scholarly journals The effectiveness of combined extracorporeal shockwave therapy and exercise for plantar heel pain: A systematic review

2020 ◽  
Author(s):  
Ian Burton
Keyword(s):  
Systematic Review ◽  
Laser Therapy ◽  
Heel Pain ◽  
High Quality ◽  
Extracorporeal Shockwave Therapy ◽  
Shockwave Therapy ◽  
Plantar Heel Pain ◽  
Moderate Quality ◽  
High Quality Evidence ◽  
Quality Evidence

Background: Plantar heel pain (PHP) is a common musculoskeletal disorder, with both extracorporeal shockwave therapy (ESWT) and specific exercise such as plantar fascia specific stretching shown to be effective treatments. This review aimed to evaluate the effectiveness of combined ESWT and exercise interventions versus other interventions in treating PHP. Methods: A systematic review of effectiveness was conducted, adhering to the PRISMA guidelines. Five databases were searched for studies published between January 2000 and March 2020, with 12 studies meeting the inclusion criteria. The Grading of Recommendations Assessment Development and Evaluation (GRADE) framework was used to determine quality of recommendations. Results: The 12 included studies (n = 861) compared ESWT and stretching with various other treatments. Due to clinical and methodological heterogeneity, pooling of data was not possible, and a narrative synthesis of findings was provided. There was high quality evidence that combined ESWT and stretching interventions are more effective than those using either alone or botulinum toxin injections, and low-quality evidence of superiority versus ultrasound and stretching. There was moderate quality evidence that combined ESWT and stretching is no more effective than corticosteroid injection (CSI), and high quality evidence that the combination is no more effective than blood-derived injection therapies, custom orthotics or low-level laser therapy (LLLT) combined with stretching. There is high quality evidence that the use of topical corticosteroid or laser therapy in combination with ESWT and stretching increases effectiveness compared to ESWT and stretching alone, and moderate quality evidence for the additive effective of dry needling. Conclusions: Combined ESWT and stretching treatments are effective and may be recommended where they are available and practical to implement. Further high-quality studies with larger sample sizes and longer follow-up durations comparing combined interventions for PHP, including different exercise types such as resistance training are required.

scholarly journals Foot orthoses for plantar heel pain: a systematic review and meta-analysis

2017 ◽  
Vol 52 (5) ◽  
pp. 322-328 ◽  
Author(s):  
Glen A Whittaker ◽  
Shannon E Munteanu ◽  
Hylton B Menz ◽  
Jade M Tan ◽  
Chantel L Rabusin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Heel Pain ◽  
Cochrane Library ◽  
Foot Orthoses ◽  
Medium Term ◽  
Eligibility Criteria ◽  
Plantar Heel Pain ◽  
Moderate Quality ◽  
Quality Evidence

ObjectiveTo investigate the effectiveness of foot orthoses for pain and function in adults with plantar heel pain.DesignSystematic review and meta-analysis. The primary outcome was pain or function categorised by duration of follow-up as short (0 to 6 weeks), medium (7 to 12 weeks) or longer term (13 to 52 weeks).Data sourcesMedline, CINAHL, SPORTDiscus, Embase and the Cochrane Library from inception to June 2017.Eligibility criteria for selecting studiesStudies must have used a randomised parallel-group design and evaluated foot orthoses for plantar heel pain. At least one outcome measure for pain or function must have been reported.ResultsA total of 19 trials (1660 participants) were included. In the short term, there was very low-quality evidence that foot orthoses do not reduce pain or improve function. In the medium term, there was moderate-quality evidence that foot orthoses were more effective than sham foot orthoses at reducing pain (standardised mean difference −0.27 (−0.48 to −0.06)). There was no improvement in function in the medium term. In the longer term, there was very low-quality evidence that foot orthoses do not reduce pain or improve function. A comparison of customised and prefabricated foot orthoses showed no difference at any time point.ConclusionThere is moderate-quality evidence that foot orthoses are effective at reducing pain in the medium term, however it is uncertain whether this is a clinically important change.

scholarly journals Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2021

Endoscopy ◽  
2021 ◽  
Vol 53 (03) ◽  
pp. 300-332
Author(s):  
Ian M. Gralnek ◽  
Adrian J. Stanley ◽  
A. John Morris ◽  
Marine Camus ◽  
James Lau ◽  
...  
Keyword(s):  
High Dose ◽  
High Quality ◽  
Peptic Ulcer Hemorrhage ◽  
Strong Recommendation ◽  
Epinephrine Injection ◽  
Moderate Quality ◽  
High Quality Evidence ◽  
Mechanical Therapy ◽  
Upper Gastrointestinal ◽  
Quality Evidence

