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1.
BMC Psychiatry ; 22(1): 589, 2022 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-36064337

RESUMO

BACKGROUND: Improving the quality of care in community settings for people with 'Complex Emotional Needs' (CEN-our preferred working term for services for people with a "personality disorder" diagnosis or comparable needs) is recognised internationally as a priority. Plans to improve care should be rooted as far as possible in evidence. We aimed to take stock of the current state of such evidence, and identify significant gaps through a scoping review of published investigations of outcomes of community-based psychosocial interventions designed for CEN. METHODS: We conducted a scoping review with systematic searches. We searched six bibliographic databases, including forward and backward citation searching, and reference searching of relevant systematic reviews. We included studies using quantitative methods to test for effects on any clinical, social, and functioning outcomes from community-based interventions for people with CEN. The final search was conducted in November 2020. RESULTS: We included 226 papers in all (210 studies). Little relevant literature was published before 2000. Since then, publications per year and sample sizes have gradually increased, but most studies are relatively small, including many pilot or uncontrolled studies. Most studies focus on symptom and self-harm outcomes of various forms of specialist psychotherapy: most result in outcomes better than from inactive controls and similar to other specialist psychotherapies. We found large evidence gaps. Adaptation and testing of therapies for significant groups (e.g. people with comorbid psychosis, bipolar disorder, post-traumatic stress disorder, or substance misuse; older and younger groups; parents) have for the most part only reached a feasibility testing stage. We found little evidence regarding interventions to improve social aspects of people's lives, peer support, or ways of designing effective services. CONCLUSIONS: Compared with other longer term mental health problems that significantly impair functioning, the evidence base on how to provide high quality care for people with CEN is very limited. There is good evidence that people with CEN can be helped when specialist therapies are available and when they are able to engage with them. However, a much more methodologically robust and substantial literature addressing a much wider range of research questions is urgently needed to optimise treatment and support across this group.


Assuntos
Transtorno Bipolar , Transtornos Psicóticos , Comportamento Autodestrutivo , Transtornos de Estresse Pós-Traumáticos , Humanos , Psicoterapia/métodos , Transtornos de Estresse Pós-Traumáticos/psicologia
2.
J Cancer Surviv ; 2022 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-36066766

RESUMO

PURPOSE: A "cancer care review" (CCR) is a conversation between a patient recently diagnosed with cancer and primary care practitioner soon after a diagnosis of cancer in the UK. This scoping review aimed to identify: methodology and validated outcome measures used to evaluate CCRs, the impact of CCRs on quality of life or symptoms, and the views of patients, their carers and healthcare professionals on CCRs. METHODS: A scoping review was performed and five databases (MEDLINE, Embase, PsychINFO, Scopus, Web of Science, Google Scholar) were searched systematically from January 2000 to March 2022. RESULTS: Of 4133 articles, ten met the inclusion criteria. These included surveys, qualitative research on stakeholders' views and a small study evaluating group consultation CCRs. There were no studies on methodology to evaluate CCRs or the impact of CCRs on patient quality of life or symptoms. Some primary care professionals felt CCRs were a tick-box exercise, and that they had inadequate time to deliver care, compounded by inadequate primary-secondary care coordination and lack of expertise which was echoed by patients. Interviews with patients found few recalled CCRs and those that recalled CCRs did, did not find them particularly helpful. Partners of patients would welcome CCRs to raise personal health concerns and remain updated on patient care. CONCLUSIONS: Further studies should identify the role that stakeholders believe they should have in CCRs, improve care coordination between primary care and secondary care and how to support caregivers. IMPLICATIONS FOR CANCER SURVIVORS: There is currently insufficient evidence to support the use of CCRs in general practice.

