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Sample records for systematic medication review

  1. Electronic medication packaging devices and medication adherence: A systematic review

    PubMed Central

    Checchi, Kyle D.; Huybrechts, Krista F.; Avorn, Jerry; Kesselheim, Aaron S.

    2014-01-01

    Importance Medication non-adherence, which has been estimated to affect 28-31% of US patients with hypertension, hyperlipidemia, and diabetes, may be improved by electronic medication packaging (EMP) devices. Objective To investigate whether EMP devices are associated with improved adherence and to identify and describe common features of EMP devices. Evidence Acquisition We systematically reviewed peer-reviewed studies testing the effectiveness of EMP systems in the MEDLINE, EMBASE, PsycINFO, CINAHL, and International Pharmaceutical Abstracts databases from searches conducted to June 13, 2014. We extracted the associations between the interventions and adherence, as well as other key findings. We assessed each study for bias using the Cochrane Handbook for Systematic Reviews of Interventions. We qualitatively assessed features of EMP devices and interventions. Results 37 studies (32 randomized and 5 non-randomized) including 4,326 patients met review criteria: 10 patient-interface-only “simple” interventions and 29 “complex” interventions integrated into the health care system (2 qualified for both categories). Overall, the effect estimates for mean adherence ranged from -2.9 to 34.0% and the effect estimates for the proportion of patients defined as adherent ranged from -8.0 to 49.5%. We identified 5 common EMP characteristics: recording dosing events and storing a record of adherence, audiovisual reminders to cue dosing, digital displays, real-time monitoring, and providing patients with adherence performance feedback. Conclusion and Relevance Many varieties of EMP exist. However, data supporting their use are limited, with variability in the quality of studies testing EMP devices and evidence of reporting bias. Devices that are integrated into the care delivery system and that are designed to record dosing events are most frequently associated with improved adherence. Higher quality evidence is needed to determine the effect, if any, of these low cost interventions on medication nonadherence and to identify their most useful components. PMID:25247520

  2. Nonadherence to Medication Therapy in Haemodialysis Patients: A Systematic Review

    PubMed Central

    Ghimire, Saurav; Castelino, Ronald L.; Lioufas, Nicole M.; Peterson, Gregory M.; Zaidi, Syed Tabish R.

    2015-01-01

    Background End-stage kidney disease (ESKD) patients are often prescribed multiple medications. Together with a demanding weekly schedule of dialysis sessions, increased number of medicines and associated regimen complexity pre-dispose them at high risk of medication nonadherence. This review summarizes existing literature on nonadherence and identifies factors associated with nonadherence to medication therapy in patients undergoing haemodialysis. Methods A comprehensive search of PubMed, Embase, CINAHL, PsycInfo, and Cochrane Database of Systematic Reviews covering the period from 1970 through November 2014 was performed following a predefined inclusion and exclusion criteria. Reference lists from relevant materials were reviewed. Data on study characteristics, measures of nonadherence, prevalence rates and factors associated with nonadherence were collected. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was followed in conducting this systematic review. Results Of 920 relevant publications, 44 were included. The prevalence of medication nonadherence varied from 12.5% to 98.6%, with widespread heterogeneity in measures and definitions employed. Most common patient-related factors significantly associated with nonadherence were younger age, non-Caucasian ethnicity, illness interfering family life, being a smoker, and living single and being divorced or widowed. Similarly, disease-related factors include longevity of haemodialysis, recurrent hospitalization, depressive symptoms and having concomitant illness like diabetes and hypertension. Medication-related factors such as daily tablet count, total pill burden, number of phosphate binders prescribed and complexity of medication regimen were also associated with poor adherence. Conclusions A number of patient-, disease-, and medication-related factors are associated with medication nonadherence in haemodialysis patients. Clinicians should be aware of such factors so that adherence to medications can be optimised in haemodialysis patients. Future research should be directed towards well-designed prospective longitudinal studies developing standard definitions and validating available measurement tools, while focusing on the role of additional factors such as psychosocial and behavioural factors in predicting nonadherence to medications. PMID:26636968

  3. A systematic review of publications studies on medical tourism

    PubMed Central

    Masoud, Ferdosi; Alireza, Jabbari; Mahmoud, Keyvanara; Zahra, Agharahimi

    2013-01-01

    Introduction: Medical tourism for any study area is complex. Materials and Methods: Using full articles from other databases, Institute for Scientific Information (ISI), Science Direct, Emerald, Oxford, Magiran, and Scientific Information Database (SID), to examine systematically published articles about medical tourism in the interval 2000-2011 paid. Articles were obtained using descriptive statistics and content analysis categories were analyzed. Results: Among the 28 articles reviewed, 11 cases were a kind of research articles, three cases were case studies in Mexico, India, Hungary, Germany, and Iran, and 14 were case studies, review documents and data were passed. The main topics of study included the definition of medical tourism, medical tourists’ motivation and development of medical tourism, ethical issues in medical tourism, and impact on health and medical tourism marketing. Conclusion: The findings indicate the definition of medical tourism in various articles, and medical tourists are motivated. However, most studies indicate the benefits of medical tourism in developing countries and more developed countries reflect the consequences of medical tourism. PMID:24251287

  4. Developing medical professionalism in future doctors: a systematic review

    PubMed Central

    Doug, Manjo; Peile, Ed; Thistlethwaite, Jill; Johnson, Neil

    2010-01-01

    Objectives: There are currently no guidelines on the most effective ways of supporting medical students to develop high standards of medical professionalism. The aim of this review is to summarise the evidence currently available on methods used by medical schools to promote medical professionalism. Methods: We performed a systematic search of electronic databases (Medline, PsychInfo, British Education Index, Educational Resources Information Centre, Sociological Abstracts and Topics in Medical Education) from January 1998 to October 2008. Outcomes studied were methods used to support and promote the development of professionalism in medical students. Results: We identified 134 papers and five main themes for supporting the development of professionalism in medical students: curriculum design, student selection, teaching and learning methods, role modelling and assessment methods. However, the level of empirical evidence supporting each of these methods is limited. Conclusions: Identification of these five areas helps medical schools to focus the emphasis of their approaches to developing professionalism and identifies future research areas. This review offers a preliminary guide to future discovery and progress in the area of medical professionalism.

