Web-Enabled Integration of Patient Data and Clinical Guidelines for Coordinated Care

2011 ◽  
pp. 151-171
Author(s):  
James R. Warren ◽  
Joseph T. Noone
Keyword(s):  
Health Hazard ◽  
Cochrane Collaboration ◽  
Developed Countries ◽  
Web Technology ◽  
Patient Data ◽  
Hospital Environment ◽  
Great Promise ◽  
Coordinated Care ◽  
Healthcare Facilities ◽  
The Cochrane Collaboration

A variety of forces are encouraging change in the healthcare systems of developed countries. Chief among these is perception of high (and rising) cost. The arsenal of tests, medications and procedures at the hands of Western medicine is ever-increasing. This, in concert with an aging population, has brought the health expenditures in the U.S., EU, Japan and Australia edging to just under 10% of GNP. Furthermore, there is concern about waste of resources, principally through lack of coordination between healthcare facilities resulting in redundant investigations. A more subtle force comes from the rise of evidence-based medicine (EBM), as illustrated, for instance, by the extensive consolidated clinical reviews of the Cochrane Collaboration. EBM highlights that typical medical practice is not necessarily efficient or effective in all cases as compared to well-established findings of randomized controlled trials (e.g., Sydney GPs have been observed to over-prescribe antibiotics, which is both a waste and a community health hazard [Bolton et al., 1996]). Happily, as motivations for change rise, we see the emergence of technologies with great promise for implementing solutions. The most obvious of these is of course Web technology. Cimino et al. (1995) illustrated (at a time that can now be considered early in the brief history of the Web) that intranet-based Web technology could provide a breakthrough in ease of integration of legacy information systems within a hospital environment, and thus be the basis for innovative clinical workstations within the hospital walls. More recently Cimino et al. (1998) have illustrated technical solutions to control the security and confidentiality risks associated with external access to the hospital intranet data. Moreover, as one uses an intranet for integration of patient data, they can simultaneously access internal (intranet) and/or external (Internet) decision support resources (such as access to Medline illustrated by Cimino et al., 1995).

scholarly journals Do we need to improve the reporting of evidence in tendinopathy management? A critical appraisal of systematic reviews with recommendations on strength of evidence assessment

2021 ◽  
Vol 7 (1) ◽  
pp. e000920
Author(s):  
Dimitris Challoumas ◽  
Neal L Millar
Keyword(s):  
Systematic Reviews ◽  
Assessment Tool ◽  
Data Extraction ◽  
Cochrane Collaboration ◽  
Mean Difference ◽  
Strength Of Evidence ◽  
The Mean ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
The Cochrane Collaboration

ObjectiveTo critically appraise the quality of published systematic reviews (SRs) of randomised controlled trials (RCTs) in tendinopathy with regard to handling and reporting of results with special emphasis on strength of evidence assessment.Data sourcesMedline from inception to June 2020.Study eligibilityAll SRs of RCTs assessing the effectiveness of any intervention(s) on any location of tendinopathy.Data extraction and synthesisIncluded SRs were appraised with the use of a 12-item tool devised by the authors arising from the Preferred Reporting Items in Systematic Reviews and Meta-Analyses statement and other relevant guidance. Subgroup analyses were performed based on impact factor (IF) of publishing journals and date of publication.ResultsA total of 57 SRs were included published in 38 journals between 2006 and 2020. The most commonly used risk-of-bias (RoB) assessment tool and strength of evidence assessment tool were the Cochrane Collaboration RoB tool and the Cochrane Collaboration Back Review Group tool, respectively. The mean score on the appraisal tool was 46.5% (range 0%–100%). SRs published in higher IF journals (>4.7) were associated with a higher mean score than those in lower IF journals (mean difference 26.4%±8.8%, p=0.004). The mean score of the 10 most recently published SRs was similar to that of the first 10 published SRs (mean difference 8.3%±13.7%, p=0.54). Only 23 SRs (40%) used the results of their RoB assessment in data synthesis and more than half (n=30; 50%) did not assess the strength of evidence of their results. Only 12 SRs (21%) assessed their strength of evidence appropriately.ConclusionsIn light of the poor presentation of evidence identified by our review, we provide recommendations to increase transparency and reproducibility in future SRs.

scholarly journals Sensory-Based Priming for Upper Extremity Hemiparesis After Stroke: A Scoping Review