3.
Can J Respir Ther ; 58: 127-135, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36062161

RESUMO

Problem: Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of death worldwide, yet frontline workers lack the capacity and education required to provide evidence-based management and support for COPD patients. Purpose: The aim of this review was to: (i) identify the respiratory education gaps within frontline health workers such as nurses, physicians, respiratory therapists, and other allied health professionals, in the initiation of integrated care coordination, and (ii) outline organizational strategies to initiate integrated care coordination towards comprehensive evidence-based management and treatment for COPD patients. Methods: A literature review representing articles published between 2011 and 2021 was conducted. The focus was examining the factors that are involved in educating frontline health workers to support evidence-based COPD management and identifying organizational strategies to provide this comprehensive care. The initial searches yielded 353 articles; 18 were retained for review. Results: Thematic analysis revealed two prominent themes as contributing factors to the challenges and strategic solutions: (i) the perceived challenges of frontline health worker respiratory education and (ii) the current deficits within organizational strategies, collaboration, resources, and educational interventions. Conclusions: Providing respiratory education to frontline health workers is imperative to optimize evidence-based care, patient support, and improve outcomes. The solutions include recognizing and focusing on identified contextual barriers, implementing/disseminating strategic solutions, and engaging specialty trained COPD certified respiratory educators as facilitators of COPD primary care.

4.
Pharmacol Res Perspect ; 10(5): e01007, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36102210

RESUMO

Pharmacy services within hospitals are changing, with more taking on medication reconciliation activities. This systematic review was conducted to determine the measured impacts of Pharmacy teams working in an acute or emergency medicine department. The protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was prospectively registered on PROSPERO, National Institute for Health and Care Research, UK registration number: CRD42020187487. The systematic review had two co-primary aims: a reduction in the number of incorrect prescriptions on admission by comparing the medication list from primary care to secondary care, and a reduction in the severity of harm caused by these incorrect prescriptions; chosen to determine the impact of pharmacy-led medication reconciliation services in the emergency and acute medicine setting. Seventeen articles were included. Fifteen were non-randomized controlled trials and two were randomized controlled trials. The number of patients combined for all studies was 7630. No studies included were based within the UK. All studies showed benefits in terms of a reduction in medicine errors and patient harm, compared to control arms. Nine articles were included in a statistical analysis comparing the pharmacy intervention arm with the non-pharmacy control arm, with a Chi2 of 101.10 and I2 value = 92%. However, studies were heterogenous with different outcome measures and many showed evidence of bias. The included studies consistently indicated that pharmacy services based within acute or emergency medicine departments in hospitals were associated with fewer medication errors. Further studies are needed to understand the health and economic impact of deploying a pharmacy service in acute medical settings including out-of-hours working.


Assuntos
Medicina de Emergência , Assistência Farmacêutica , Humanos , Erros de Medicação/prevenção & controle , Reconciliação de Medicamentos/métodos
5.
Child Youth Care Forum ; : 1-23, 2022 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-35966643

RESUMO

Background: Technology and its use within mental health services has advanced dramatically over recent years. Opportunities for mental health services to utilise technology to introduce novel, effective, and more efficient means of delivering assessment, and treatment are increasing. Objective: The current rapid-evidence paper reviews evidence regarding the introduction of novel technology to support young people's mental health and psychological well-being. Methods: A rapid evidence review was conducted. PSYCHINFO and CINAHL were searched for research articles between 2016 and 2021 that were specific to young people, mental health, and technology developments within this domain. N = 27 studies which explored the introduction, feasibility, and value of technology for mental health purposes were included in a narrative synthesis. Quality or risk of bias analyses were not completed. Results: Overall, technological advancements in young people's care were considered positive and engaging for young people. Factors including resources, efficiency of care, engagement, therapeutic effectiveness, ethical considerations, therapeutic alliance, and flexibility were considered within this review. Nevertheless, potential barriers include clinician concerns, socioeconomic factors, and motivation. Conclusion: Effective and sustained use of technology within young people's mental health services will depend on the technology's usability, efficiency, and ability to engage young people. This paper expands on existing research by reviewing a broader range of technology proposed to support young people's mental health and well-being. This will assist in the application of novel technological advancements by indicating effectiveness, preferences, potential barriers, and recommendations for the feasibility and efficacy of introducing technology into young people's services.

