Exploring the structure and characteristics of the Anglo-American paramedic system in developed countries: a scoping review

PurposeThis study aims to map and examine the existing evidence to provide an overview of what is known about the structure and characteristics of the Anglo-American paramedic system in developed countries.Design/methodology/approachThe review includes results examining the structure and characteristics of the Anglo-American paramedic system in English-speaking developed countries. Databases, including Embase, MEDLINE, Web of Science, EBSCOhost, CINAHL, Google Scholar and Epistemonikos, were searched from the inception of the databases. A grey literature search strategy was conducted to identify non-indexed relevant literature along with forward and backward searching of citations and references of included studies. Two reviewers undertook title and abstract screening, followed by full-text screening. Finally, data extraction was performed using a customised instrument. Included studies were summarised using narrative synthesis structured around broad themes exploring the structure and characteristics of the Anglo-American paramedic system.Findings The synthesis of information shows that varying models (or subsystems) exist within the Anglo-American paramedic system. The use of metaphorical models based on philosophical underpinnings are used to describe two novel subsystems within the Anglo-American paramedic system. These are the professionally autonomous and directive paramedic systems, with the directive model being further categorised into the rescue and hospital-managed submodels.Originality/valueThis study is the first of its kind to explore the modern subcategorisation of the Anglo-American paramedic system using a realist lens as the basis for its approach.

OP129 The Use Of A Text-Mining Screening Tool For Systematic Review Of Treatments For Relapsed/Refractory Diffuse Large B-Cell Lymphoma

IntroductionHuman screening of title and abstracts in a systematic literature review (SLR) is labor intensive and time-consuming. In many instances, thousands of citations may be retrieved; the vast majority excluded upon screening. Text-mining semi-automates and accelerates screening by identifying patterns in relevant and irrelevant citations, as labelled by the screener. One such text-mining tool, Abstrackr, uses an algorithm within an active-learning framework to predict the likelihood of citations being relevant. The objective of this study was to assesses the performance of Abstrackr for title and abstract screening in an SLR of treatments for relapsed/refractory diffuse large B-cell lymphoma.MethodsCitations identified from searches of electronic databases were imported to Abstrackr. An investigator-selected database of terms indicating relevance of title and abstract to the research question were uploaded. These terms were partly informed by the SLR inclusion/exclusion criteria. Citations deemed most relevant by Abstrackr were screened first (screening prioritization). Screening was carried out until a maximum prediction score of 0.4 or less, based on previous experience in the literature, was reached. Remaining citations were deemed unlikely to be relevant and did not undergo screening (screening truncation). Separately, a single-human screener screened all citations using Covidence.ResultsA total of 7,723 citations and 154 initial terms were uploaded to Abstrackr. Of these citations, 2,572 (33 percent) were screened before a prediction score of 0.39 was reached. Compared to single-human screening (conducted on all citations), the workload saving associated with Abstrackr was 5 days. A total of 451 (6 percent) citations proceeded to full-text screening; ten (0.1 percent) were included in the final evidence base. No citations predicted to be irrelevant by Abstrackr were included in the final evidence base.ConclusionsText-mining tools such as Abstrackr have the potential to reduce workload associated with title and abstract screening, without missing relevant citations.

Guidance for using artificial intelligence for title and abstract screening while conducting knowledge syntheses

Background Systematic reviews are the cornerstone of evidence-based medicine. However, systematic reviews are time consuming and there is growing demand to produce evidence more quickly, while maintaining robust methods. In recent years, artificial intelligence and active-machine learning (AML) have been implemented into several SR software applications. As some of the barriers to adoption of new technologies are the challenges in set-up and how best to use these technologies, we have provided different situations and considerations for knowledge synthesis teams to consider when using artificial intelligence and AML for title and abstract screening. Methods We retrospectively evaluated the implementation and performance of AML across a set of ten historically completed systematic reviews. Based upon the findings from this work and in consideration of the barriers we have encountered and navigated during the past 24 months in using these tools prospectively in our research, we discussed and developed a series of practical recommendations for research teams to consider in seeking to implement AML tools for citation screening into their workflow. Results We developed a seven-step framework and provide guidance for when and how to integrate artificial intelligence and AML into the title and abstract screening process. Steps include: (1) Consulting with Knowledge user/Expert Panel; (2) Developing the search strategy; (3) Preparing your review team; (4) Preparing your database; (5) Building the initial training set; (6) Ongoing screening; and (7) Truncating screening. During Step 6 and/or 7, you may also choose to optimize your team, by shifting some members to other review stages (e.g., full-text screening, data extraction). Conclusion Artificial intelligence and, more specifically, AML are well-developed tools for title and abstract screening and can be integrated into the screening process in several ways. Regardless of the method chosen, transparent reporting of these methods is critical for future studies evaluating artificial intelligence and AML.

