scholarly journals Clinical effectiveness and cost-effectiveness of parenting interventions for children with severe attachment problems: a systematic review and meta-analysis

2015 ◽  
Vol 19 (52) ◽  
pp. 1-348 ◽  
Author(s):  
Barry Wright ◽  
Melissa Barry ◽  
Ellen Hughes ◽  
Dominic Trépel ◽  
Shehzad Ali ◽  
...  
Keyword(s):  
At Risk ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Maternal Sensitivity ◽  
Clinical Effectiveness ◽  
Risk Groups ◽  
Assessment Tools ◽  
Parenting Interventions ◽  
Attachment Disorders ◽  
Attachment Problems

Background and objectivesServices have variable practices for identifying and providing interventions for ‘severe attachment problems’ (disorganised attachment patterns and attachment disorders). Several government reports have highlighted the need for better parenting interventions in at-risk groups. This report was commissioned to evaluate the clinical effectiveness and cost-effectiveness of parenting interventions for children with severe attachment problems (the main review). One supplementary review explored the evaluation of assessment tools and a second reviewed 10-year outcome data to better inform health economic aspects of the main review.Data sourcesA total of 29 electronic databases were searched with additional mechanisms for identifying a wide pool of references using the Cochrane methodology. Examples of databases searched include PsycINFO (1806 to January week 1, 2012), MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations (1946 to December week 4, 2011) and EMBASE (1974 to week 1, 2012). Searches were carried out between 6 and 12 January 2012.Review methodsPapers identified were screened and data were extracted by two independent reviewers, with disagreements arbitrated by a third independent reviewer. Quality assessment tools were used, including quality assessment of diagnostic accuracy studies – version 2 and the Cochrane risk of bias tool. Meta-analysis of randomised controlled trials (RCTs) of parenting interventions was undertaken. A health economics analysis was conducted.ResultsThe initial search returned 10,167 citations. This yielded 29 RCTs in the main review of parenting interventions to improve attachment patterns, and one involving children with reactive attachment disorder. A meta-analysis of eight studies seeking to improve outcome in at-risk populations showed statistically significant improvement in disorganised attachment. The interventions saw less disorganised attachment at outcome than the control (odds ratio 0.47, 95% confidence interval 0.34 to 0.65;p < 0.00001). Much of this focused around interventions improving maternal sensitivity, with or without video feedback. In our first supplementary review, 35 papers evaluated an attachment assessment tool demonstrating validity or psychometric data. Only five reported test–retest data. Twenty-six studies reported inter-rater reliability, with 24 reporting a level of 0.7 or above. Cronbach’s alphas were reported in 12 studies for the comparative tests (11 with α > 0.7) and four studies for the reference tests (four with α > 0.7). Three carried out concurrent validity comparing the Strange Situation Procedure (SSP) with another assessment tool. These had good sensitivity but poor specificity. The Disturbances of Attachment Interview had good sensitivity and specificity with the research diagnostic criteria (RDC) for attachment disorders. In our supplementary review of 10-year outcomes in cohorts using a baseline reference standard, two studies were found with disorganised attachment at baseline, with one finding raised psychopathology in adolescence. Budget impact analysis of costs was estimated because a decision model could not be justifiably populated. This, alongside other findings, informed research priorities.LimitationsThere are relatively few UK-based clinical trials. A 10-year follow-up, while necessary for our health economists for long-term sequelae, yielded a limited number of papers.ConclusionsMaternal sensitivity interventions show good outcomes in at-risk populations, but require further research with complex children. The SSP and RDC for attachment disorders remain the reference standards for identification until more concurrent and predictive validity research is conducted. A birth cohort with sequential attachment measures and outcomes across different domains is recommended with further, methodologically sound randomised controlled intervention trials. The main area identified for future work was a need for good-quality RCTs in at-risk groups such as those entering foster care or adoption.Study registrationThis study is registered as PROSPERO CRD42011001395.FundingThe National Institute for Health Research Health Technology Assessment programme.