6.
Curr Psychiatry Rep ; 2022 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-35969335

RESUMO

PURPOSE OF REVIEW: We reviewed the literature from 2017 to 2022 on autistic adults' use of mental healthcare and barriers to care. To encourage immediate improvement in mental healthcare, we provide five strategies mental health providers can use to better care for autistic adults. RECENT FINDINGS: Most autistic adults use mental healthcare and use it more often than non-autistic adults. Autistic adults' experiences with mental healthcare are characterized by (1) lack of providers knowledgeable about autism, (2) use of treatments that may not be accommodating to individual needs, and (3) difficulty navigating the complex healthcare system. These barriers contribute to prevalent unmet needs for mental healthcare. Autistic adults use mental healthcare frequently but have unmet mental health needs. As necessary systemic changes develop, providers can begin immediately to better care for autistic adults by learning about their needs and taking personalized care approaches to meet those needs.

7.
Cureus ; 14(7): e27180, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36035037

RESUMO

Diabetes is a leading chronic illness in the modern world and 19-34% develop chronic diabetic foot ulcers (DFUs) in their lifetime, often necessitating amputation. The reduction in tissue growth factors and resulting imbalance between proteolytic enzymes and their inhibitors, along with systemic factors impairing healing appear particularly important in chronic wounds. Growth factors applied topically have thus been suggested to be a non-invasive, safe, and cost-effective adjunct to improve wound healing and prevent complications. Comprehensive database searches of MEDLINE via PubMed, EMBASE, Cochrane, and ClinicalTrials.gov were performed to identify clinical evidence and ongoing trials. The risk of bias analysis included randomized controlled trials (RCTs) was performed using the Cochrane Risk of Bias 2.0 tool. We included randomized controlled trials that compared the use of a topical biologic growth factor-containing regimen to any other regimen. Primary outcomes of interest were time to wound closure, healing rate, and time. Secondary outcomes included the incidence of adverse events such as infection. A total of 41 trials from 1992-2020 were included in this review, with a total recorded 3,112 patients. Platelet-derived growth factors (PDGF) in the form of becaplermin gel are likely to reduce the time of closure, increase the incidence of wound closure, and complete wound healing. Human umbilical cord-related treatments, dehydrated human amnion and chorion allograft (dHACA), and hypothermically stored amniotic membrane (HSAM), consistently increased the rates and incidence of complete ulcer healing while reducing ulcer size and time to complete ulcer healing. Fibroblast growth factor-1 (FGF1) showed only a slight benefit in multiple studies regarding increasing complete ulcer healing rates and incidence while reducing ulcer size and time to complete ulcer healing, with a few studies showing no statistical difference from placebo. Platelet-rich fibrin (PRF) is consistent in reducing the time to complete ulcer healing and increasing wound healing rate but may not reduce ulcer size or increase the incidence of complete ulcer healing. Targeting the wound healing pathway via the extrinsic administration of growth factors is a promising option to augment wound healing in diabetic patients. Growth factors have also shown promise in specific subgroups of patients who are at risk of significantly impaired wound healing such as those with a history of secondary infection and vasculopathy. As diabetes impairs multiple stages of wound healing, combining growth factors in diabetic wound care may prove to be an area of interest. Evidence from this systematic literature review suggests that topical adjuncts probably reduce time to wound closure, reduce healing time, and increase the healing rate in patients with chronic DFUs.

9.
PLoS One ; 17(7): e0271002, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35797386

RESUMO

Drug repurposing has been applied in the biomedical field to optimize the use of existing drugs, leading to a more efficient allocation of research resources. In oncology, this approach is particularly interesting, considering the high cost related to the discovery of new drugs with therapeutic potential. Computational methods have been applied to predict associations between drugs and their targets. However, drug repurposing has not always been promising and its efficiency has yet to be proven. Therefore, the present scoping review protocol was developed to screen the literature on how in silico strategies can be implemented in drug repurposing in oncology. The scoping review will be conducted according to the Arksey and O'Malley framework (2005) and the Joanna Briggs Institute recommendations. We will search the PubMed/MEDLINE, Embase, Scopus, and Web of Science databases, as well as the grey literature. We will include peer-reviewed research articles involving in silico strategies applied to drug repurposing in oncology, published between January 1, 2003, and December 31, 2021. Data will be charted and findings described according to review questions. We will report the scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review guidelines (PRISMA-ScR).