Assessment and classification of peripheral pain in athletes: a scoping review protocol

Pain is often presumed to be part of the sport injury experience. The time-loss definition of injury leads to under-reported athletic pain impacting performance and quality of life. Whilst research regarding the assessment and classification of back pain in athletes is emerging, little has been reported regarding how peripheral pain is assessed and classified in research and practice. Six databases will be searched for relevant articles. Title and abstract screening followed by full-text screening will be completed by two independent reviewers. Data charting will be carried out using a modified standardised form. Descriptive results and frequencies will be reported. Pain measures identified in the studies will be mapped against the IOC Athlete Pain Framework alongside a narrative summary. Published peer-reviewed primary research studies alongside systematic reviews and clinical practice guidelines reporting the assessment or classification of pain in athletes of any age with chronic or acute peripheral pain across all study contexts in the English language on human participants from inception of the databases will be included. The results of this study are part of a body of research which will be used to inform the development of a pain assessment framework. The scoping review will be submitted for peer-reviewed journal publication and presented at sports medicine conferences. This review will inform researchers and clinicians working with athletes in pain how pain assessment and classification is currently conducted and positioned against the IOC Athlete Pain Framework.

Metabolic Syndrome and Its Components in Patients with COVID-19: Severe Acute Respiratory Syndrome (SARS) and Mortality. A Systematic Review and Meta-Analysis

Recent meta-analysis studies have reported that metabolic comorbidities such as diabetes, obesity, dyslipidaemia and hypertension are associated with higher risk of severe acute respiratory syndrome (SARS) and mortality in patients with COVID-19. This meta-analysis aims to investigate the relationship between metabolic syndrome (MetS) and its components with SARS and mortality in COVID-19 patients. Methods: A systematic search was conducted in the several databases up until 1 September 2021. Primary observational longitudinal studies published in peer review journals were selected. Two independent reviewers performed title and abstract screening, extracted data and assessed the risk of bias using the Newcastle–Ottawa Scale. Results: The random effects meta-analysis showed that MetS was significantly associated with SARS with a pooled OR (95% CI) of 3.21 (2.88–3.58) and mortality with a pooled OR (95% CI) of 2.32 (1.16–4.63). According to SARS, the pooled OR for MetS was 2.19 (1.71–2.67), p < 0.001; significantly higher than the hypertension component. With regard to mortality, although the pooled OR for MetS was greater than for its individual components, no significant differences were observed. Conclusions: this meta-analysis of cohort studies, showed that MetS is better associated to SARS and mortality in COVID-19 patients than its individual components.

Protocol of a Systematic Review on Telemedicine Solutions in COVID-19 Pandemic

Introduction: On March 20, 2020, the World Health Organization (WHO) announced the spread of SARS-CoV-2 infection in most countries worldwide as a pandemic. COVID-19 is mainly disseminated through human-to-human transmission route via direct contact and respiratory droplets. Telehealth and/or telemedicine technologies are beneficial methods that could be employed to deal with pandemic situation of communicable infections. The purpose of this proposed systematic review study is to sum up the functionalities, applications, and technologies of telemedicine during COVID-19 outbreak.Material and Methods: This review will be carried out in accordance with the Cochrane Handbook and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. PubMed and Scopus databases were searched for related articles. Randomized and non-randomized controlled trials published in English in scientific journals were identified to be evaluated for eligibility. Articles conducted on telemedicine services (TMS) during COVID-19 outbreak (2019-2020) were identified to be evaluated.Results: The literature search for related articles in PubMed and Scopus databases led to the identification and retrieval of a total of 1118 and 485 articles, respectively. After eliminating duplicate articles, title and abstract screening process was performed for the remaining 1440 articles. The current study findings are anticipated to be used as a guide by researchers, decision makers, and managers to design, implement, and assess TMS during COVID-19 crisis.Conclusion: As far as we know, this systematic review is conducted to comprehensively evaluate TM methods and technologies developed with the aim of controlling and managing COVID-19 pandemic. This study highlights important applications of telemedicine in pandemic conditions, which could be employed by future health systems in controlling and managing communicable infections when an outbreak occurs.