OP138 Stakeholders’ Involvement When Developing A mHealth Assessment Tool

2019 ◽  
Vol 35 (S1) ◽  
pp. 31-32
Author(s):  
Elisa Puigdomenech Puig ◽  
Elisa Poses Ferrer ◽  
Lina Masana ◽  
Mireia Espallargues
Keyword(s):  
Focus Groups ◽  
User Experience ◽  
Delphi Technique ◽  
Assessment Tool ◽  
Clinical Effectiveness ◽  
Assessment Tools ◽  
Evaluation Tool ◽  
Privacy And Security ◽  
Safety Issues ◽  
Health Apps

IntroductionDue to the specific characteristics and challenges of mobile health (mHealth) technologies there is a need to have assessment tools based on their particularities to be used by health technology assessment (HTA) agencies and evaluation experts. In the development of a comprehensive and practical evaluation tool for the evaluation of mHealth solutions we aimed to include the views and opinions of key stakeholders: health professionals, developers, hospital managers, HTA agencies, patients and general public.MethodsFocus groups and an online modification of the Delphi technique are being used to discuss and agree on domains and criteria to be included in the mHealth assessment tool. Domains and criteria used for health apps evaluation were drawn from a literature review on the topic. The initial list includes 95 criteria grouped into the following domains: purpose of the app, privacy and security, clinical effectiveness, content of the intervention, user experience and usability, interoperability, expenses, impact on the organization, and legal and ethical aspects. Data coming from focus groups is currently being analyzed from a thematic and content analysis perspective.ResultsFocus groups with professionals have showed that the most important domains to be considered when evaluating health apps are those related with security, user experience, and clinical effectiveness. Some criteria were considered to be mandatory (mainly regarding safety issues), on which a first step assessment should indicate whether the app ‘pass or fails’ for the subsequent throughout assessment. Focus groups with patients will provide insight on critical aspects related to the choice, use and adherence to a health app.ConclusionsInsights from main stakeholders on the design of the tool for mHealth assessment are relevant and complementary between them. Next steps include (i) the agreement of criteria by using an online modification of the Delphi Technique and (ii) piloting of the tool.

scholarly journals Delirium Assessment in Acute Stroke: A Systematic Review and Meta-Analysis of Incidence, Assessment Tools, and Assessment Frequencies

2019 ◽  
Vol 11 ◽  
pp. 117957351989708
Author(s):  
Jannik Stokholm ◽  
Janni Vagner Steenholt ◽  
Claudio Csilag ◽  
Troels Wesenberg Kjær ◽  
Thomas Christensen
Keyword(s):  
Health Professional ◽  
Acute Stroke ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Assessment Tools ◽  
Significant Heterogeneity ◽  
Chi Square ◽  
Delirium Assessment ◽  
Retrospective Cohort Studies ◽  
Assessment Frequency

Purpose: The purpose of this systematic literature review was to examine whether different assessment methods contribute to the variance in delirium incidence detected in populations of patients with acute stroke. Specifically, the aim was to address the influence of (1) choice of assessment tool, (2) frequency of assessment, and (3) type of health professional doing the assessment. Methods: We searched MEDLINE, EMBASE, and PsycINFO and included pro- and retrospective cohort studies assessing delirium during hospitalization of adult acute stroke patients. Results: In 30 articles, 24 unique populations were identified and included in the review. Delirium incidence ranged from 1.4% to 75.6% in total and a chi-square test showed a significant heterogeneity across studies (χ2 = 536.5, df = 23, P < .0001). No studies had an assessment for delirium before a patient entered the study. No specific patterns regarding the influence of tool, assessment frequency or health professional were discernible. Discussion: Subgroups analyses were not conducted due to the heterogeneity across studies. Studies comparing delirium assessment tools directly with each other are needed. Conclusions: Delirium is a common complication in acute stroke. No firm conclusions about a possible correlation of choice of tool, assessment frequency, and delirium incidence could be made due to the great heterogeneity of the study populations. Only 1 study compared 2 tools directly with each other. Further studies comparing delirium assessment tools directly with each other are needed.

scholarly journals Breastfeeding assessment tools for at-risk and malnourished infants aged under 6 months old: a systematic review

F1000Research ◽  
2021 ◽  
Vol 9 ◽  
pp. 1310
Author(s):  
Concetta Brugaletta ◽  
Karine Le Roch ◽  
Jennifer Saxton ◽  
Cécile Bizouerne ◽  
Marie McGrath ◽  
...  
Keyword(s):  
At Risk ◽  
Assessment Tool ◽  
Assessment Tools ◽  
World Health ◽  
Baby Friendly Hospital Initiative ◽  
Cochrane Reviews ◽  
Resource Poor ◽  
Education Tool ◽  
Health Organization ◽  
Emergency Fund

