyword(s):  
Health Care ◽  
Systematic Reviews ◽  
Asylum Seekers ◽  
Research Literature ◽  
Refugee Health ◽  
Cochrane Library ◽  
Economic Evaluations ◽  
Content Type ◽  
Mapping Review ◽  
Refugees And Asylum Seekers

PurposeThe purpose of this paper is to map research literature on all aspects of refugee health in Europe (2015–2019): by research domain, study design, targeted population, type of setting, host country, journal title. This will help to identify recent research trends in the field, provide policymakers with useful source of information and help researches to target important gaps in evidence.Design/methodology/approachWHO (with other international agencies) has developed strategic documents and produced technical guidance, which formulate priority issues of refugee health in Europe. These documents state the need for relevant information and research data to support effective decision-making at all levels of health care systems. Although recent bibliometric analysis of global migration health research (2000–2016) concluded that 25.4% of retrieved documents were about refugees and asylum seekers, still there remain critical gaps in the knowledge base on a wide range of determinants of health service delivery and access for refugees and asylum seekers in the WHO European Region. Mapping review design was chosen as it maps and categorizes existing literature from which to commission further reviews and/or primary research by identifying gaps in research literature. Search strategy was developed and searches were executed in six databases: PubMed Medline; Scopus; ProQuest (Thesis and Dissertations); Cochrane Library; BASE; eLibrary (Russian journal articles).FindingsMapping review revealed that although research in some domains of refugee health was growing (mental health, infectious diseases, access to health care), there are still gaps in evidence in many important aspects: maternal and reproductive health, NCD, nutrition and economic evaluations. Most of 1,291 retrieved studies used observational or quasi-experimental design (75%), while very few were experimental studies (1.8%). Secondary research constituted a significant portion of retrieved publications: systematic reviews and meta-analysis – 8%, other reviews with systematic approach – 16%.Originality/valueDetailed mapping of research by a combination of setting, population and research domains and comparison of results with those from previous decades and with planned trials and systematic reviews.

scholarly journals Umbrella review of strategies to improve uptake of screening programmes

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
L Hyseni ◽  
M Maden ◽  
A Boland ◽  
C Kypridemos ◽  
B Collins ◽  
...  
Keyword(s):  
Health Care ◽  
Systematic Reviews ◽  
Program Implementation ◽  
Screening Programme ◽  
Participation Rate ◽  
System Level ◽  
Umbrella Review ◽  
High Participation ◽  
Contradictory Evidence ◽  
The Impact

Abstract Introduction High participation rates in screening programmes targeting non-communicable diseases are instrumental in achieving full screening benefits; however, screening programmes remain underused, especially among vulnerable populations. We conducted an umbrella review to assess the type of approaches screening programmes use to maximise uptake, the effectiveness of the approaches and the impact on equity. Methods Electronic databases were searched (1999-2019) for systematic reviews on approaches aimed at improving uptake of screening programmes for adults in middle- and high-income countries, with participation rate as the primary outcome. A narrative synthesis was undertaken to present the results by strategy, screening programme and strength of evidence. This study was registered in PROSPERO [CRD42019132087]. Results In total, 3,059 records were identified, and 82 systematic reviews were included. Preliminary findings suggest contradictory evidence, and effectiveness appears to depend on the disease screened for and specific program implementation. Invitation methods including letters and direct reminders seem to work universally. However, combined approaches using access-enhancing, individual- and system-directed strategies seem to be more effective than single approaches such as invitation methods alone. Few studies evaluated the impact on equity. Conclusions Strategies to improve uptake of screening programmes have the potential to be effective. However, there are many components within the system, either at individual, health care professional or health care system level that can influence uptake of screening programmes. Within each screening programme, it is likely that a range of interventions is needed to improve the uptake as opposed to a single intervention. Key messages Improving uptake of screening programmes is a complex issue with many factors influencing the process. A range of interventions is favoured over single interventions.

scholarly journals Mapping the Evidence on the Effectiveness of Telemedicine Interventions in Diabetes, Dyslipidemia, and Hypertension: An Umbrella Review of Systematic Reviews and Meta-Analyses

10.2196/16791 ◽  
2020 ◽  
Vol 22 (3) ◽  
pp. e16791 ◽  
Author(s):  
Patrick Timpel ◽  
Sarah Oswald ◽  
Peter E H Schwarz ◽  
Lorenz Harst
Keyword(s):  
Clinical Outcomes ◽  
Systematic Reviews ◽  
Population Characteristics ◽  
Cochrane Library ◽  
Low Grade ◽  
Umbrella Review ◽  
Eligibility Criteria ◽  
Patients With Diabetes ◽  
Meta Analyses