Reporting Quality in Math Meta-Analyses for Students with or at Risk of Disabilities

Researchers and practitioners alike often look to meta-analyses to identify effective practices to use with students with disabilities. The number of meta-analyses in special education has also expanded in recent years. The purpose of this systematic review is to evaluate the quality of reporting in meta-analyses focused on mathematics interventions for students with or at risk of disabilities. We applied 53 quality indicators (QIs) across eight categories based on recommendations from Talbott et al. to 22 mathematics intervention meta-analyses published between 2000 and 2020. Overall, the meta-analyses met 61% of QIs and results indicated that meta-analyses most frequently met QIs related to providing a clear purpose (95%) and data analysis plan (77%), whereas meta-analyses typically met fewer QIs related to describing participants (39%) and explaining the abstract screening process (48%). We discuss the variation in quality indicator scores within and across the quality categories and provide recommendations for future researchers.

The role of patient navigators in ambulatory care: overview of systematic reviews

Background Patient navigators have been introduced across various countries to enable timely access to healthcare services and to ensure completion of diagnosis and follow-up of care. There is an increasing evidence on the the role of patient navigation for patients and healthcare systems. The aim of this study was to analyse the evidence on patient navigation interventions in ambulatory care and to evaluate their effects on individuals and health system outcomes. Methods An overview of reviews was conducted, following a prespecified protocol. All patients in ambulatory care or transitional care setting were included in this review as long as it was related to the role of patient navigators. The study analysed patient navigators covering a wide range of health professionals such as physicians, nurses, pharmacists, social workers and lay health workers or community-based workers with no or very limited training. Studies including patient-related measures and health system-related outcomes were eligible for inclusion. A rigorous search was performed in multiple data bases. After reaching a high inter-rater agreement of 0.86, title and abstract screening was independently performed. Of an initial 14,248 search results and an additional 62 articles identified through the snowballing approach, a total of 7159 hits were eligible for title/abstract screening. 679 articles were included for full-text screening. Results Eleven systematic reviews were included covering various patient navigation intervention in cancer care, disease screening, transitional care and for various chronic conditions and multimorbidity. Nine systematic reviews primarily tailored services to ethnic minorities or other disadvantaged groups. Patient navigators performed tasks such as providing education and counselling, translations, home visits, outreach, scheduling of appointments and follow-up. Eight reviews identified positive outcomes in expanding access to care, in particular for vulnerable patient groups. Two reviews on patient navigation in transitional care reported improved patient outcomes, hospital readmission rates and mixed evidence on quality of life and emergency department visits. Two reviews demonstrated improved patient outcomes for persons with various chronic conditions and multimorbidity. Conclusions Patient navigators were shown to expand access to screenings and health services for vulnerable patients or population groups with chronic conditions who tend to underuse health services.

The vital role of physiotherapy during COVID-19: A systematic review

BACKGROUND: The current COVID-19 pandemic has changed the entire world population’s physical and mental wellbeing irrespective of the person being infected or not. Flourishing numbers of new research recommends physiotherapy for the management of COVID-19 patients. However, there are cavities in the study in the recommendation of physiotherapy specific to the current pandemic. OBJECTIVE: This review aimed to synthesize physiotherapy-related articles to COVID-19 and summarize their efficacious highlights. METHODS: For the literature search PubMed, PEDro, DOAJ and The Cochrane Database of Systematic Reviews were used. The keywords included “Physiotherapy”, “COVID-19”, and “Coronavirus”. The Boolean search was applied as required. Selection criteria included studies that included physiotherapy intervention as a tool for recovery of COVID-19. Exclusion criteria included animal studies, non-COVID-19 studies and physiotherapy as an adjunct treatment. The study evaluated evidence of all full-text articles in English from December 2019 to August 2020. RESULTS: Of the retrieved 577 articles, 390 articles were excluded at the title and abstract screening. 167 articles underwent full-text screening and further narrowed to 11 studies matching the expected criteria. 156 studies were excluded for various reasons. CONCLUSION: The current study findings support that physiotherapy interventions facilitate recovery in COVID-19 patients and act as a protective barrier. Further results include a reduced length of stay in intensive care and reduced treatment cost since this outbreak has brought a significant economic burden to many countries.