Efficacy of different dietary patterns on lowering of blood pressure level: an umbrella review.

BACKGROUND: Many systematic reviews and meta-analyses have assessed the efficacy of dietary patterns on blood pressure (BP) lowering but their findings are largely conflicting. OBJECTIVE: This umbrella review aims to provide an update on the available evidence for the efficacy of different dietary patterns on BP lowering. METHODS: PubMed and Scopus databases were searched to identify relevant studies through to June 2020. Systematic reviews with meta-analyses of randomized controlled trials (RCTs) were eligible if they measured the effect of dietary patterns on systolic (SBP) and/or diastolic blood pressure (DBP) levels. The methodological quality of included systematic reviews was assessed by A Measurement Tool to Assess Systematic Review version 2. The efficacy of each dietary pattern was summarized qualitatively. The confidence of the effect estimates for each dietary pattern was graded using the NutriGrade scoring system. RESULTS: Fifty systematic reviews and meta-analyses of RCTs were eligible for review. Twelve dietary patterns namely the Dietary Approaches to Stop Hypertension (DASH), Mediterranean, Nordic, vegetarian, low-salt, low-carbohydrate, low-fat, high-protein, low glycemic index, portfolio, pulse, and Paleolithic diets were included in this umbrella review. Among these dietary patterns, the DASH diet was associated with the greatest overall reduction in BP with unstandardized mean differences ranging from -3.20 to -7.62 mmHg for SBP and from -2.50 to -4.22 mmHg for DBP. Adherence to Nordic, portfolio, and low-salt diets also significantly decreased SBP and DBP levels. In contrast, evidence for the efficacy of BP lowering using the Mediterranean, vegetarian, Paleolithic, low-carbohydrate, low glycemic index, high-protein, and low-fat diets was inconsistent. CONCLUSION: Adherence to the DASH, Nordic, and portfolio diets effectively reduced BP. Low-salt diets significantly decreased BP levels in normotensive Afro-Caribbean people and in hypertensive patients of all ethnic origins. This review was registered at PROSPERO as CRD42018104733.

Does medical training in Thailand prepare doctors for work in community hospitals? An analysis of critical incidents.

BACKGROUND: Compulsory 3-year public service was implemented in 1967 as a measure to tackle the maldistribution of doctors in Thailand. Currently, therefore, most medical graduates work in rural community hospitals for their first jobs. This research explored doctors' perceptions of preparedness for practice using a critical incident technique. METHODS: A self-administered critical incident questionnaire was developed. Convenient samples were used, i.e. Family Medicine residents at Ramathibodi Hospital who had worked in a community hospital after graduation before returning to residency training. Participants were asked to write about two incidents that had occurred while working in a community hospital, one in which they felt the knowledge and skills obtained in medical school had prepared them for managing the situation effectively and the other in which they felt ill-prepared. Data were thematically analysed. RESULTS: Fifty-six critical incidents were reported from 28 participants. There were representatives from both normal and rural tracks of undergraduate training and community hospitals of all sizes and all regions. Doctors felt well-prepared to provide care for patients in emergency situations and as in-patients, but under-prepared for obstetric and paediatric emergencies, out-patient care, and palliative care. Moreover, they felt poorly prepared to deal with difficult patients, hospital administration and quality assurance. CONCLUSIONS: Long-term solutions are needed to solve the rural doctor shortage. Medical graduates from both normal and rural tracks felt poorly prepared for working effectively in community hospitals. Medical training should prepare doctors for rural work, and they should be supported while in post.

Efficacy of home-based non-pharmacological interventions for treating depression: a systematic review and network meta-analysis of randomised controlled trials.