Background Telemedicine is defined by three characteristics: (1) using information and communication technologies, (2) covering a geographical distance, and (3) involving professionals who deliver care directly to a patient or a group of patients. It is said to improve chronic care management and self-management in patients with chronic diseases. However, currently available guidelines for the care of patients with diabetes, hypertension, or dyslipidemia do not include evidence-based guidance on which components of telemedicine are most effective for which patient populations. Objective The primary aim of this study was to identify, synthesize, and critically appraise evidence on the effectiveness of telemedicine solutions and their components on clinical outcomes in patients with diabetes, hypertension, or dyslipidemia. Methods We conducted an umbrella review of high-level evidence, including systematic reviews and meta-analyses of randomized controlled trials. On the basis of predefined eligibility criteria, extensive automated and manual searches of the databases PubMed, EMBASE, and Cochrane Library were conducted. Two authors independently screened the studies, extracted data, and carried out the quality assessments. Extracted data were presented according to intervention components and patient characteristics using defined thresholds of clinical relevance. Overall certainty of outcomes was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. Results Overall, 3564 references were identified, of which 46 records were included after applying eligibility criteria. The majority of included studies were published after 2015. Significant and clinically relevant reduction rates for glycated hemoglobin (HbA1c; ≤−0.5%) were found in patients with diabetes. Higher reduction rates were found for recently diagnosed patients and those with higher baseline HbA1c (>8%). Telemedicine was not found to have a significant and clinically meaningful impact on blood pressure. Only reviews or meta-analyses reporting lipid outcomes in patients with diabetes were found. GRADE assessment revealed that the overall quality of the evidence was low to very low. Conclusions The results of this umbrella review indicate that telemedicine has the potential to improve clinical outcomes in patients with diabetes. Although subgroup-specific effectiveness rates favoring certain intervention and population characteristics were found, the low GRADE ratings indicate that evidence can be considered as limited. Future updates of clinical care and practice guidelines should carefully assess the methodological quality of studies and the overall certainty of subgroup-specific outcomes before recommending telemedicine interventions for certain patient populations.

scholarly journals Effectiveness of Music-Based Intervention in Improving Uncomfortable Symptoms in ICU Patients: An Umbrella Review

2021 ◽  
Vol 18 (21) ◽  
pp. 11500
Author(s):  
Yu-Fen Chen ◽  
Mei-Yu Chang ◽  
Lok-Hi Chow ◽  
Wei-Fen Ma
Keyword(s):  
Systematic Reviews ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Music Intervention ◽  
Umbrella Review ◽  
Icu Patients ◽  
Review Protocol ◽  
Meta Analyses ◽  
Study Participants ◽  
Patients Experience

Background: Intensive care unit (ICU) patients experience multiple uncomfortable symptoms, which may be alleviated using music-based intervention, a nondrug treatment. This umbrella review aims to combine the data of systematic reviews and/or meta-analyses to evaluate the effectiveness of music-based intervention in improving uncomfortable symptoms in ICU patients. Methods: A comprehensive literature search was performed on the PubMed, Embase, Cochrane Library, Airiti Library, CINAHL, ProQuest, and Web of Science databases, and Epistemonikos. The search had no language restrictions, and articles on the improvement of symptoms using music-based intervention in adult ICU patients were included. This review protocol was registered on PROSPERO (CRD42021240327). Results: This umbrella review retrieved 5 systematic reviews and 41 original studies, including 39 randomized controlled trials, and 2 nonrandomized controlled trials. Diverse music was the most common music type used for music-based intervention, the intervention music was typically decided by the study participants (61%), and most subjects underwent one intervention session (78%). Furthermore, most music intervention sessions lasted for 30 min (44%). The positive results included decreased anxiety, decreased pain, decreased agitation, decreased anesthesia dose and sedative use, decreased chances of delirium, decreased feelings of uncomfort, and improved sleep quality. Conclusions: A systematic review on the effectiveness of music-based intervention in improving uncomfortable symptoms in ICU patients revealed that 20–30 min intervention sessions showed the best improvement in the uncomfortable symptoms in patients. This study provides a basis for using music-based intervention to relieve the uncomfortable symptoms in critically ill ICU patients, and a reference for empirical clinical practice.

scholarly journals Methodological and Terminological Issues in Animal-Assisted Interventions: An Umbrella Review of Systematic Reviews

Animals ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. 759 ◽  
Author(s):  
Antonio Santaniello ◽  
Francesca Dicé ◽  
Roberta Claudia Carratú ◽  
Alessia Amato ◽  
Alessandro Fioretti ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Poor Quality ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Umbrella Review ◽  
Online Databases ◽  
Psychological Educational ◽  
Methodological Aspects ◽  
Appropriate Practices

Recently, animal-assisted interventions (AAIs), which are defined as psychological, educational, and rehabilitation support activities, have become widespread in different contexts. For many years, they have been a subject of interest in the international scientific community and are at the center of an important discussion regarding their effectiveness and the most appropriate practices for their realization. We carried out an umbrella review (UR) of systematic reviews (SRs), created for the purpose of exploring the literature and aimed at deepening the terminological and methodological aspects of AAIs. It is created by exploring the online databases PubMed, Google Scholar, and Cochrane Library. The SRs present in the high-impact indexed search engines Web of Sciences and Scopus are selected. After screening, we selected 15 SRs that met the inclusion criteria. All papers complained of the poor quality of AAIs; some considered articles containing interventions that did not always correspond to the terminology they have explored and whose operating practices were not always comparable. This stresses the need for the development and consequent diffusion of not only operational protocols, but also research protocols which provide for the homogeneous use of universally recognized terminologies, thus facilitating the study, deepening, and comparison between the numerous experiences described.

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