Assuntos
Reposicionamento de Medicamentos , Revisão por Pares , Atenção à Saúde , Projetos de Pesquisa , Literatura de Revisão como Assunto , Revisões Sistemáticas como Assunto
10.
Syst Rev ; 11(1): 120, 2022 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-35698207

RESUMO

BACKGROUND: The rising burden of non-communicable diseases (NCDs) is a global health concern. To reduce the burden of morbidity, mortality and disability due to NCDs, the World Health Organization (WHO) developed 'best buys' and other interventions for the prevention and control of NCDs by member countries. However, their extent of implementation especially in sub-Saharan African countries (SSA) is not known. Therefore, this scoping review aims to map and describe research evidence on implementation of the WHO's 'best buys' and other interventions for reducing unhealthy diets in SSA. METHODS: This review will be guided by the enhanced version of Arksey and O'Malley's framework and the recent Joanna Briggs Institute guidelines for scoping reviews. To identify the relevant published literature for this review, a comprehensive keyword search will be conducted in PubMed, SCOPUS, EBSCOhost (CINAHL, Health Resource and PsycINFO) and Cochrane Library from 2017 to 2021. Boolean terms ('AND' and 'OR'), as well as Medical Subject Heading terms, will be included where essential. Government websites of SSA countries, the WHO's website and Google Scholar will be consulted for grey literature such as governmental policies/strategies focus on reducing unhealthy diets. Moreover, the reference list of included evidence sources will be searched for additional literature. Two reviewers will independently screen the articles at the abstract and full-text screening phases guided by the review eligibility criteria. Also, all relevant data will be extracted independently by two reviewers, analysed thematically and the findings reported qualitatively. DISCUSSION: The evidence produced by this review will help identify implementation and policy gaps to inform future implementation research/interventions studies using a variety of evidence-based strategies towards the prevention and control of NCDs due to unhealthy diets in the WHO Africa Region. Platforms such as peer review journals, policy briefs and conferences will be used to disseminate this review's findings.


Assuntos
Doenças não Transmissíveis , África ao Sul do Saara , Atenção à Saúde/métodos , Saúde Global , Humanos , Doenças não Transmissíveis/prevenção & controle , Literatura de Revisão como Assunto , Organização Mundial da Saúde
11.
J Patient Rep Outcomes ; 6(1): 57, 2022 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-35652983

RESUMO

BACKGROUND: Real-world evidence (RWE) plays an increasingly important role within global regulatory and reimbursement processes. RWE generation can be enhanced by the collection and use of patient-reported outcomes (PROs), which can provide valuable information on the effectiveness, safety, and tolerability of health interventions from the patient perspective. This systematic review aims to examine and summarise the available PRO-specific recommendations and guidance for RWE generation. METHODS AND FINDINGS: Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, and websites of selected organisations were systematically searched to identify relevant publications. 1,249 articles were screened of which 7 papers met the eligibility criteria and were included in the review. The included publications provided PRO-specific recommendations to facilitate the use of PROs for RWE generation and these were extracted and grouped into eight major categories. These included: (1) instrument selection, (2) participation and engagement, (3) burden to health care professionals and patients, (4) stakeholder collaboration, (5) education and training, (6) PRO implementation process, (7) data collection and management, and (8) data analysis and presentation of results. The main limitation of the study was the potential exclusion of relevant publications, due to poor indexing of the databases and websites searched. CONCLUSIONS: PROs may provide valuable and crucial patient input in RWE generation. Whilst valuable insights can be gained from guidance for use of PROs in clinical care, there is a lack of international guidance specific to RWE generation in the context of use for regulatory decision-making, reimbursement, and health policy. Clear and appropriate evidence-based guidance is required to maximise the potential benefits of implementing PROs for RWE generation. Unique aspects between PRO guidance for clinical care and other purposes should be differentiated. The needs of various stakeholder groups (including patients, health care professionals, regulators, payers, and industry) should be considered when developing future guidelines.