2021 ◽  
pp. 153944922110326
Author(s):  
Mary E. Stoykov ◽  
Courtney Heidle ◽  
Shamshir Kang ◽  
Lisa Lodesky ◽  
Lindsay E. Maccary ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Motor Skills ◽  
Upper Limb ◽  
Scoping Review ◽  
Web Of Science ◽  
Motor Impairment ◽  
Cochrane Collaboration ◽  
Prisma Statement ◽  
Meta Analyses ◽  
The Cochrane Collaboration

Sensory priming is a technique to facilitate neuroplasticity and improve motor skills after injury. Common sensory priming modalities include peripheral nerve stimulation/somatosensory electrical stimulation (PNS/SES), transient functional deafferentation (TFD), and vibration. The aim of this study was to determine whether sensory priming with a motor intervention results in improved upper limb motor impairment or function after stroke. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and EMBASE were the databases used to search the literature in July 2020. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and recommendations for the Cochrane collaboration. In total, 30 studies were included in the analysis: three studies examined TFD, 16 examined PNS/SES, 10 studied vibration, and one combined the three stimulation techniques. Most studies reported significant improvements for participants receiving sensory priming. Given the low risk, it may be advantageous to use sensory-based priming prior to or concurrent with upper limb training after stroke.

scholarly journals Effect of Composite Core Materials on Fracture Resistance of Endodontically Treated Teeth: A Systematic Review and Meta-Analysis of In Vitro Studies

Polymers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 2251
Author(s):  
Maciej Zarow ◽  
Marzena Dominiak ◽  
Katarzyna Szczeklik ◽  
Louis Hardan ◽  
Rim Bourgi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Fracture Resistance ◽  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Composite Resins ◽  
In Vitro Studies ◽  
Endodontically Treated Teeth ◽  
The Cochrane Collaboration ◽  
Core Materials

Various material properties are involved in the success of endodontically treated restorations. At present, restorative composites are commonly employed as core build-up materials. This study aimed to systematically review the literature to assess the effect of using composite core materials on the in vitro fracture of endodontically treated teeth. Two different reviewers screened the literature, up to June 2021, in five distinct electronic databases: PubMed (MedLine), Scopus, Scielo, ISI Web of Science, and EMBASE. Only in vitro studies reporting the effect of the use of composite core materials on the fracture resistance of endodontically treated teeth were included. A meta-analysis was carried out using a software program (Review Manager v5.4.1; The Cochrane Collaboration, Copenhagen, Denmark). The risk of bias in each study was assessed following the parameters of another systematic review. A total of 5016 relevant papers were retrieved from all databases. After assessing the title and abstract, five publications remained for qualitative analysis. From these, only three studies remained for meta-analysis. The fracture strength of endodontically treated teeth where a core build-up composite was used was statistically significantly higher than the control (p = 0.04). Most of the analyses showed a high heterogenicity. The in vitro evidence suggests that the composite core build-up with higher filler content tended to improve the fracture resistance of the endodontically treated teeth, in comparison with conventional composite resins. This research received no external funding. Considering that this systematic review was only carried out on in vitro papers, registration was not performed. Furthermore, there were no identified clinical studies assessing core build-up materials; therefore, more well-designed research on these materials is needed.

scholarly journals Neonatal Uterine Bleedings: An Ignored Sign but a Possible Cause of Early-Onset Endometriosis – A Systematic Review

2021 ◽  
pp. 6-16
Author(s):  
Judith  Dekker ◽  
Isabelle Hooijer ◽  
Johannes C.F. Ket ◽  
Aleksandra Vejnović ◽  
Giuseppe Benagiano ◽  
...  
Keyword(s):  
Systematic Review ◽  
Full Text ◽  
Early Onset ◽  
Cochrane Collaboration ◽  
Systematic Search ◽  
Future Research ◽  
Screening Techniques ◽  
Screening Strategies ◽  
The Cochrane Collaboration ◽  
Possible Cause