  5. Medication adherence to oral anticancer drugs: systematic review.

    PubMed

    Huang, Wen-Chuan; Chen, Chung-Yu; Lin, Shun-Jin; Chang, Chao-Sung

    2016-04-01

    Many studies have demonstrated that non-adherence to oral anticancer drugs (OACDs) has challenged treatment efficacy. Otherwise, few validated tools exist to measure patients' adherence to medication regimen in clinical practice. To synthesize previous studies on adherence by cancer patients taking OACDs, especially in targeted therapy, a systematic search of several electronic databases was conducted. We analyzed existing scales' contents for various cancer patients and outcomes of studies assessing adherence. However, a well-validated scale designed particularly for OACD adherence is still lacking. Most adherence scales used in the studies reviewed contain items focused on measuring patients' medication-taking behavior more than their barriers to medication compliance and beliefs. However, non-adherence to OACDs is a complex phenomenon, and drug-taking barriers and patient beliefs significantly affect patients' non-adherence. To understand the key drivers and predisposing factors for non-adherence, we need to develop a well-validated, multidimensional scale. PMID:26935964

  6. Medical Virtual Instrumentation for Personalized Health Monitoring: A Systematic Review.

    PubMed

    Adeluyi, Olufemi; Lee, Jeong-A

    2015-01-01

    The rising cost of healthcare and the increased senior population are some reasons for the growing adoption of the Personalized Health Monitoring (PHM) systems. Medical Virtual Instruments (MVIs) provide portable, flexible, and low-cost options for these systems. Our systematic literature search covered the Cochrane Library, Web of Science, and MEDLINE databases, resulting in 915 articles, and 25 of which were selected for inclusion after a detailed screening process that involved five stages. The review sought to understand the key aspects regarding the use of MVIs for PHM, and we identified the main disease domains, sensors, platforms, algorithms, and communication protocols for such systems. We also identified the key challenges affecting the level of integration of MVIs into the global healthcare framework. The review shows that MVIs provide a good opportunity for the development of low cost personalized health systems that meet the unique instrumentation requirements for a given medical domain. PMID:27010194

  7. Quality of Pharmaceutical Advertisements in Medical Journals: A Systematic Review

    PubMed Central

    Othman, Noordin; Vitry, Agnes; Roughead, Elizabeth E.

    2009-01-01

    Background Journal advertising is one of the main sources of medicines information to doctors. Despite the availability of regulations and controls of drug promotion worldwide, information on medicines provided in journal advertising has been criticized in several studies for being of poor quality. However, no attempt has been made to systematically summarise this body of research. We designed this systematic review to assess all studies that have examined the quality of pharmaceutical advertisements for prescription products in medical and pharmacy journals. Methods and Findings Studies were identified via searching electronic databases, web library, search engine and reviewing citations (1950 – February 2006). Only articles published in English and examined the quality of information included in pharmaceutical advertisements for prescription products in medical or pharmacy journals were included. For each eligible article, a researcher independently extracted the data on the study methodology and outcomes. The data were then reviewed by a second researcher. Any disagreements were resolved by consensus. The data were analysed descriptively. The final analysis included 24 articles. The studies reviewed advertisements from 26 countries. The number of journals surveyed in each study ranged from four to 24 journals. Several outcome measures were examined including references and claims provided in advertisements, availability of product information, adherence to codes or guidelines and presentation of risk results. The majority of studies employed a convenience-sampling method. Brand name, generic name and indications were usually provided. Journal articles were commonly cited to support pharmaceutical claims. Less than 67% of the claims were supported by a systematic review, a meta-analysis or a randomised control trial. Studies that assessed misleading claims had at least one advertisement with a misleading claim. Two studies found that less than 28% of claims were unambiguous clinical claims. Most advertisements with quantitative information provided risk results as relative risk reduction. Studies were conducted in 26 countries only and then the generalizability of the results is limited. Conclusions Evidence from this review indicates that low quality of journal advertising is a global issue. As information provided in journal advertising has the potential to change doctors' prescribing behaviour, ongoing efforts to increase education about drug promotion are crucial. The results from our review suggest the need for a global pro-active and effective regulatory system to ensure that information provided in medical journal advertising is supporting the quality use of medicines. PMID:19623259

  8. Medical Management of Oral Lichen Planus: A Systematic Review

    PubMed Central

    Chokshi, Krunal; Desai, Sachin; Malu, Rahul; Chokshi, Achala

    2016-01-01

    Introduction Oral Lichen Planus (OLP) is a chronic inflammatory, T-cell-mediated autoimmune oral mucosal disease with unclear aetiology. The clinical management of OLP poses considerable difficulties to the oral physician. Aim The aim was to assess the efficacy of any form of intervention used to medically manage OLP. Materials and Methods We searched and analysed the following databases (from January 1990 to December 2014):- Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE. All Randomised Controlled Trials (RCTs) for the medical management of OLP which compared active treatment with placebo or between active treatments were considered in this systematic review. Participants of any age, gender or race having symptomatic OLP (including mixed forms), unconnected to any identifiable cause (e.g. lichenoid drug reactions) and confirmed by histopathology have been included. Interventions of all types, including topical treatments or systemic drugs of variable dosage, duration & frequency of delivery have been considered. All the trials identified were appraised by five review authors and the data for all the trials were synthesised using specifically designed data extraction form. Binary data has been presented as risk ratios (RR) with 95% confidence intervals (CI) and continuous data as mean differences (MD) with 95% CIs. Results A total of 35 RCTs were included in this systematic review on medical management of OLP. No strong evidence suggesting superiority of any specific intervention in reducing pain and clinical signs of OLP were shown by the RCTs included here. Conclusion Future RCTs on a larger scale, adopting standardized outcome assessing parameters should be considered. PMID:27042598