12.
J Epidemiol ; 2022 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-35753792

RESUMO

BACKGROUND: The Longevity Improvement & Fair Evidence (LIFE) Study, which was launched in 2019, is a multi-region community-based database project that aims to generate evidence toward extending healthy life expectancy and reducing health disparities in Japan. Herein, we describe the LIFE Study's design and baseline participant profile. METHODS: Municipalities participating in the LIFE Study provide data from government-administered health insurance enrollees and public assistance recipients. These participants cover all disease types and age groups. Centered on healthcare claims data, the project also collects long-term care claims data, health checkup data, vaccination records, residence-related information, and income-related information. The different data types are converted into a common data model containing five modules (health care, long-term care, health checkup, socioeconomic status, and health services). We calculated the descriptive statistics of participants at baseline in 2018. RESULTS: The LIFE Study currently stores data from 1,420,437 residents of 18 municipalities. The health care module contains 1,280,756 participants (mean age: 65.2 years), the long-term care module contains 189,069 participants (mean age: 84.3 years), and the health checkup module contains 274,375 participants (mean age: 69.0 years). Although coverage and follow-up rates were lower among younger persons, the health care module includes 74,151 children (0-19 years), 273,157 working-age adults (20-59 years), and 933,448 older persons (≥60 years). CONCLUSION: The LIFE Study provides data from over 1 million participants and can facilitate a wide variety of life-course research and cohort studies. This project is expected to be a useful platform for generating real-world evidence from Japan.

13.
J Nutr ; 152(8): 1823-1830, 2022 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-35704675

RESUMO

The Nutrition Evidence Systematic Review (NESR) team conducts nutrition- and public health-related systematic reviews and is within the USDA's Center for Nutrition Policy and Promotion. NESR has collaborated with scientific experts to conduct systematic reviews on nutrition and public health topics for more than a decade and is uniquely positioned to share recommendations with the research community to strengthen research quality and impact, especially the evidence base that supports public health nutrition guidance, including future editions of the Dietary Guidelines for Americans. Leveraging the expertise of NESR and its systematic review process resulted in the following recommendations for the research community: a) use the strongest study design feasible with sufficient sample size(s); b) enroll study participants who reflect the diversity of the population of interest and report participant characteristics; c) use valid and reliable dietary assessment methods; d) describe the interventions or exposures of interest and use standard definitions to promote consistency; e) use valid and reliable health outcome measures; f) account for variables that may impact the relationship between nutrition-related interventions or exposures and health outcomes; g) carry out studies for a sufficient duration and include repeated measures, as appropriate; and h) report all relevant information to inform accurate interpretation and evaluation of study results. Implementing these recommendations can strengthen nutrition and public health evidence and increase its utility in future public health nutrition systematic reviews. However, implementation will require additional support from the entire research community, including scientific journals and funding agencies.


Assuntos
Medicina Baseada em Evidências , Saúde Pública , Dieta , Humanos , Política Nutricional , Estados Unidos , United States Department of Agriculture
14.
São Paulo; s.n; 20220609. 100 p.
Tese em Português | LILACS, BBO - Odontologia | ID: biblio-1372957