MAIN RECOMMENDATIONS 1 ESGE recommends in patients with acute upper gastrointestinal hemorrhage (UGIH) the use of the Glasgow–Blatchford Score (GBS) for pre-endoscopy risk stratification. Patients with GBS ≤ 1 are at very low risk of rebleeding, mortality within 30 days, or needing hospital-based intervention and can be safely managed as outpatients with outpatient endoscopy.Strong recommendation, moderate quality evidence. 2 ESGE recommends that in patients with acute UGIH who are taking low-dose aspirin as monotherapy for secondary cardiovascular prophylaxis, aspirin should not be interrupted. If for any reason it is interrupted, aspirin should be re-started as soon as possible, preferably within 3–5 days.Strong recommendation, moderate quality evidence. 3 ESGE recommends that following hemodynamic resuscitation, early (≤ 24 hours) upper gastrointestinal (GI) endoscopy should be performed. Strong recommendation, high quality evidence. 4 ESGE does not recommend urgent (≤ 12 hours) upper GI endoscopy since as compared to early endoscopy, patient outcomes are not improved. Strong recommendation, high quality evidence. 5 ESGE recommends for patients with actively bleeding ulcers (FIa, FIb), combination therapy using epinephrine injection plus a second hemostasis modality (contact thermal or mechanical therapy). Strong recommendation, high quality evidence. 6 ESGE recommends for patients with an ulcer with a nonbleeding visible vessel (FIIa), contact or noncontact thermal therapy, mechanical therapy, or injection of a sclerosing agent, each as monotherapy or in combination with epinephrine injection. Strong recommendation, high quality evidence. 7 ESGE suggests that in patients with persistent bleeding refractory to standard hemostasis modalities, the use of a topical hemostatic spray/powder or cap-mounted clip should be considered. Weak recommendation, low quality evidence. 8 ESGE recommends that for patients with clinical evidence of recurrent peptic ulcer hemorrhage, use of a cap-mounted clip should be considered. In the case of failure of this second attempt at endoscopic hemostasis, transcatheter angiographic embolization (TAE) should be considered. Surgery is indicated when TAE is not locally available or after failed TAE. Strong recommendation, moderate quality evidence. 9 ESGE recommends high dose proton pump inhibitor (PPI) therapy for patients who receive endoscopic hemostasis and for patients with FIIb ulcer stigmata (adherent clot) not treated endoscopically. (a) PPI therapy should be administered as an intravenous bolus followed by continuous infusion (e. g., 80 mg then 8 mg/hour) for 72 hours post endoscopy. (b) High dose PPI therapies given as intravenous bolus dosing (twice-daily) or in oral formulation (twice-daily) can be considered as alternative regimens.Strong recommendation, high quality evidence. 10 ESGE recommends that in patients who require ongoing anticoagulation therapy following acute NVUGIH (e. g., peptic ulcer hemorrhage), anticoagulation should be resumed as soon as the bleeding has been controlled, preferably within or soon after 7 days of the bleeding event, based on thromboembolic risk. The rapid onset of action of direct oral anticoagulants (DOACS), as compared to vitamin K antagonists (VKAs), must be considered in this context.Strong recommendation, low quality evidence.

scholarly journals Measurement properties of patient-reported outcome measures (PROMs) in hyperhidrosis: a systematic review

2021 ◽  
Author(s):  
Michaela Gabes ◽  
Helge Knüttel ◽  
Gesina Kann ◽  
Christina Tischer ◽  
Christian J. Apfelbacher
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Measurement Properties ◽  
High Quality ◽  
High Quality Evidence ◽  
Patient Reported ◽  
Quality Evidence