  9. Expert Involvement and Adherence to Medical Evidence in Medical Mobile Phone Apps: A Systematic Review

    PubMed Central

    Bube, Sarah Hjartbro; Rolskov Bojsen, Signe; Skou Thomsen, Ann Sofia; Konge, Lars

    2015-01-01

    Background Both clinicians and patients use medical mobile phone apps. Anyone can publish medical apps, which leads to contents with variable quality that may have a serious impact on human lives. We herein provide an overview of the prevalence of expert involvement in app development and whether or not app contents adhere to current medical evidence. Objective To systematically review studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. Methods We systematically searched 3 databases (PubMed, The Cochrane Library, and EMBASE), and included studies evaluating expert involvement or adherence of app content to medical evidence in medical mobile phone apps. Two authors performed data extraction independently. Qualitative analysis of the included studies was performed. Results Based on inclusion criteria, 52 studies were included in this review. These studies assessed a total of 6520 apps. Studies dealt with a variety of medical specialties and topics. As much as 28 studies assessed expert involvement, which was found in 9-67% of the assessed apps. Thirty studies (including 6 studies that also assessed expert involvement) assessed adherence of app content to current medical evidence. Thirteen studies found that 10-87% of the assessed apps adhered fully to the compared evidence (published studies, recommendations, and guidelines). Seventeen studies found that none of the assessed apps (n=2237) adhered fully to the compared evidence. Conclusions Most medical mobile phone apps lack expert involvement and do not adhere to relevant medical evidence. PMID:26215371

  10. Medication Errors in the Southeast Asian Countries: A Systematic Review

    PubMed Central

    Salmasi, Shahrzad; Khan, Tahir Mehmood; Hong, Yet Hoi; Ming, Long Chiau; Wong, Tin Wui

    2015-01-01

    Background Medication error (ME) is a worldwide issue, but most studies on ME have been undertaken in developed countries and very little is known about ME in Southeast Asian countries. This study aimed systematically to identify and review research done on ME in Southeast Asian countries in order to identify common types of ME and estimate its prevalence in this region. Methods The literature relating to MEs in Southeast Asian countries was systematically reviewed in December 2014 by using; Embase, Medline, Pubmed, ProQuest Central and the CINAHL. Inclusion criteria were studies (in any languages) that investigated the incidence and the contributing factors of ME in patients of all ages. Results The 17 included studies reported data from six of the eleven Southeast Asian countries: five studies in Singapore, four in Malaysia, three in Thailand, three in Vietnam, one in the Philippines and one in Indonesia. There was no data on MEs in Brunei, Laos, Cambodia, Myanmar and Timor. Of the seventeen included studies, eleven measured administration errors, four focused on prescribing errors, three were done on preparation errors, three on dispensing errors and two on transcribing errors. There was only one study of reconciliation error. Three studies were interventional. Discussion The most frequently reported types of administration error were incorrect time, omission error and incorrect dose. Staff shortages, and hence heavy workload for nurses, doctor/nurse distraction, and misinterpretation of the prescription/medication chart, were identified as contributing factors of ME. There is a serious lack of studies on this topic in this region which needs to be addressed if the issue of ME is to be fully understood and addressed. PMID:26340679

  11. Physical activity counseling in medical school education: a systematic review

    PubMed Central

    Dacey, Marie L.; Kennedy, Mary A.; Polak, Rani; Phillips, Edward M.

    2014-01-01

    Background Despite a large evidence base to demonstrate the health benefits of regular physical activity (PA), few physicians incorporate PA counseling into office visits. Inadequate medical training has been cited as a cause for this. This review describes curricular components and assesses the effectiveness of programs that have reported outcomes of PA counseling education in medical schools. Methods The authors systematically searched MEDLINE, EMBASE, PsychINFO, and ERIC databases for articles published in English from 2000 through 2012 that met PICOS inclusion criteria of medical school programs with PA counseling skill development and evaluation of outcomes. An initial search yielded 1944 citations, and 11 studies representing 10 unique programs met criteria for this review. These studies were described and analyzed for study quality. Strength of evidence for six measured outcomes shared by multiple studies was also evaluated, that is, students’ awareness of benefits of PA, change in students’ attitudes toward PA, change in personal PA behaviors, improvements in PA counseling knowledge and skills, self-efficacy to conduct PA counseling, and change in attitude toward PA counseling. Results Considerable heterogeneity of teaching methods, duration, and placement within the curriculum was noted. Weak research designs limited an optimal evaluation of effectiveness, that is, few provided pre-/post-intervention assessments, and/or included control comparisons, or met criteria for intervention transparency and control for risk of bias. The programs with the most evidence of improvement indicated positive changes in students’ attitudes toward PA, their PA counseling knowledge and skills, and their self-efficacy to conduct PA counseling. These programs were most likely to follow previous recommendations to include experiential learning, theoretically based frameworks, and students’ personal PA behaviors. Conclusions Current results provide some support for previous recommendations, and current initiatives are underway that build upon these. However, evidence of improvements in physician practices and patient outcomes is lacking. Recommendations include future directions for curriculum development and more rigorous research designs. PMID:25062944

  12. Prescription Medication Sharing: A Systematic Review of the Literature

    PubMed Central

    Beyene, Kebede A.; Sheridan, Janie; Aspden, Trudi

    2014-01-01

    We reviewed the literature on nonrecreational prescription medication sharing. We searched PubMed, EMBASE, PsycINFO, and a customized multidatabase for all relevant articles published through 2013; our final sample comprised 19 studies from 9 countries with 36 182 participants, ranging in age from children to older adults, and published between 1990 and 2011. The prevalence rate for borrowing someone’s prescription medication was 5% to 51.9% and for lending prescription medication to someone else was 6% to 22.9%. A wide range of medicines were shared between family members, friends, and acquaintances. Sharing of many classes of prescription medication was common. Further research should explore why people share, how they decide to lend or borrow, whether they are aware of the risks, and how they assess the relevance of those risks. PMID:24524496