RESUMO

Introdução: O Ministério da Saúde do governo Jair Bolsonaro instituiu por meio da Portaria nº. 2.979/2019 o programa "Previne Brasil, criando um novo modelo de financiamento de custeio para a Atenção Básica à Saúde (ABS) no Sistema Único de Saúde (SUS). Além de estimular a captação de pessoas que utilizam o serviço por meio de uma oferta focalizada e seletiva de procedimentos, o programa Previne Brasil encerra o repasse federal destinado à contratação de profissionais para compor as equipes multiprofissionais dos Núcleos Ampliados de Saúde da Familia e Atenção Básica, os Nasf-AB. Objetivo: neste cenário mais recente de desmonte da saúde pública, esta dissertação tem como principal objetivo discutir os efeitos do Previne Brasil nos processos de trabalho das equipes Multiprofissionais Nasf-AB que atuam no Brasil. Metodologia: para atingir os objetivos desta pesquisa, utilizou-se três momentos metodológicos distintos. Primeiro, realizou-se uma revisão de literatura sobre seletividade e neoseletividade no âmbito das políticas públicas de saúde. Em um segundo momento, foi realizada uma revisão sistemática do tipo metassíntese qualitativa sobre os processos de trabalho dos Núcleos Ampliados de Saúde da Família e Atenção Básica. Por último, elaboramos uma análise dos resultados da metassíntese à luz da neoseletividade das políticas públicas de saúde. Resultados: A partir da identificação dos artigos inseridos na metassíntese, foi possível organizar os resultados em 2 grandes grupos a saber: 1) considerações sobre os processos de trabalho; 2) potencialidades e desafios. Os grupos potencialidades e desafios foram subdivididos ainda em: a) acesso; b) organização dos processos de trabalho; c) qualidade do trabalho e d) saúde do trabalhador. 1) Considerações sobre os processos de trabalho: diferentes arranjos de apoio e organização dos processos de trabalho, assim como a coexistência de diferentes tipos de apoio dentro dos serviços; Perfil e identificação com o trabalho nas equipes Nasf-AB, predomínio de trabalhadoras mulheres e aumento dos encaminhamentos. 2) potencialidades e desafio: a) Acesso: melhora no acesso, porém, ainda insuficiente e restrito; b) Organização dos processos de trabalho: Arranjo matricial é visto como potente pelos trabalhadores. Estes não são formados para a atuação matricial e interdisciplinar. Reuniões, discussões de casos, articulações com a rede de saúde são potencialidades e servem como espaços de formação em serviço e educação permanente; c) Qualidade do trabalho: maior resolutividade da ABS com as atividades desenvolvidas pelas equipes Nasf-AB junto às equipes de saúde, maior articulação da ABS com a RAS, qualificação dos encaminhamentos, maior articulação intersetorial, maior planejamento e integralidade das ações, maior vínculo e responsabilização por usuários, famílias, comunidades e trabalhadores de saúde, além de melhoras estruturais. Apesar de todas as melhoras descritas acima, observase ainda limitações em todos os aspectos a cima citados. d) Saúde do Trabalhador: respeito, interação, valorização, tolerância, comprometimento, atitude de mudança, humildade, ética, liderança, empatia, disponibilidade, colaboração, autonomia, liberdade criativa, amadurecimento, formação profissional, adaptação e flexibilidade nas equipes NASF, boa compreensão, valorização e organização do apoio matricial, satisfação e prazer com as trocas profissionais, resiliência, aceitação e efetivação da proposta NASF, além do predomínio de vínculo estatutário e baixa rotatividade profissional são potencialidades identificadas. Contratações sem concurso e sem critérios, insegurança trabalhista e inexperiência profissional, vulnerabilidade e violência territorial, isolamento e sensação de não pertencimento, presença de muitos fatores disparadores de estresse, conflitos e sofrimento, além de falta de solidariedade e baixo reconhecimento profissional são desafios identificados.


Assuntos
Equipe de Assistência ao Paciente , Atenção Primária à Saúde , Sistema Único de Saúde , Gestão em Saúde
15.
BMJ Open ; 12(6): e057555, 2022 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-35725258

RESUMO

INTRODUCTION: Clinical research broadly aims to influence decision-making in order to promote appropriate healthcare. Funding agencies should prioritise research projects according to needed research topics, methodological and cost-effectiveness considerations, and expected social value. In Chile, there is no local diagnosis regarding recent clinical research that might inform prioritisation for future research funding. This research aims to comprehensively identify and classify Chilean health research studies, elaborating evidence gap maps for the most burdensome local conditions. METHODS AND ANALYSIS: We will search in electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, LILACS and WoS) and perform hand searches to retrieve, identify and classify health research studies conducted in Chile or by authors whose affiliations are based in Chile, from 2000 onwards. We will elaborate evidence matrices for the 20 conditions with the highest burden in Chile (according to the Global Burden of Disease 2019) selected from those defined under the General Regime of the Health Guarantees Act. To elaborate the evidence gap maps, we will consider prioritised interventions and core outcome sets. To identify knowledge gaps and estimate redundant research, we will contrast these gap maps with the available international evidence of high or moderate certainty of evidence, for each specific clinical question. For this purpose, we will search systematic reviews using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. ETHICS AND DISSEMINATION: No ethical approval is required to conduct this project. We will submit our results in both peer-reviewed journals and scientific conferences. We will aim to disseminate our findings through different academic platforms, social media, local press, among others. The final results will be communicated to local funding agencies and government stakeholders. DISCUSSION: We aim to provide an accurate and up-to-date picture of the research gaps-to be filled by new future findings-and the identification of redundant research, which will constitute relevant information for local decision-makers.