OBJECTIVES: To systematically review and compare the efficacy of all available home-based non-pharmacological treatments of depression. DESIGN: Systematic review and network meta-analysis of randomised controlled trials. DATA SOURCES: Medline, Scopus and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched since inceptions to 7 August 2016. ELIGIBILITY CRITERIA: Randomised controlled trials comparing the efficacy of home-based non-pharmacological interventions with usual care of patients with depression were included in the review. MAIN OUTCOMES: Depression symptom scores and disease remission rates at the end of treatment. RESULTS: Seventeen studies were included in the review. Home-based non-pharmacological interventions were categorised as (1) home-based psychological intervention, (2) home-based exercise intervention, (3) combined home-based psychological intervention with exercise intervention and (4) complementary medicine. Complementary medicine approaches were excluded from the meta-analysis due to heterogeneity. The standardised mean differences of post-treatment depression symptom scores between usual care groups and home-based psychological intervention, home-based exercise intervention and combined home-based psychological intervention with exercise intervention were âˆ'0.57 (95% CI âˆ'0.84 to âˆ'0.31), âˆ'1.03 (95% CI âˆ'2.89 to 0.82) and âˆ'0.78 (95% CI âˆ'1.09 to âˆ'0.47), respectively. These results suggest that only home-based psychological intervention and combined home-based psychological intervention with exercise intervention could significantly decrease depression scores. Compared with usual care groups, the disease remission rate was also significantly higher for home-based psychological intervention (pooled risk ratio=1.53; 95% CI 1.19 to 1.98) and combined home-based psychological intervention with exercise intervention (pooled risk ratio=3.47; 95% CI 2.11 to 5.70). Of all the studied interventions, combined home-based psychological intervention with exercise intervention had the highest probability of resulting in disease remission. CONCLUSION: Our study confirms the efficacy of home-based psychological intervention and combined home-based psychological intervention with exercise intervention in the treatment of depression. Combined home-based psychological intervention and exercise intervention was the best treatment and should be considered for inclusion in clinical guidelines for managing depression.

Cartoon versus traditional self-study handouts for medical students: CARTOON randomized controlled trial.

OBJECTIVE: The objective of this study is to compare the effectiveness of a "cartoon-style" handout with a "traditional-style" handout in a self-study assignment for preclinical medical students. METHODS: Third-year medical students (n = 93) at the Faculty of Medicine Ramathibodi Hospital, Mahidol University, took a pre-learning assessment of their knowledge of intercostal chest drainage. They were then randomly allocated to receive either a "cartoon-style" or a "traditional-style" handout on the same topic. After studying these over a 2-week period, students completed a post-learning assessment and estimated their levels of reading completion. RESULTS: Of the 79 participants completing the post-learning test, those in the cartoon-style group achieved a score 13.8% higher than the traditional-style group (p = 0.018). A higher proportion of students in the cartoon-style group reported reading ≥75% of the handout content (70.7% versus 42.1%). In post-hoc analyses, students whose cumulative grade point averages (GPA) from previous academic assessments were in the middle and lower range achieved higher scores with the cartoon-style handout than with the traditional one. In the lower-GPA group, the use of a cartoon-style handout was independently associated with a higher score. CONCLUSIONS: Students given a cartoon-style handout reported reading more of the material and achieved higher post-learning test scores than students given a traditional handout.

To be or not to be a facilitator of reflective learning for medical students? a case study of medical teachers' perceptions of introducing a reflective writing exercise to an undergraduate curriculum.

BACKGROUND: Introducing reflective writing to a medical curriculum requires the acceptance and participation of teachers. The purpose of this study was to explore medical teachers' views on the benefits of introducing a reflective writing exercise into an undergraduate medical curriculum, including their levels of satisfaction and their concerns. We also investigated effects on the teachers' personal and professional development arising from their roles as novice facilitators. METHODS: A qualitative approach was employed using semi-structured interviews. During an attachment to Primary Care Medicine course, fourth-year medical students (n = 180) in the Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand were assigned to write a reflective essay titled, "A Significant Event in My First Clinical Year". After reading the essays and facilitating between one to three small group discussions based on these, each of the 18 teachers enrolled in our study completed an in-depth face to face interview. Transcripts of these were studied, using thematic content analysis to identify emerging themes. RESULTS: The novice facilitators felt that facilitated reflection was both valuable and appropriate for students. They also perceived that it had a positive impact on their own personal and professional lives. In the early phase of implementing this activity, teachers expressed concerns about 1) their ability and confidence as facilitators in small group discussion 2) their ability to deal with emotions raised within their groups 3) the effectiveness of the activity 4) poor presentation and possible fabrication of student work. CONCLUSIONS: Most teachers regarded this activity as being beneficial to them, to student learning, and to the curriculum. Their insights, including concerns about the level of skill needed for facilitation, provide valuable material for planning a comprehensive faculty development programme.

Efficacy of additional psychosocial intervention in reducing low birth weight and preterm birth in teenage pregnancy: A systematic review and meta-analysis.

This systematic review aimed to assess the efficacy of psychosocial interventions in reducing risk of low birth weight (LBW) and preterm birth (PTB) in teenage pregnancy. Relevant studies were identified from Medline, Scopus, CINAHL, and CENTRAL databases. Randomized controlled trials investigating effect of psychosocial interventions on risk of LBW and PTB, compared to routine antenatal care (ANC) were eligible. Relative risks (RR) of LBW and PTB were pooled using inverse variance method. Mean differences of birth weight (BW) between intervention and control groups were pooled using unstandardized mean difference (USMD). Five studies were included in the review. Compared with routine ANC, psychosocial interventions significantly reduced risk of LBW by 40% (95%CI: 8%,62%) but not for PTB (pooled RR = 0.67, 95%CI: 0.42,1.05). Mean BW of the intervention group was significantly higher than that of the control group with USMD of 200.63 g (95% CI: 21.02, 380.25). Results of our study suggest that psychosocial interventions significantly reduced risk of LBW in teenage pregnancy.