Abstract Purpose To critically appraise, compare and summarize the quality of all existing PROMs that have been validated in hyperhidrosis to at least some extend by applying the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. Thereby, we aim to give a recommendation for the use of PROMs in future clinical trials in hyperhidrosis. Methods We considered studies evaluating, describing or comparing measurement properties of PROMs as eligible. A systematic literature search in three big databases (MEDLINE, EMBASE and Web of Science) was performed. We assessed the methodological quality of each included study using the COSMIN Risk of Bias checklist. Furthermore, we applied predefined quality criteria for good measurement properties and finally, graded the quality of the evidence. Results Twenty-four articles reporting on 13 patient-reported outcome measures were included. Three instruments can be further recommended for use. They showed evidence for sufficient content validity and moderate- to high-quality evidence for sufficient internal consistency. The methodological assessment showed existing evidence gaps for eight other PROMs, which therefore require further validation studies to make an adequate decision on their recommendation. The Hyperhidrosis Disease Severity Measure-Axillary (HDSM-Ax) and the short-form health survey with 36 items (SF-36) were the only questionnaires not recommended for use in patients with hyperhidrosis due to moderate- to high-quality evidence for insufficient measurement properties. Conclusion Three PROMs, the Hyperhidrosis Quality of Life Index (HidroQoL), the Hyperhidrosis Questionnaire (HQ) and the Sweating Cognitions Inventory (SCI), can be recommended for use in future clinical trials in hyperhidrosis. Results obtained with these three instruments can be seen as trustworthy. Nevertheless, further validation of all three PROMs is desirable. Systematic review registration PROSPERO CRD42020170247

Analysis Of Factors Influencing Acupuncture Clinical Effects: A Systematic Review

2021 ◽  
Author(s):  
Yali Liu ◽  
Honglin Jiang ◽  
Xiaotong Li ◽  
Xingyue Yang
Keyword(s):  
Systematic Review ◽  
Individual Difference ◽  
Current Status ◽  
Clinical Effects ◽  
High Quality ◽  
Psychological States ◽  
Factors Influencing ◽  
High Quality Evidence ◽  
Stimulus Parameters ◽  
Quality Evidence

Background: Acupuncture therapy has been widely applied all around the world. But there still lacks high-quality evidence to evaluate its clinical effects, safety and cost-effectiveness, which seriously restricts its further promotion and development. Acupuncture, as an operational intervention, is more complex than drug therapy. Factors involved in the acupuncture operation process, such as individual and interventional factors, may affect clinical effects. Purpose:s Through this systematic review, we attempt to analyze the current status of studies about the key factors influencing clinical effects, so as to provide evidence for the design of acupuncture studies. Methods: A literature research was conducted in six databases until May, 2020. Studies were screened and assessed by two authors independently. Data extraction was made after screening. We extracted the basic information of these studies, including publishing years and countries, population and factors influencing clinical effects.Results: Through the initial search in these six database, 6404 records were retrieved. After duplication and screening, a total of 355 studies were finally included in the qualitative analysis. About 88.5% of these studies were conducted in China with increasing number in the past decades, covering neurological disorders, orthopedic disorders, obstetrical and gynecological diseases, digestive diseases and so on; 239 studies focused on stimulus parameters which may influence effects, accounting for 67.3%, and 128, 44, 39, 32, 15, 11 studies discussed acupoints, patients’ pathological states, individual difference, psychological states, deqi, and other factors separately. Conclusion: There are more and more studies focusing on factors influencing acupuncture clinical effects, including stimulus parameters, acupoints, individual difference, patient pathological and psychological states. Based on this systematic review, several ignored factors should be considered for future researches, and more scientifically and objectively high quality evidence should also be proved.

scholarly journals Technical aspects of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Technical Guideline – March 2017

Endoscopy ◽  
2017 ◽  
Vol 49 (10) ◽  
pp. 989-1006 ◽  
Author(s):  
Marcin Polkowski ◽  
Christian Jenssen ◽  
Philip Kaye ◽  
Silvia Carrara ◽  
Pierre Deprez ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Solid Component ◽  
Cystic Lesions ◽  
High Quality ◽  
Strong Recommendation ◽  
Fine Needle ◽  
Weak Recommendation ◽  
Moderate Quality ◽  
High Quality Evidence ◽  
Quality Evidence