Assuntos
Projetos de Pesquisa , Literatura de Revisão como Assunto , Chile , Análise Custo-Benefício , Humanos
16.
Vision (Basel) ; 6(2)2022 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-35737423

RESUMO

The World Health Organization (WHO) is developing a Package of Eye Care Interventions (PECI) to facilitate the integration of eye care into Universal Health Coverage. This paper presents the results of a systematic review of clinical practice guidelines for cataract in adults, to help inform PECI development. We searched academic and guideline databases, and websites of professional associations, for guidelines published between January 2010 and April 2020. Guidelines were excluded if there was commercial funding or unmanaged conflicts of interest. Quality appraisal was conducted using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. We identified 3778 reports, 35 related to cataract guidelines, four of which met the inclusion criteria (United Kingdom: 2, United States: 1, Iran: 1). The recommendations across the four guidelines covered pre-operative (43%), intra-operative (37%), and post-operative interventions (20%). Most 'strong' recommendations were supported by good quality evidence. Differences in recommendations across guidelines may be attributable to time of publication or regional differences in surgical practice. Few guidelines met the quality criteria, and only three countries were represented. The results of this step of the PECI development process will inform subsequent phases for development of the WHO's package of evidence-based eye care interventions for cataract.

17.
BMJ Open ; 12(6): e061073, 2022 06 22.
Artigo em Inglês | MEDLINE | ID: mdl-35732394

RESUMO

INTRODUCTION: Especially in acute care, evidence points to an association between care staffing and resident outcomes. However, this evidence is more limited in residential long-term care (LTC). Due to fundamental differences in the population of care recipients, organisational processes and staffing models, studies in acute care may not be applicable to LTC settings. We especially lack evidence on the complex interplay among nurse staffing and organisational context factors such as leadership, work culture or communication, and how these complex interactions influence resident outcomes. Our systematic review will identify and synthesise the available evidence on how nurse staffing and organisational context in residential LTC interact and how this impacts resident outcomes. METHODS AND ANALYSIS: We will systematically search the databases MEDLINE, EMBASE, CINAHL, Scopus and PsycINFO from inception for quantitative research studies and systematically conducted reviews that statistically modelled interactions among nurse staffing and organisational context variables. We will include original studies that included nurse staffing and organisational context in LTC as independent variables, modelled interactions between these variables and described associations of these interactions with resident outcomes. Two reviewers will independently screen titles/abstracts and full texts for inclusion. They will also screen contents of key journals, publications of key authors and reference lists of all included studies. Discrepancies at any stage of the process will be resolved by consensus. Data extraction will be performed by one research team member and checked by a second team member. Two reviewers will independently assess the methodological quality of included studies using four validated checklists appropriate for different research designs. We will conduct a meta-analysis if pooling is possible. Otherwise, we will synthesise results using thematic analysis and vote counting. ETHICS AND DISSEMINATION: Ethical approval is not required as this project does not involve primary data collection. The results of this study will be disseminated via peer-reviewed publications and conference presentation. PROSPERO REGISTRATION NUMBER: CRD42021272671.


Assuntos
Atenção à Saúde , Assistência de Longa Duração , Humanos , Liderança , Metanálise como Assunto , Organizações , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Recursos Humanos
18.
Rehabil Nurs ; 47(4): 147-159, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35701986

RESUMO

INTRODUCTION: The use of exergames has become an increasingly frequent intervention in rehabilitation, referred to as a fun and motivating activity that involves patients. This systematic review aimed to evaluate the effectiveness of exergames in the rehabilitation of the shoulder joint compared to other types of care. METHODS: We performed a systematic review and GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) evidence synthesis. The search was conducted using the following databases: MEDLINE, CINAHL, SPORTDiscus, SCOPUS, SciELO, Psychology and Behavioral Sciences Collection, Cochrane Central Register of Controlled Trials, and PEDRo. Databases were searched from the first record until July 2021. Randomized controlled trials using exergames as an intervention were included. RESULTS: The search resulted in 1,048 records. A total of 10 articles published between 2013 and 2020 met inclusion criteria and were reviewed for this study. A positive impact was observed in using exergames to increase shoulders' range of motion, namely, extension, flexion, abduction, internal and external rotation, and functionality postinjury. CONCLUSIONS: The results of this review provide evidence of the benefits of exergames in shoulder joint rehabilitation. However, more robust clinical trials need to be developed that assess the effectiveness of using exergames as a complement to traditional rehabilitation and assess participants' degree of satisfaction, motivation, and adherence.