Does Family Medicine training in Thailand affect patient satisfaction with primary care doctors?

BACKGROUND: Recent national healthcare reforms in Thailand aim to transfer primary care to family physicians, away from more expensive specialists. As Family Medicine has yet to be established as a separate discipline in Thailand, newly trained family physicians work alongside untrained general doctors in primary care. While it has been shown that Family Medicine training programs in Thailand can increase the quality of referrals from primary care doctors to specialists, information is lacking about whether such training affects the quality of patient care. In the Department of Family Medicine at Ramathibodi Hospital, trained family physicians work with residents and general doctors. Although this situation is not typical within Thailand, it offers us the opportunity to look for variations in the levels of satisfaction reported by patients treated by different types of primary care doctor. METHODS: During a two-week period in December 2005, 2,600 questionnaires (GPAQ) were given to patients visiting the Department of Family Medicine at Ramathibodi Hospital. Patients were given the choice of whether or not they wanted to participate in the study. A cross-sectional analysis was performed on the completed questionnaires. Mean GPAQ scores were calculated for each dimension and scored out of 100. Student t-tests, ANOVA with F-test statistic and multiple comparisons by Scheffe were used to compare the perceived characteristics of the different groups of doctors. Five dimensions were measured ranging from access to care, continuity of care, communication skills, enablement (the patient's knowledge of a self-care plan after the consultation) and overall satisfaction. RESULTS: The response rate was 70%. There were significant differences in mean GPAQ scores among faculty family physicians, residents and general doctors. For continuity of care, patients gave higher scores for faculty family physicians (67.87) compared to residents (64.57) and general doctors (62.51). For communication skills, patients gave the highest GPAQ scores to faculty family physicians (69.77) and family medicine residents (69.79). For enablement, faculty family physicians received the highest score (82.44) followed by family medicine residents (80.75) and general doctors (76.29). CONCLUSION: Faculty family physicians scored higher for continuity of care when compared with general doctors and residents. General doctors had lower GPAQ scores for communication skills and enablement when compared to faculty family physicians and residents. Faculty family physicians had the highest GPAQ scores in many dimensions of family practice skills, followed by residents and general doctors.

Reliability and validity of a Thai version of the General Practice Assessment Questionnaire (GPAQ).

BACKGROUND: The Assessment Questionnaire (GPAQ) is a questionnaire for patients to evaluate primary care in a number of key areas ranging from the access to care, the helpfulness of receptionists, the continuity of care, the doctors'communication skills, the patient's knowledge of self the General Practice care plans after consultation, and overall satisfaction. All questions can be calculated as a GPAQ score allowing services to be analysed, developed, and improved. OBJECTIVE: The General Practice Assessment Questionnaire (GPAQ) was developed in the United Kingdom to evaluate the quality of general practice (i.e. primary care or family medicine). The aim of the present study was to translate and validate a Thai language version of GPAQ. MATERIAL AND METHOD: Cross-sectional study: the content validity was examined by three experts in the Family Medicine field, and then the original GPAQ was translated into Thai with permission from the National Primary Care Research and Development Centre, University of Manchester and Safran. The translation process followed the guidelines for cross-cultural adaptation of self-report measures, including forward translation, synthesis of the translation, back translation, cross-cultural adaptation and pre-testing. The pilot study was done by distributing the questionnaire to a sample of 30 people before revision of the questionnaire. The reliability and validity of the translated version was then examined by distributing the questionnaire to 2,600 people visiting the out-patient clinic at the Department of Family Medicine, Ramathibodi Hospital in October, 2005. RESULTS: The response rate is about 70 percent. The results of the present study showed that the Thai version of GPAQ achieved good levels of reliability and validity, with the range of Cronbach's alpha coefficients being 0.7293-0.8324 in each aspect of GPAQ, namely access, doctor's communication skills, and patient enablement (understanding of self care after the consultation). However, a question about telephone consultations had to be excluded from the questionnaire to reach Cronbach's alpha coefficient of 0.8221. CONCLUSION: After translation and cross-cultural adaptation the Thai version of GPAQ can be used as a patient-administered instrument to evaluate the quality of primary care in Thailand.