  13. Causes of academic failure of medical and medical sciences students in Iran: a systematic review

    PubMed Central

    Azari, Sheida; Baradaran, Hamid Reza; Fata, Ladan

    2015-01-01

    Background: Academic failure of medical and medical sciences students is one of the major problems of higher education centers in many countries. This study aims to collect and compare relevant researches in this field in Iran. Methods: The appropriate keywords were searched in the national and international databases, and the findings were categorized into related and non-related articles accordingly. Results: Only 22 articles were included in this systematic review. In terms of content analysis, gender, living in a dorm, employment, marital status, age, special rights in the entrance exams, the time lag between diploma and university, diploma average, learning style, being nonnative students, being a transferred student, psychological problems, occupation of the mother, salary level, diploma type, field of study, self-esteem, exam anxiety and interest on the field of study were considered as the influential factors for academic failure of the students. Conclusion: This systematic review shows that there is no definite academic failure criterion. It is also suggested Iranian researchers should pay more attention on the documentation of the higher educational strategies that have been implemented to prevent avoidable academic failure and contain physiological academic failure. PMID:26913265

  14. Medical Wikis Dedicated to Clinical Practice: A Systematic Review

    PubMed Central

    Llorca, Guy; Letrilliart, Laurent

    2015-01-01

    Background Wikis may give clinician communities the opportunity to build knowledge relevant to their practice. The only previous study reviewing a set of health-related wikis, without specification of purpose or audience, globally showed a poor reliability. Objective Our aim was to review medical wiki websites dedicated to clinical practices. Methods We used Google in ten languages, PubMed, Embase, Lilacs, and Web of Science to identify websites. The review included wiki sites, accessible and operating, having a topic relevant for clinical medicine, targeting physicians or medical students. Wikis were described according to their purposes, platform, management, information framework, contributions, content, and activity. Purposes were classified as “encyclopedic” or “non-encyclopedic”. The information framework quality was assessed based on the Health On the Net (HONcode) principles for collaborative websites, with additional criteria related to users’ transparency and editorial policy. From a sample of five articles per wikis, we assessed the readability using the Flesch test and compared articles according to the wikis’ main purpose. Annual editorial activities were estimated using the Google engine. Results Among 25 wikis included, 11 aimed at building an encyclopedia, five a textbook, three lessons, two oncology protocols, one a single article, and three at reporting clinical cases. Sixteen wikis were specialized with specific themes or disciplines. Fifteen wikis were using MediaWiki software as-is, three were hosted by online wiki farms, and seven were purpose-built. Except for one MediaWiki-based site, only purpose-built platforms managed detailed user disclosures. The owners were ten organizations, six individuals, four private companies, two universities, two scientific societies, and one unknown. Among 21 open communities, 10 required users’ credentials to give editing rights. The median information framework quality score was 6 out of 16 (range 0-15). Beyond this score, only one wiki had standardized peer-reviews. Physicians contributed to 22 wikis, medical learners to nine, and lay persons to four. Among 116 sampled articles, those from encyclopedic wikis had more videos, pictures, and external resources, whereas others had more posology details and better readability. The median creation year was 2007 (1997-2011), the median number of content pages was 620.5 (3-98,039), the median of revisions per article was 17.7 (3.6-180.5) and 0.015 of talk pages per article (0-0.42). Five wikis were particularly active, whereas six were declining. Two wikis have been discontinued after the completion of the study. Conclusions The 25 medical wikis we studied present various limitations in their format, management, and collaborative features. Professional medical wikis may be improved by using clinical cases, developing more detailed transparency and editorial policies, and involving postgraduate and continuing medical education learners. PMID:25700482

  15. Barcode medication administration work-arounds: a systematic review and implications for nurse executives.

    PubMed

    Voshall, Barbara; Piscotty, Ronald; Lawrence, Jeanette; Targosz, Mary

    2013-10-01

    Safe medication administration is necessary to ensure quality healthcare. Barcode medication administration systems were developed to reduce drug administration errors and the related costs and improve patient safety. Work-arounds created by nurses in the execution of the required processes can lead to unintended consequences, including errors. This article provides a systematic review of the literature associated with barcoded medication administration and work-arounds and suggests interventions that should be adopted by nurse executives to ensure medication safety. PMID:24061586

  16. Disaster-Driven Evacuation and Medication Loss: a Systematic Literature Review

    PubMed Central

    Ochi, Sae; Hodgson, Susan; Landeg, Owen; Mayner, Lidia; Murray, Virginia

    2014-01-01

    AIM: The aim of this systematic literature review was to identify the extent and implications of medication loss and the burden of prescription refill on medical relief teams following extreme weather events and other natural hazards. METHOD: The search strategy followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Key health journal databases (Medline, Embase, PsycINFO, Maternity and Infant Care, and Health Management Information Consortium (HMIC)) were searched via the OvidSP search engine. Search terms were identified by consulting MeSH terms. The inclusion criteria comprised articles published from January 2003 to August 2013, written in English and containing an abstract. The exclusion criteria included abstracts for conferences or dissertations, book chapters and articles written in a language other than English. A total of 70 articles which fulfilled the inclusion criteria were included in this systematic review. RESULTS: All relevant information was collated regarding medication loss, prescription loss and refills, and medical aids loss which indicated a significant burden on the medical relief teams. Data also showed the difficulty in filling prescriptions due to lack of information from the evacuees. People with chronic conditions are most at risk when their medication is not available. This systematic review also showed that medical aids such as eye glasses, hearing aids as well as dental treatment are a high necessity among evacuees. DISCUSSION: This systematic review revealed that a considerable number of patients lose their medication during evacuation, many lose essential medical aids such as insulin pens and many do not bring prescriptions with them when evacuated.. Since medication loss is partly a responsibility of evacuees, understanding the impact of medication loss may lead to raising awareness and better preparations among the patients and health care professionals. People who are not prepared could have worse outcomes and many risk dying when their medication is not available. PMID:25642363