Assuntos
Jogos Eletrônicos de Movimento , Lesões do Ombro , Humanos , Amplitude de Movimento Articular
19.
Epidemics ; 39: 100570, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35569248

RESUMO

Mathematical modeling studies are frequently conducted to guide policy in global health. However, the contribution of mathematical modeling studies to World Health Organization (WHO) guideline recommendations, and the quality of evidence contributed by these studies remains unknown. We conducted a systematic review of the WHO Guidelines Review Committee database to identify guideline recommendations that included evidence from mathematical modeling studies since inception of the Guidelines Review Committee on 1 December, 2007. We included WHO guideline recommendations citing a mathematical modeling study in the primary evidence base. We defined a mathematical model as a framework that predicted epidemiologic, health or economic impact of an intervention or decision in the clinical or public health context. The primary outcome was inclusion of evidence from mathematical modeling studies in a guideline recommendation. We evaluated each unique modeling study across multiple domains of quality. Between 1 December 2007 and 1 April 2019, the WHO Guidelines Review Committee approved 154 guidelines providing 1619 guideline recommendations. Mathematical modeling studies informed 46 WHO guidelines (29.9%) and 101 unique guideline recommendations (6.2%). Modeling evidence addressed topics related to infectious diseases in 38 guidelines (82.6%) and 81 recommendations (80.2%), most commonly for HIV and tuberculosis. Evidence from modeling studies was assessed in the GRADE evidence profile for 12 recommendations (12.9%) and GRADE evidence-to-decision framework for 45 recommendations (44.6%). Modeling-informed recommendations were more likely than other recommendations within the same guidelines to be issued with a "conditional" rather than "strong" strength of recommendation (53.5% versus 37.8%), and the evidence underlying modeling-informed recommendations was more likely to be assessed as very low quality (41.6% versus 24.1%). Upon review of individual modeling studies, we estimated that 33.8% of models performed a calibration, 29.4% of models performed a validation of results, and 20.6% of models reported a change in the study conclusion in the sensitivity analysis. While policy recommendations in WHO guidelines are informed by evidence from modeling studies, the validity of modeling studies included in guidelines development is heterogeneous. Quality assessment is needed to support the evaluation and incorporation of evidence from mathematical modeling studies in guidelines development.


Assuntos
Medicina Baseada em Evidências , Modelos Teóricos , Calibragem , Medicina Baseada em Evidências/métodos , Saúde Pública , Organização Mundial da Saúde
20.
Digit Health ; 8: 20552076221089725, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35531090

RESUMO

Background: Poor adherence to anti-hypertensive medications leads to poorly controlled blood pressure which is associated with worse cardiovascular outcomes. Emerging technologies may be utilised advantageously in interventions to improve adherence and reduce morbidity and mortality from poorly controlled hypertension. Objective: To determine the efficacy of technology-based interventions in improving adherence to antihypertensive medications. Methods: PubMed and EMBASE databases were searched using keywords and MeSH terms. Included studies met the following criteria: randomized controlled trial (RCT); adults ≥ 18 years old taking anti-hypertensives; intervention delivered by or accessed using a technological device or process; intervention designed to improve adherence. Results: 12 papers met inclusion criteria for the current review: 5 studies significantly improved adherence when compared to usual care; of these 5 studies, 2 had corresponding significant improvement in blood pressure. Successful interventions were: electronic medication bottle cap with audio-visual reminder; short message service (SMS) containing educational information (2 studies); reporting of self-measured blood pressure to a telephone-linked computer system; sending a video of every drug ingestion to obtain monetary rewards. Conclusion: RCTs on technological interventions to improve adherence and those showing significant effect are rare. Some of the interventions show potential to be applied to other populations, especially if targeted at patients with poor adherence at baseline.

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