<b><i>Objective:</i></b> Based on the hypothesis that neonatal uterine bleedings (NUB), occurring mostly in the first week after birth, could represent a pathogenetic mechanism for early-onset endometriosis, this systematic review (SR) was undertaken to evaluate the prevalence and screening strategies used to assess and quantify NUB. <b><i>Design:</i></b> Both a SR and a sample literature search in PubMed and Embase were conducted to gather information on NUB prevalence and screening techniques. This was performed by an information specialist. Only full-text articles regarding the assessment of NUB in neonates in the first 2 weeks after birth were included. No limit on language or publication data was used. <b><i>Materials and Methods:</i></b> The SR was registered in PROSPERO (CRD42019138121). Data was first assessed for eligibility on title and abstract by 2 blinded review authors. Any disagreements were discussed with a third reviewer if necessary. Subsequently, full-text articles were read and assessed for quality using the Cochrane Collaboration Handbook. <b><i>Results:</i></b> Out of 1,988 articles in the systematic search, 10 relevant articles were selected, of which 8 were identified through the systematic search and 2 were found through other sources. The sample search of 4,445 articles did not bring up relevant articles. Results were not comparable due to the heterogeneity of screening techniques, although data showed consensus. The prevalence of visible bleeding ranged from 3.3 to 53.8% and the prevalence of occult bleeding from 25.4 to 96.7%. The occurrence was the highest between the 3rd and 7th day postpartum (PP) and the bleeding lasted for 3–4 days on average. Various screening techniques for detecting NUB were found in the literature, including the use of hemoglobin detection devices (such as Hemastix) in the vaginal vestibulum, comparison of diapers with stains of known volume, colposcopy, and ultrasonography. <b><i>Conclusion:</i></b> The reported prevalence of NUB varies considerably, with a consistent occurrence between the 3rd and the 7th day PP. Literature to assess NUB is dated. The techniques are poorly described and heterogeneous. Future research should focus on prospective cohort studies in order to attempt to correlate NUB cases to (early-onset) endometriosis.

scholarly journals Nurses’ Perceptions of Barriers and Facilitators to Implement EBP in the Maldives

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Fathimath Shifaza ◽  
David Evans ◽  
Helen Bradley
Keyword(s):  
Relevant Literature ◽  
Developed Countries ◽  
Perceived Barriers ◽  
Barriers And Facilitators ◽  
Healthcare Organisation ◽  
Clear Understanding ◽  
Healthcare Facilities ◽  
New Ideas ◽  
Insufficient Time ◽  
Nurses Perceptions

This study aims to explore the barriers to evidence based practice (EBP) experienced by nurses working in a Maldivian healthcare organisation. A total of 400 questionnaires were distributed to nurses in 5 healthcare facilities and 198 completed questionnaires were returned. The results of this study show that the perceived barriers by the nurses in the Maldives are not significantly different from those reported in developed countries. For healthcare organisations in the Maldives, it is necessary to have a clear understanding of the barriers and facilitators to research practice in order to implement EBP. The study showed that the major barriers to research use were that “the relevant literature is not compiled in one place,” there is “insufficient time on the job to implement new ideas,” and “administration will not allow implementation.” The key facilitating factors for EBP include support, encouragement, and recognition by the management and administration. The findings of this study can be useful for determining strategies that can be introduced in the clinical setting to use EBP. Healthcare organisations must continue their support in order to decrease the barriers and optimise care in healthcare facilities.

scholarly journals Assessing the evidence on case management

2002 ◽  
Vol 181 (1) ◽  
pp. 17-21 ◽  
Author(s):  
S. J. Ziguras ◽  
G. W. Stuart ◽  
A. C. Jackson
Keyword(s):  
Mental Health ◽  
Case Management ◽  
Statistical Power ◽  
Cochrane Collaboration ◽  
Randomised Trials ◽  
Inclusion Criteria ◽  
Management Effectiveness ◽  
Trade Off ◽  
The Cochrane Collaboration ◽  
The Impact

BackgroundEvidence on the impact of case management is contradictory.AimsTo discuss two different systematic reviews (one conducted by the authors and one conducted through the Cochrane collaboration) that came to contradictory conclusions about the impact of case management in mental health services.MethodWe summarised the findings of the two reviews with respect to case management effectiveness, examined key methodological differences between the two approaches and discuss the impact of these on the validity of the results.ResultsThe differences in conclusions between the two reviews result from the differences in inclusion criteria, namely non-randomised trials, data from unpublished scales and data from variables with skewed distributions. The theoretical and empirical effects of these are discussed.ConclusionsSystematic reviewers may face a trade-off between the application of strict criteria for the inclusion of studies and the amount of data available for analysis and hence statistical power. The available research suggests that case management is generally effective.

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