  17. MEDICATION ADHERENCE IN ELDERLY WITH POLYPHARMACY LIVING AT HOME: A SYSTEMATIC REVIEW OF EXISTING STUDIES

    PubMed Central

    Zelko, Erika; Klemenc-Ketis, Zalika; Tusek-Bunc, Ksenija

    2016-01-01

    Background: We wanted to systematically review the available evidence to evaluate the drug adherence in elderly with polypharmacy living at home. Methods: We performed a literature search using MEDLINE, ISI Web of Science, ProQuest, EMBASE, SCOPUS, Springer Link, Sage Journals and CINAHL. We used the following terms: Medication Adherence, Medication Compliance, Polypharmacy, and Elderly. The search was limited to English-language articles. We included only clinical trials, systematic reviews, meta-analysis and cross-sectional studies. Results: A total of seven articles were included in this systematic review after applying the search strategy. Six studies dealt with the prevalence of medication adherence and its correlates in patients aged 65 years or more with polypharmacy. Two studies dealt with the effect of various interventions on medication adherence in patients aged 65 years or more with polypharmacy. Conclusion: The available literature on the polypharmacy and drug adherence in elderly living at home is scarce and further studies are needed. PMID:27147920

  18. The value of systematic reviews as research activities in medical education.

    PubMed

    Lang, Thomas A

    2004-11-01

    Medical residents and postdoctoral fellows are often required to conduct and publish original research as part of their medical education. However, their relative lack of experience, time, money, and sometimes supervision in conducting original research often results in research of modest quality on topics of limited importance. Such research may also consume scarce resources from the sponsoring institution. Manuscripts describing such research are often unremarkable, although most are submitted for publication, where editors and peer reviewers will spend time evaluating them. Systematic reviews of the literature, however, offer similar training in the scientific method, are relatively inexpensive to conduct, teach critical appraisal of the literature, give trainees a thorough command of the topic studied, and provide even new investigators the opportunity to make important contributions to the literature. Systematic reviews of the literature should thus be acceptable alternatives to original research assignments for most trainees in medical education programs. The author reviews the characteristics of systematic reviews, outlines the steps in conducting them, identifies the lessons learned from completing each step, and compares the advantages and disadvantages of systematic reviews with those of conducting original research. PMID:15504773

  19. Attitudes of Medical Students toward Psychiatry and Psychiatry as a Career: A Systematic Review

    ERIC Educational Resources Information Center

    Lyons, Zaza

    2013-01-01

    Objective: The discipline of psychiatry, and psychiatry as a career option, have been negatively regarded by medical students for decades. There is a large amount of literature on attitudes of students and the factors that attract them to and detract from psychiatry. The aim of this article is to systematically review this literature from 1990 to…

  20. Inappropriateness of Medication Prescriptions to Elderly Patients in the Primary Care Setting: A Systematic Review

    PubMed Central

    Opondo, Dedan; Eslami, Saied; Visscher, Stefan; de Rooij, Sophia E.; Verheij, Robert; Korevaar, Joke C.; Abu-Hanna, Ameen

    2012-01-01

    Background Inappropriate medication prescription is a common cause of preventable adverse drug events among elderly persons in the primary care setting. Objective The aim of this systematic review is to quantify the extent of inappropriate prescription to elderly persons in the primary care setting. Methods We systematically searched Ovid-Medline and Ovid-EMBASE from 1950 and 1980 respectively to March 2012. Two independent reviewers screened and selected primary studies published in English that measured (in)appropriate medication prescription among elderly persons (>65 years) in the primary care setting. We extracted data sources, instruments for assessing medication prescription appropriateness, and the rate of inappropriate medication prescriptions. We grouped the reported individual medications according to the Anatomical Therapeutic and Chemical (ATC) classification and compared the median rate of inappropriate medication prescription and its range within each therapeutic class. Results We included 19 studies, 14 of which used the Beers criteria as the instrument for assessing appropriateness of prescriptions. The median rate of inappropriate medication prescriptions (IMP) was 20.5% [IQR 18.1 to 25.6%.]. Medications with largest median rate of inappropriate medication prescriptions were propoxyphene 4.52(0.10–23.30)%, doxazosin 3.96 (0.32 15.70)%, diphenhydramine 3.30(0.02–4.40)% and amitriptiline 3.20 (0.05–20.5)% in a decreasing order of IMP rate. Available studies described unequal sets of medications and different measurement tools to estimate the overall prevalence of inappropriate prescription. Conclusions Approximately one in five prescriptions to elderly persons in primary care is inappropropriate despite the attention that has been directed to quality of prescription. Diphenhydramine and amitriptiline are the most common inappropriately prescribed medications with high risk adverse events while propoxyphene and doxazoxin are the most commonly prescribed medications with low risk adverse events. These medications are good candidates for being targeted for improvement e.g. by computerized clinical decision support. PMID:22928004

  1. Utilisation of helicopter emergency medical services in the early medical response to major incidents: a systematic literature review

    PubMed Central

    Johnsen, Anne Siri; Fattah, Sabina; Sollid, Stephen J M; Rehn, Marius

    2016-01-01

    Objective This systematic review identifies, describes and appraises the literature describing the utilisation of helicopter emergency medical services (HEMS) in the early medical response to major incidents. Setting Early prehospital phase of a major incident. Design Systematic literature review performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, the Web of Science, PsycINFO, Scopus, Cinahl, Bibsys Ask, Norart, Svemed and UpToDate were searched using phrases that combined HEMS and ‘major incidents’ to identify when and how HEMS was utilised. The identified studies were subjected to data extraction and appraisal. Results The database search identified 4948 articles. Based on the title and abstract, the full text of 96 articles was obtained; of these, 37 articles were included in the review, and an additional five were identified by searching the reference lists of the 37 articles. HEMS was used to transport medical and rescue personnel to the incident and to transport patients to the hospital, especially when the infrastructure was damaged. Insufficient air traffic control, weather conditions, inadequate landing sites and failing communication were described as challenging in some incidents. Conclusions HEMS was used mainly for patient treatment and to transport patients, personnel and equipment in the early medical management of major incidents, but the optimal utilisation of this specialised resource remains unclear. This review identified operational areas with improvement potential. A lack of systematic indexing, heterogeneous data reporting and weak methodological design, complicated the identification and comparison of incidents, and more systematic reporting is needed. Trial registration number CRD42013004473. PMID:26861938