RECOMMENDATIONSFor routine EUS-guided sampling of solid masses and lymph nodes (LNs) ESGE recommends 25G or 22G needles (high quality evidence, strong recommendation); fine needle aspiration (FNA) and fine needle biopsy (FNB) needles are equally recommended (high quality evidence, strong recommendation).When the primary aim of sampling is to obtain a core tissue specimen, ESGE suggests using 19G FNA or FNB needles or 22G FNB needles (low quality evidence, weak recommendation).ESGE recommends using 10-mL syringe suction for EUS-guided sampling of solid masses and LNs with 25G or 22G FNA needles (high quality evidence, strong recommendation) and other types of needles (low quality evidence, weak recommendation). ESGE suggests neutralizing residual negative pressure in the needle before withdrawing the needle from the target lesion (moderate quality evidence, weak recommendation).ESGE does not recommend for or against using the needle stylet for EUS-guided sampling of solid masses and LNs with FNA needles (high quality evidence, strong recommendation) and suggests using the needle stylet for EUS-guided sampling with FNB needles (low quality evidence, weak recommendation).ESGE suggests fanning the needle throughout the lesion when sampling solid masses and LNs (moderate quality evidence, weak recommendation).ESGE equally recommends EUS-guided sampling with or without on-site cytologic evaluation (moderate quality evidence, strong recommendation). When on-site cytologic evaluation is unavailable, ESGE suggests performance of three to four needle passes with an FNA needle or two to three passes with an FNB needle (low quality evidence, weak recommendation).For diagnostic sampling of pancreatic cystic lesions without a solid component, ESGE suggests emptying the cyst with a single pass of a 22G or 19G needle (low quality evidence, weak recommendation). For pancreatic cystic lesions with a solid component, ESGE suggests sampling of the solid component using the same technique as in the case of other solid lesions (low quality evidence, weak recommendation).ESGE does not recommend antibiotic prophylaxis for EUS-guided sampling of solid masses or LNs (low quality evidence, strong recommendation), and suggests antibiotic prophylaxis with fluoroquinolones or beta-lactam antibiotics for EUS-guided sampling of cystic lesions (low quality evidence, weak recommendation). ESGE suggests that evaluation of tissue obtained by EUS-guided sampling should include histologic preparations (e. g., cell blocks and/or formalin-fixed and paraffin-embedded tissue fragments) and should not be limited to smear cytology (low quality evidence, weak recommendation).

scholarly journals Polysulfonate Resins in Hyperkalemia: A Systematic Review

2020 ◽  
Vol 7 ◽  
pp. 205435812096583
Author(s):  
Sheung Wing Sherwin Wong ◽  
Grace Zhang ◽  
Patrick Norman ◽  
Hasitha Welihinda ◽  
Don Thiwanka Wijeratne
Keyword(s):  
Systematic Review ◽  
Serum Potassium ◽  
Observational Studies ◽  
Primary Outcome ◽  
Case Series ◽  
Sodium Polystyrene Sulfonate ◽  
Polystyrene Sulfonate ◽  
High Quality ◽  
High Quality Evidence ◽  
Quality Evidence

Background: Hyperkalemia is a potentially life-threatening electrolyte abnormality defined as a serum potassium above the lab reference range (usually >5.0-5.5 mEq/L). Polystyrene resins, including sodium polystyrene sulfonate (SPS) and calcium polystyrene sulfonate (CPS), have long been used to treat hyperkalemia. Sodium polystyrene sulfonate/calcium polystyrene sulfonate act by exchanging a cation for potassium within the intestinal lumen. While SPS and CPS have been available since the 1960s, there are rising concerns about the validity of the data supporting its use and about serious adverse gastrointestinal effects. Objective: The objective of this systematic review was to quantify the efficacy and safety of polystyrene sulfonate resins (SPS/CPS) in the treatment of adults with hyperkalemia. This review focuses on the randomized control trial (RCT), interventional non-RCT, and observational data available on SPS/CPS use. Design: Systematic review. Setting: Any country of origin. Both inpatient and outpatient settings. Patients: Adults with hyperkalemia treated with polystyrene sulfonate resins. Measurements: The primary outcome was change in serum potassium. The secondary outcomes included adverse effects of SPS/CPS and prevention of recurrent hyperkalemia. Methods: We conducted a systematic review using Cochrane Library, EMBASE (1947-2019), and Medline (1946-2019) databases. Literature reviews, systematic reviews, case studies, case series, and editorial pieces were excluded. Included studies were assessed for risk of bias. Results: Four RCTs, 21 observational studies, and 5 quasi-experimental trials were included. A total of 212 351 patients were included. Two thousand and fifty-eight patients were studied for the primary outcome and 210 293 patients were studied for the secondary outcomes. Study designs were heterogeneous and not amenable to meta-analysis. Most studies included nonhemodialysis outpatients older than 65 years. Of the included studies, 22/25 (88%) demonstrated a reduction of serum potassium >0.5 mEq/L over the study period. The magnitude of reduction in serum potassium of potassium resin compared with placebo or matched controls in the 3 low-risk studies identified was 0.14 to 1.04 mEq/L. However, each study used different dosing regimens. Ten of 22 studies reported the effects of polystyrene resins on serum potassium within 24 hours. A few high-quality observational studies suggest an increased risk of serious adverse gastrointestinal events with a relative risk of 2.10 and a hazard ratio of 1.25 to 1.94; however, the absolute risk remains low. The incidence of adverse gastrointestinal events is 16 to 23 events per 1000 person-years. Limitations: We acknowledge several limitations in this study. Case studies and case series were excluded from the search results. Large case series may have been excluded despite having comparable sample sizes to studies included due to lack of a comparator and calculated estimates. Due to the heterogeneity of the studies, the data were unable to be meta-analyzed and as such the potassium-lowering effect of polystyrene sulfonate resins remains founded on small studies with potential confounders. Conclusions: This systematic review demonstrates a continued lack of high-quality evidence for the use of SPS/CPS in hyperkalemia. Studies investigated highly variable timelines and the most robust evidence for SPS/CPS use is in chronic hyperkalemia. While the absence of high-quality evidence does not exclude the possibility of benefit, prescribers must understand that the use of SPS/CPS in acute hyperkalemia is not supported by high-quality evidence. Trial registration: The protocol for this systematic review was not registered.