Background: Many small and malnourished infants under 6 months of age have problems with breastfeeding and restoring effective exclusive breastfeeding is a common treatment goal. Assessment is a critical first step of case management, but most malnutrition guidelines do not specify how best to do this. We aimed to identify breastfeeding assessment tools for use in assessing at-risk and malnourished infants in resource-poor settings. Methods: We systematically searched: Medline and Embase; Web of Knowledge; Cochrane Reviews; Eldis and Google Scholar databases. Also the World Health Organization (WHO), United Nations International Children’s Emergency Fund (UNICEF), CAse REport guidelines, Emergency Nutrition Network, and Field Exchange websites. Assessment tool content was analysed using a framework describing breastfeeding ‘domains’ (baby’s behaviour; mother’s behaviour; position; latching; effective feeding; breast health; baby’s health; mother’s view of  feed; number, timing and length of feeds). Results: We identified 29 breastfeeding assessment tools and 45 validation studies. Eight tools had not been validated. Evidence underpinning most tools was low quality and mainly from high-income countries and hospital settings. The most comprehensive tools were the Breastfeeding, Evaluation and Education Tool, UNICEF Baby-Friendly Hospital Initiative tools and CARE training package. The tool with the strongest evidence was the WHO/UNICEF B-R-E-A-S-T-Feed Observation Form. Conclusions: Despite many possible tools, there is currently no one gold standard. For assessing malnourished infants in resource-poor settings, UNICEF Baby-Friendly Hospital Initiative tools, Module IFE and the WHO/UNICEF B-R-E-A-S-T-Feed Observation Form are the best available tools but could be improved by adding questions from other tools. Allowing for context, one tool for rapid community-based assessment plus a more detailed one for clinic/hospital assessment might help optimally identify breastfeeding problems and the support required. Further research is important to refine existing tools and develop new ones. Rigorous testing, especially against outcomes such as breastfeeding status and growth, is key.

scholarly journals 1439Hepatitis B prevalence in the Indian Subcontinent: a systematic review and meta-analysis

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Sam Hogan ◽  
Kate McBride ◽  
Andrew Page ◽  
Sameer Dixit
Keyword(s):  
At Risk ◽  
Indian Subcontinent ◽  
Meta Analysis ◽  
Risk Groups ◽  
Sample Population ◽  
Health Issues ◽  
Vaccination Programs ◽  
Rural And Urban ◽  
Pooled Prevalence ◽  
Hbv Prevalence

Abstract Background Hepatitis B virus (HBV) infections are a major global health burden. Although a vaccine exists for HBV, some developing nations still struggle to reduce prevalence. While the countries within the Indian Subcontinent have vaccination programs, HBV prevalence varies. It is important to identify population groups at risk. Methods Several databases were systematically searched for papers appropriate studies. Studies were included if the sample population lived within one of the selected countries and had no other existing health issues. The studies were assessed for risk of bias, and pooled estimates were created. Subgroups which were assessed included countries, sex, rural and urban populations. Results The pooled prevalence of all studies (N = 56) was 4%. For the countries with multiple included studies, the prevalence for India, Pakistan, Bangladesh and Nepal were calculated as 3%, 6%, 5% and 1% respectively. Most of the studies were assessed as being of reasonable quality. There was a chance that publication bias was present. Conclusions While some of the populations had the expected prevalence for the country in which the study was set, other subpopulations had higher prevalence. The highest HBV prevalence was found in displaced persons and those engaging in risk taking behaviours, however some high prevalence groups did not have a clear reason. Key messages Although HBV prevalence in general is lower at present than in the past, there are still at-risk groups with higher prevalence than the general population.

scholarly journals Breastfeeding assessment tools for at-risk and malnourished infants aged under 6 months old: a systematic review

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1310
Author(s):  
Concetta Brugaletta ◽  
Karine Le Roch ◽  
Jennifer Saxton ◽  
Cécile Bizouerne ◽  
Marie McGrath ◽  
...  
Keyword(s):  
At Risk ◽  
Assessment Tool ◽  
Assessment Tools ◽  
World Health ◽  
Baby Friendly Hospital Initiative ◽  
Cochrane Reviews ◽  
Resource Poor ◽  
Education Tool ◽  
Health Organization ◽  
Emergency Fund