  2. Systematic reviews need systematic searchers

    PubMed Central

    McGowan, Jessie; Sampson, Margaret

    2005-01-01

    Purpose: This paper will provide a description of the methods, skills, and knowledge of expert searchers working on systematic review teams. Brief Description: Systematic reviews and meta-analyses are very important to health care practitioners, who need to keep abreast of the medical literature and make informed decisions. Searching is a critical part of conducting these systematic reviews, as errors made in the search process potentially result in a biased or otherwise incomplete evidence base for the review. Searches for systematic reviews need to be constructed to maximize recall and deal effectively with a number of potentially biasing factors. Librarians who conduct the searches for systematic reviews must be experts. Discussion/Conclusion: Expert searchers need to understand the specifics about data structure and functions of bibliographic and specialized databases, as well as the technical and methodological issues of searching. Search methodology must be based on research about retrieval practices, and it is vital that expert searchers keep informed about, advocate for, and, moreover, conduct research in information retrieval. Expert searchers are an important part of the systematic review team, crucial throughout the review process—from the development of the proposal and research question to publication. PMID:15685278

  3. A Systematic Review of Medication Exposure Assessment in Prospective Cohort Studies of Community Dwelling Older Australians

    PubMed Central

    Poole, Susan G.; Bell, J. Simon; Jokanovic, Natali; Kirkpatrick, Carl M.; Dooley, Michael J.

    2015-01-01

    Introduction It is not known to what extent medication use has been comprehensively assessed in prospective cohort studies of older Australians. Understanding the varying methods to assess medication use is necessary to establish comparability and to understand the opportunities for pharmacoepidemiological analysis. The objective of this review was to compare and contrast how medication-related data have been collected in prospective cohorts of community-dwelling older Australians. Methods MEDLINE and EMBASE (1990–2014) were systematically searched to identify prospective cohorts of ≥1000 older participants that commenced recruitment after 1990. The data collection tools used to assess medication use in each cohort were independently examined by two investigators using a structured approach. Results Thirteen eligible cohorts were included. Baseline medication use was assessed in participant self-completed surveys (n = 3), by an investigator inspecting medications brought to a clinic interview (n = 7), and by interviewing participants in their home (n = 3). Five cohorts sought participant consent to access administrative claims data. Six cohorts used multiple methods to assess medication use across one or more study waves. All cohorts assessed medication use at baseline and 12 cohorts in follow-up waves. Twelve cohorts recorded prescription medications by trade or generic name; 12 cohorts recorded medication strength; and 9 recorded the daily medication dose in at least one wave of the cohort. Seven cohorts asked participants about their “current” medication use without providing a definition of “current”; and nine cohorts asked participants to report medication use over recall periods ranging from 1-week to 3-months in at least one wave of the cohort. Sixty-five original publications, that reported the prevalence or outcomes of medication use, in the 13 cohorts were identified (median = 3, range 1–21). Conclusion There has been considerable variability in the assessment of medication use within and between cohorts. This may limit the comparability of medication data collected in these cohorts. PMID:25909191

  4. Reducing Medication Costs to Prevent Cardiovascular Disease: A Community Guide Systematic Review

    PubMed Central

    Finnie, Ramona K.C.; Acharya, Sushama D.; Jacob, Verughese; Proia, Krista K.; Hopkins, David P.; Pronk, Nicolaas P.; Goetzel, Ron Z.; Kottke, Thomas E.; Rask, Kimberly J.; Lackland, Daniel T.; Braun, Lynne T.

    2015-01-01

    Introduction Hypertension and hyperlipidemia are major cardiovascular disease risk factors. To modify them, patients often need to adopt healthier lifestyles and adhere to prescribed medications. However, patients’ adherence to recommended treatments has been suboptimal. Reducing out-of-pocket costs (ROPC) to patients may improve medication adherence and consequently improve health outcomes. This Community Guide systematic review examined the effectiveness of ROPC for medications prescribed for patients with hypertension and hyperlipidemia. Methods We assessed effectiveness and economics of ROPC for medications to treat hypertension, hyperlipidemia, or both. Per Community Guide review methods, reviewers identified, evaluated, and summarized available evidence published from January 1980 through July 2015. Results Eighteen studies were included in the analysis. ROPC interventions resulted in increased medication adherence for patients taking blood pressure and cholesterol medications by a median of 3.0 percentage points; proportion achieving 80% adherence to medication increased by 5.1 percentage points. Blood pressure and cholesterol outcomes also improved. Nine studies were included in the economic review, with a median intervention cost of $172 per person per year and a median change in health care cost of −$127 per person per year. Conclusion ROPC for medications to treat hypertension and hyperlipidemia is effective in increasing medication adherence, and, thus, improving blood pressure and cholesterol outcomes. Most ROPC interventions are implemented in combination with evidence-based health care interventions such as team-based care with medication counseling. An overall conclusion about the economics of the intervention could not be reached with the small body of inconsistent cost-benefit evidence. PMID:26605708