scholarly journals Predictors of Unemployment After Breast Cancer Surgery: A Systematic Review and Meta-Analysis of Observational Studies

2018 ◽  
Vol 36 (18) ◽  
pp. 1868-1879 ◽  
Author(s):  
Li Wang ◽  
Brian Y. Hong ◽  
Sean A. Kennedy ◽  
Yaping Chang ◽  
Chris J. Hong ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Observational Studies ◽  
Job Demands ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Axillary Lymph ◽  
High Quality ◽  
Moderate Quality ◽  
High Quality Evidence ◽  
Quality Evidence

Purpose Breast cancer surgery is associated with unemployment. Identifying high-risk patients could help inform strategies to promote return to work. We systematically reviewed observational studies to explore factors associated with unemployment after breast cancer surgery. Methods We searched MEDLINE, EMBASE, CINAHL, and PsycINFO to identify studies that explored risk factors for unemployment after breast cancer surgery. When possible, we pooled estimates of association for all independent variables reported by more than one study. Results Twenty-six studies (46,927 patients) reported the association of 127 variables with unemployment after breast cancer surgery. Access to universal health care was associated with higher rates of unemployment (26.6% v 15.4%; test of interaction P = .05). High-quality evidence showed that unemployment after breast cancer surgery was associated with high psychological job demands (odds ratio [OR], 4.26; 95% CI, 2.27 to 7.97), childlessness (OR, 1.30; 95% CI, 1.11 to 1.53), lower education level (OR, 1.15; 95% CI, 1.05 to 1.25), lower income level (OR, 1.46; 95% CI, 1.24 to 1.73), cancer stage II, III or IV (OR, 1.43; 95% CI, 1.13 to 1.82), and mastectomy versus breast-conserving surgery (OR, 1.18; 95% CI, 1.07 to 1.30). Moderate-quality evidence suggested an association with high physical job demands (OR, 2.11; 95%CI, 1.52 to 2.93), African-American ethnicity (OR, 1.89; 95% CI, 1.21 to 2.96), and receipt of chemotherapy (OR, 1.95; 95% CI, 1.36 to 2.79). High-quality evidence demonstrated no significant association with part-time hours, blue-collar work, tumor size, positive lymph nodes, or receipt of radiotherapy or endocrine therapy; moderate-quality evidence suggested no association with age, marital status, or axillary lymph node dissection. Conclusion Addressing high physical and psychological job demands may be important in reducing unemployment after breast cancer surgery.

scholarly journals Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019

Endoscopy ◽  
2019 ◽  
Vol 51 (12) ◽  
pp. 1155-1179 ◽  
Author(s):  
Raf Bisschops ◽  
James E. East ◽  
Cesare Hassan ◽  
Yark Hazewinkel ◽  
Michał F. Kamiński ◽  
...  
Keyword(s):  
Colorectal Neoplasia ◽  
Colorectal Polyps ◽  
High Definition ◽  
High Quality ◽  
Strong Recommendation ◽  
Weak Recommendation ◽  
Moderate Quality ◽  
High Quality Evidence ◽  
Virtual Chromoendoscopy ◽  
Quality Evidence