Background: Many small and malnourished infants under 6 months of age have problems with breastfeeding and restoring effective exclusive breastfeeding is a common treatment goal. Assessment is a critical first step of case management, but most malnutrition guidelines do not specify how best to do this. We aimed to identify breastfeeding assessment tools for use in assessing at-risk and malnourished infants in resource-poor settings. Methods: We systematically searched: Medline and Embase; Web of Knowledge; Cochrane Reviews; Eldis and Google Scholar databases. Also the World Health Organization (WHO), United Nations International Children’s Emergency Fund (UNICEF), CAse REport guidelines, Emergency Nutrition Network, and Field Exchange websites. Assessment tool content was analysed using a framework describing breastfeeding ‘domains’ (baby’s behaviour; mother’s behaviour; position; latching; effective feeding; breast health; baby’s health; mother’s view of  feed; number, timing and length of feeds). Results: We identified 29 breastfeeding assessment tools and 45 validation studies. Eight tools had not been validated. Evidence underpinning most tools was low quality and mainly from high-income countries and hospital settings. The most comprehensive tools were the Breastfeeding, Evaluation and Education Tool, UNICEF Baby-Friendly Hospital Initiative tools and CARE training package. The tool with the strongest evidence was the WHO/UNICEF B-R-E-A-S-T-Feed Observation Form. Conclusions: Despite many possible tools, there is currently no one gold standard. For assessing malnourished infants in resource-poor settings, UNICEF Baby-Friendly Hospital Initiative tools, Module IFE and the WHO/UNICEF B-R-E-A-S-T-Feed Observation Form are the best available tools but could be improved by adding questions from other tools. Allowing for context, one tool for rapid community-based assessment plus a more detailed one for clinic/hospital assessment might help optimally identify breastfeeding problems and the support required. Further research is important to refine existing tools and develop new ones. Rigorous testing, especially against outcomes such as breastfeeding status and growth, is key.

Do Sideline Tests of Vestibular and Oculomotor Function Accurately Diagnose Sports-Related Concussion in Adults? A Systematic Review and Meta-analysis

2021 ◽  
pp. 036354652110279
Author(s):  
Sarah A. Harris ◽  
Alasdair R. Dempsey ◽  
Katherine Mackie ◽  
Doug King ◽  
Mark Hecimovich ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sensitivity And Specificity ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Assessment Tools ◽  
Emotional Symptoms ◽  
Level Of Evidence ◽  
Clinical Signs And Symptoms

Background: Sports-related concussion (SRC) assessment tools are primarily based on subjective assessments of somatic, cognitive, and psychosocial/emotional symptoms. SRC symptoms remain underreported, and objective measures of SRC impairments would be valuable to assist diagnosis. Measurable impairments to vestibular and oculomotor processing have been shown to occur after SRC and may provide valid objective assessments. Purpose: Determine the diagnostic accuracy of sideline tests of vestibular and oculomotor dysfunction to identify SRC in adults. Study Design: Systematic review; Level of evidence, 4. Methods: Electronic databases and gray literature were searched from inception until February 12, 2020. Physically active individuals (>16 years of age) who participated in sports were included. The reference standard for SRC was a combination of clinical signs and symptoms (eg, the Sport Concussion Assessment Tool [SCAT]), and index tests included any oculomotor assessment tool. The QUADAS tool was used to assess risk of bias, with the credibility of the evidence being rated according to GRADE. Results: A total of 8 studies were included in this review. All included studies used the King-Devick test, with no other measures being identified. Meta-analysis was performed on 4 studies with a summary sensitivity and specificity of 0.77 and 0.82, respectively. The overall credibility of the evidence was rated as very low. Conclusion: Caution must be taken when interpreting these results given the very low credibility of the evidence, and the true summary sensitivity and specificity may substantially differ from the values calculated within this systematic review. Therefore, we recommend that clinicians using the King-Devick test to diagnose SRC in adults do so in conjunction with other tools such as the SCAT. PROSPERO Registration: CRD42018106632.

scholarly journals A Comparison of Two Assessment Tools Used in Overviews of Systematic Reviews: ROBIS versus AMSTAR-2

2021 ◽  
Author(s):  
Rachel Perry ◽  
Alex Whitmarsh ◽  
Verity Leach ◽  
Philippa Davies
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Assessment Tools ◽  
Substantial Agreement ◽  
Rater Reliability ◽  
Response Options ◽  
Overviews Of Systematic Reviews