  5. Does current provision of undergraduate education prepare UK medical students in ENT? A systematic literature review

    PubMed Central

    Ferguson, Gary R; Bacila, Irina A; Swamy, Meenakshi

    2016-01-01

    Objective To systematically identify and analyse all published literature relating to the provision of undergraduate education for preparedness in ear, nose and throat (ENT) surgery, as perceived by medical students and clinicians in the UK. Design Systematic literature review. Data sources 5 major databases were searched: MEDLINE, EMBASE, ERIC, Cochrane and Web of Science. The literature search was conducted from February to April 2015. Eligibility criteria for selecting studies Primary research or studies that report on the provision of undergraduate education for preparedness in ENT, from the perspective of medical students and clinicians in the UK. The timescale of searches was limited from 1999 onwards (ie, the past 15 years). Data extraction The literature search was conducted by 2 independent reviewers. Search terms used involved the combination and variation of 5 key concepts, namely: medical student, clinician, ENT, undergraduate medical education and UK. A data extraction form was designed for and used in this study, based on guidelines provided by the UK National Health Service (NHS) Centre for Reviews and Dissemination. Textual narrative synthesis was used for data analysis. Results A total of 7 studies were included in the final review. 4 main themes were identified: confidence in managing patients, teaching delivery, student assessment and duration of rotations. A consistent finding in this review was that the majority of final year medical students and junior doctors did not feel adequately prepared to practise ENT. Important factors influencing preparedness in ENT included the duration of clinical rotations, the opportunity for hands-on learning and formal assessment. Conclusions The findings of this review suggest the need for further development of the ENT undergraduate curricula across the UK. However, there is insufficient evidence from which to draw strong conclusions; this in itself is beneficial as it highlights a gap in the existing literature and supports the need for primary research. PMID:27084273

  6. Medical students-as-teachers: a systematic review of peer-assisted teaching during medical school

    PubMed Central

    Yu, Tzu-Chieh; Wilson, Nichola C; Singh, Primal P; Lemanu, Daniel P; Hawken, Susan J; Hill, Andrew G

    2011-01-01

    Introduction International interest in peer-teaching and peer-assisted learning (PAL) during undergraduate medical programs has grown in recent years, reflected both in literature and in practice. There, remains however, a distinct lack of objective clarity and consensus on the true effectiveness of peer-teaching and its short- and long-term impacts on learning outcomes and clinical practice. Objective To summarize and critically appraise evidence presented on peer-teaching effectiveness and its impact on objective learning outcomes of medical students. Method A literature search was conducted in four electronic databases. Titles and abstracts were screened and selection was based on strict eligibility criteria after examining full-texts. Two reviewers used a standard review and analysis framework to independently extract data from each study. Discrepancies in opinions were resolved by discussion in consultation with other reviewers. Adapted models of “Kirkpatrick’s Levels of Learning” were used to grade the impact size of study outcomes. Results From 127 potential titles, 41 were obtained as full-texts, and 19 selected after close examination and group deliberation. Fifteen studies focused on student-learner outcomes and four on student-teacher learning outcomes. Ten studies utilized randomized allocation and the majority of study participants were self-selected volunteers. Written examinations and observed clinical evaluations were common study outcome assessments. Eleven studies provided student-teachers with formal teacher training. Overall, results suggest that peer-teaching, in highly selective contexts, achieves short-term learner outcomes that are comparable with those produced by faculty-based teaching. Furthermore, peer-teaching has beneficial effects on student-teacher learning outcomes. Conclusions Peer-teaching in undergraduate medical programs is comparable to conventional teaching when utilized in selected contexts. There is evidence to suggest that participating student-teachers benefit academically and professionally. Long-term effects of peer-teaching during medical school remain poorly understood and future research should aim to address this. PMID:23745087

  7. The Impact of Social Media on Medical Professionalism: A Systematic Qualitative Review of Challenges and Opportunities

    PubMed Central

    Gholami-Kordkheili, Fatemeh; Wild, Verina

    2013-01-01

    Background The rising impact of social media on the private and working lives of health care professionals has made researchers and health care institutions study and rethink the concept and content of medical professionalism in the digital age. In the last decade, several specific policies, original research studies, and comments have been published on the responsible use of social media by health care professionals. However, there is no systematic literature review that analyzes the full spectrum of (1) social media–related challenges imposed on medical professionalism and (2) social media–related opportunities to both undermine and improve medical professionalism. Objective The aim of this systematic qualitative review is to present this full spectrum of social media–related challenges and opportunities. Methods We performed a systematic literature search in PubMed (restricted to English and German literature published between 2002 and 2011) for papers that address social media–related challenges and opportunities for medical professionalism. To operationalize “medical professionalism”, we refer to the 10 commitments presented in the physicians’ charter “Medical professionalism in the new millennium” published by the ABIM Foundation. We applied qualitative text analysis to categorize the spectrum of social media–related challenges and opportunities for medical professionalism. Results The literature review retrieved 108 references, consisting of 46 original research studies and 62 commentaries, editorials, or opinion papers. All references together mentioned a spectrum of 23 broad and 12 further-specified, narrow categories for social media–related opportunities (n=10) and challenges (n=13) for medical professionalism, grouped under the 10 commitments of the physicians’ charter. Conclusions The accommodation of the traditional core values of medicine to the characteristics of social media presents opportunities as well as challenges for medical professionalism. As a profession that is entitled to self-regulation, health care professionals should proactively approach these challenges and seize the opportunities. There should be room to foster interprofessional and intergenerational dialogue (and eventually guidelines and policies) on both challenges and opportunities of social media in modern health care. This review builds a unique source of information that can inform further research and policy development in this regard. PMID:23985172

  8. Reflective writing and its impact on empathy in medical education: systematic review

    PubMed Central

    2014-01-01

    Purpose: Medical schools are increasingly aware of the ways in which physician empathy can have a profound impact on patients’ lives and have developed humanities initiatives to address this concern. Reflective writing in particular is more commonly promoted in medical curricula, but there is limited research on the impact of reflective writing on medical student empathy levels. It aims to find the emotional effects of reflective writing interventions on medical and healthcare students by systemic review. Methods: Two investigators independently reviewed educational publications for critical analysis. This review focused systematically on quantitative papers that measure the impact of reflective writing on empathy. Results: Of the 1,032 studies found on Medline and CINAHL, only 8 used quantitative measures pre- and postwritten reflection to measure any impact on empathy outcomes. The outcomes measured included impact of reflective writing exercises on student wellness, aptitude, and/or clinical skills. Of these studies, a significant change in student empathy was observed in 100% of the studies, demonstrating a significant change in outcomes. Conclusion: Although the lack of homogeneity in outcome measurement in the literature limits possible conclusion from this review, the overwhelmingly positive reporting of outcomes suggests that reflective writing should be considered in any medical curriculum. PMID:25112448