Main Recommendations 1 ESGE suggests that high definition endoscopy, and dye or virtual chromoendoscopy, as well as add-on devices, can be used in average risk patients to increase the endoscopist’s adenoma detection rate. However, their routine use must be balanced against costs and practical considerations.Weak recommendation, high quality evidence. 2 ESGE recommends the routine use of high definition systems in individuals with Lynch syndrome.Strong recommendation, high quality evidence. 3 ESGE recommends the routine use, with targeted biopsies, of dye-based pancolonic chromoendoscopy or virtual chromoendoscopy for neoplasia surveillance in patients with long-standing colitis.Strong recommendation, moderate quality evidence. 4 ESGE suggests that virtual chromoendoscopy and dye-based chromoendoscopy can be used, under strictly controlled conditions, for real-time optical diagnosis of diminutive (≤ 5 mm) colorectal polyps and can replace histopathological diagnosis. The optical diagnosis has to be reported using validated scales, must be adequately photodocumented, and can be performed only by experienced endoscopists who are adequately trained, as defined in the ESGE curriculum, and audited.Weak recommendation, high quality evidence. 5 ESGE recommends the use of high definition white-light endoscopy in combination with (virtual) chromoendoscopy to predict the presence and depth of any submucosal invasion in nonpedunculated colorectal polyps prior to any treatment. Strong recommendation, moderate quality evidence. 6 ESGE recommends the use of virtual or dye-based chromoendoscopy in addition to white-light endoscopy for the detection of residual neoplasia at a piecemeal polypectomy scar site. Strong recommendation, moderate quality evidence. 7 ESGE suggests the possible incorporation of computer-aided diagnosis (detection and characterization of lesions) to colonoscopy, if acceptable and reproducible accuracy for colorectal neoplasia is demonstrated in high quality multicenter in vivo clinical studies. Possible significant risks with implementation, specifically endoscopist deskilling and over-reliance on artificial intelligence, unrepresentative training datasets, and hacking, need to be considered. Weak recommendation, low quality evidence.

scholarly journals The effect of electronic audits and feedback in primary care and factors that contribute to their effectiveness: a systematic review

2020 ◽  
Vol 32 (10) ◽  
pp. 708-720
Author(s):  
Steve Van Den Bulck ◽  
David Spitaels ◽  
Bert Vaes ◽  
Geert Goderis ◽  
Rosella Hermens ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Cognitive Load ◽  
Medication Safety ◽  
Data Extraction ◽  
Cochrane Review ◽  
High Quality ◽  
Electronic Feedback ◽  
High Quality Evidence ◽  
Quality Evidence

Abstract Purpose The aim of this systematic review was (i) to assess whether electronic audit and feedback (A&F) is effective in primary care and (ii) to evaluate important features concerning content and delivery of the feedback in primary care, including the use of benchmarks, the frequency of feedback, the cognitive load of feedback and the evidence-based aspects of the feedback. Data sources The MEDLINE, Embase, CINAHL and CENTRAL databases were searched for articles published since 2010 by replicating the search strategy used in the last Cochrane review on A&F. Study selection Two independent reviewers assessed the records for their eligibility, performed the data extraction and evaluated the risk of bias. Our search resulted in 8744 records, including the 140 randomized controlled trials (RCTs) from the last Cochrane Review. The full texts of 431 articles were assessed to determine their eligibility. Finally, 29 articles were included. Data extraction Two independent reviewers extracted standard data, data on the effectiveness and outcomes of the interventions, data on the kind of electronic feedback (static versus interactive) and data on the aforementioned feedback features. Results of data synthesis Twenty-two studies (76%) showed that electronic A&F was effective. All interventions targeting medication safety, preventive medicine, cholesterol management and depression showed an effect. Approximately 70% of the included studies used benchmarks and high-quality evidence in the content of the feedback. In almost half of the studies, the cognitive load of feedback was not reported. Due to high heterogeneity in the results, no meta-analysis was performed. Conclusion This systematic review included 29 articles examining electronic A&F interventions in primary care, and 76% of the interventions were effective. Our findings suggest electronic A&F is effective in primary care for different conditions such as medication safety and preventive medicine. Some of the benefits of electronic A&F include its scalability and the potential to be cost effective. The use of benchmarks as comparators and feedback based on high-quality evidence are widely used and important features of electronic feedback in primary care. However, other important features such as the cognitive load of feedback and the frequency of feedback provision are poorly described in the design of many electronic A&F intervention, indicating that a better description or implementation of these features is needed. Developing a framework or methodology for automated A&F interventions in primary care could be useful for future research.

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