Abstract Background:AMSTAR-2 is a 16-item assessment tool to check the quality of a systematic review and establish whether the most important elements are reported. ROBIS is another assessment tool which was designed to evaluate the level of bias present within a systematic review. Our objective was to compare, contrast and establish both inter-rater reliability and usability of both tools as part of two overviews of systematic reviews. Strictly speaking, one tool assesses methodological quality (AMSTAR-2) and the other assesses risk of bias (ROBIS), but there is considerable overlap between the tools in terms of the signalling questions. Methods:Three reviewers independently assessed 31 systematic reviews using both tools. The inter-rater reliability of all sub-sections using each instrument (AMSTAR-2 and ROBIS) were calculated using Gwet’s agreement coefficient (AC1 for unweighted analysis and AC2 for weighted analysis).Results:Thirty-one systematic reviews were included. For AMSTAR-2 the median agreement for all questions was 0.61. Eight of the 16 AMSTAR-2 questions had substantial agreement or higher (>0.61). For ROBIS, the median agreement for all questions was also 0.61. Eleven of the 24 ROBIS questions had substantial agreement or higher. Conclusion:ROBIS is an effective tool for assessing risk of bias in systematic reviews and AMSTAR-2 is an effective tool at assessing quality. The median agreement between raters for both tools was identical (0.61). Reviews that included a meta-analysis were easier to rate with ROBIS; however, further developmental work could improve its use in reviews without a formal synthesis. AMSTAR-2 was more straightforward to use, however, more response options would be beneficial.

scholarly journals A comparison of two assessment tools used in overviews of systematic reviews: ROBIS versus AMSTAR-2

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
R. Perry ◽  
A. Whitmarsh ◽  
V. Leach ◽  
P. Davies
Keyword(s):  
Systematic Review ◽  
Systematic Reviews ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Assessment Tools ◽  
Substantial Agreement ◽  
Rater Reliability ◽  
Response Options ◽  
Overviews Of Systematic Reviews

Abstract Background AMSTAR-2 is a 16-item assessment tool to check the quality of a systematic review and establish whether the most important elements are reported. ROBIS is another assessment tool which was designed to evaluate the level of bias present within a systematic review. Our objective was to compare, contrast and establish both inter-rater reliability and usability of both tools as part of two overviews of systematic reviews. Strictly speaking, one tool assesses methodological quality (AMSTAR-2) and the other assesses risk of bias (ROBIS), but there is considerable overlap between the tools in terms of the signalling questions. Methods Three reviewers independently assessed 31 systematic reviews using both tools. The inter-rater reliability of all sub-sections using each instrument (AMSTAR-2 and ROBIS) was calculated using Gwet’s agreement coefficient (AC1 for unweighted analysis and AC2 for weighted analysis). Results Thirty-one systematic reviews were included. For AMSTAR-2, the median agreement for all questions was 0.61. Eight of the 16 AMSTAR-2 questions had substantial agreement or higher (> 0.61). For ROBIS, the median agreement for all questions was also 0.61. Eleven of the 24 ROBIS questions had substantial agreement or higher. Conclusion ROBIS is an effective tool for assessing risk of bias in systematic reviews and AMSTAR-2 is an effective tool at assessing quality. The median agreement between raters for both tools was identical (0.61). Reviews that included a meta-analysis were easier to rate with ROBIS; however, further developmental work could improve its use in reviews without a formal synthesis. AMSTAR-2 was more straightforward to use; however, more response options would be beneficial.

Success of Two Caries Risk Assessment Tools in Children: A Pilot Study With a 3-Year Follow-Up

2019 ◽  
Vol 40 (4) ◽  
pp. 317-320
Author(s):  
Elif Kuru ◽  
Ece Eden
Keyword(s):  
Risk Assessment ◽  
Preschool Children ◽  
Dental Caries ◽  
Dietary Habits ◽  
Assessment Tool ◽  
Systemic Disease ◽  
Risk Groups ◽  
Assessment Tools ◽  
Caries Risk ◽  
Caries Risk Assessment

Caries risk is defined as the dental caries probability under the individual bacteriological environment, dietary habits, and environmental factors. Assessment of caries risk plays a major role in the prevention of dental caries. The aim of this study was to compare the effectiveness of two different caries risk assessment methods on caries-free preschool children. A sample of 90 caries-free 4- to 6-year-old children were selected from 400 preschool children. The selection was limited to children who had no dental caries, visible plaque, and systemic disease. American Academy of Pediatric Dentistry’s Caries Risk Assessment Tool (CAT) and Clinpro Cario L-Pop (CCLP; 3M ESPE, Germany) were used to categorize children into caries risk groups. Children were classified as being in high-, medium-, or low-risk groups by two methods. Determining risk factors according to CAT were examined. The compliance among the two methods was evaluated. Sixty-eight children were reevaluated intraorally after 3 years. The compliance between CAT and CCLP was sought using Kappa test. Statistical evaluation revealed moderate compliance among methods at baseline. The three most determinant factors in the high-risk group according to CAT were no topical fluoride exposure, no use of dental services, and active caries in mother. CAT is found statistically more successful than CCLP in predicting caries risk 3 years later. Caries risk assessment is effective to predict future caries and can be helpful for the clinician to choose the right tailor-made caries prevention plans.

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