  9. Nursing administration of medication via enteral tubes in adults: a systematic review.

    PubMed

    Phillips, Nicole M; Nay, Rhonda

    2007-09-01

    Background  Enteral tubes are frequently inserted as part of medical treatment in a wide range of patient situations. Patients with an enteral tube are cared for by nurses in a variety of settings, including general and specialised acute care areas, aged care facilities and at home. Regardless of the setting, nurses have the primary responsibility for administering medication through enteral tubes. Medication administration via an enteral tube is a reasonably common nursing intervention that entails a number of skills, including preparing the medication, verifying the tube position, flushing the tube and assessing for potential complications. If medications are not given effectively through an enteral tube, harmful consequences may result leading to increased morbidity, for example, tube occlusion, diarrhoea and aspiration pneumonia. There are resultant costs for the health-care system related to possible increased length of stay and increased use of equipment. Presently what is considered to be best practice to give medications through enteral tubes is unknown. Objectives  The objective of this systematic review was to determine the best available evidence on which nursing interventions are effective in minimising the complications associated with the administration of medications via enteral tubes in adults. Nursing interventions and considerations related to medication administration included form of medication, verifying tube placement before administration, methods used to give medication, methods used to flush tubes, maintenance of tube patency and specific practices to prevent possible complications related to the administration of enteral medications. Search strategy  The following databases were searched for literature reported in English only: CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO. There was no date restriction applied. In addition, the reference lists of all included studies were scrutinised for other potentially relevant studies. Selection criteria  Systematic reviews of randomised controlled trials (RCTs) and RCTs that compared the effectiveness of nursing interventions and considerations used in the administration of medications via enteral tubes. Other research methods, such as non-randomised controlled trials, longitudinal studies, cohort and case control studies, were also included. Exclusion criteria included studies investigating drug-nutrient interactions or the bioavailability of specific medications. Data collection and analysis  Initial consideration of potential relevance to the review was carried out by the primary author (NP). Two reviewers independently assessed study eligibility for inclusion. A meta-analysis could not be undertaken, as there were no comparable RCTs identified. All data were presented in a narrative summary. Results  There is very limited evidence regarding the effectiveness of nursing interventions in minimising the complications associated with enteral tube medication administration in adults. The review highlights a lack of high quality research on many important nursing issues relating to enteral medication administration. There is huge scope for further research. Some of the evidence that was identified included that nurses should consider the use of liquid form medications as there may be fewer tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastronomy tubes. Nurses may need to consider the sorbitol content of some liquid medications, for example, elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself. In addition, the use of 30 mL of water for irrigation when administering medications or flushing small-diameter nasoenteral tubes may reduce the number of tube occlusions. PMID:21631795

  10. Non-psychotropic medication and risk of suicide or attempted suicide: a systematic review

    PubMed Central

    Gorton, Hayley C; Webb, Roger T; Kapur, Navneet; Ashcroft, Darren M

    2016-01-01

    Objectives To establish which non-psychotropic medications have been assessed in relation to risk of suicide or attempted suicide in observational studies, document reported associations and consider study strengths and limitations. Design Systematic review. Methods Four databases (Embase, Medline, PsycINFO and International Pharmaceutical Abstracts) were searched from 1990 to June 2014, and reference lists of included articles were hand-searched. Case–control, cohort and case only studies which reported suicide or attempted suicide in association with any non-psychotropic medication were included. Outcome measures The outcomes eligible for inclusion were suicide and attempted suicide, as defined by the authors of the included study. Results Of 11 792 retrieved articles, 19 were eligible for inclusion. Five studies considered cardiovascular medication and antiepileptics; two considered leukotriene receptor antagonists, isotretinoin and corticosteroids; one assessed antibiotics and another assessed varenicline. An additional study compared multiple medications prescribed to suicide cases versus controls. There was marked heterogeneity in study design, outcome and exposure classification, and control for confounding factors; particularly comorbid mental and physical illness. No increased risk was associated with cardiovascular medications, but associations with other medications remained inconclusive and meta-analysis was inappropriate due to study heterogeneity. Conclusions Whether non-psychotropic medications are associated with increased risk of suicide or attempted suicide remains largely unknown. Robust identification of suicide outcomes and control of comorbidities could improve quantification of risk associated with non-psychotropic medication, beyond that conferred by underlying physical and mental illnesses. PMID:26769782

  11. Psychotropic Medications in Children with Autism Spectrum Disorders: A Systematic Review and Synthesis for Evidence-Based Practice

    ERIC Educational Resources Information Center

    Siegel, Matthew; Beaulieu, Amy A.

    2012-01-01

    This paper presents a systematic review, rating and synthesis of the empirical evidence for the use of psychotropic medications in children with autism spectrum disorders (ASD). Thirty-three randomized controlled trials (RCTs) published in peer-reviewed journals qualified for inclusion and were coded and analyzed using a systematic evaluative…

  12. Changes in Medical Student and Doctor Attitudes Toward Older Adults After an Intervention: A Systematic Review

    PubMed Central

    Samra, Rajvinder; Griffiths, Amanda; Cox, Tom; Conroy, Simon; Knight, Alec

    2013-01-01

    Research investigating the effects of attitude-focused interventions on doctors’ and medical students’ attitudes toward older adults has produced mixed results. The objective of this systematic review was to determine whether factors pertaining to study design and quality might provide some explanation of this inconclusive picture. Articles were judged of interest if they reported doctors’ or medicals students’ attitude scores before and after a geriatric-focused intervention. Articles that did not report the measure used, mean scores, or inferential statistics were excluded. Twenty-seven databases, including Medline, PsychInfo, and Embase, were searched through April 2011 using a systematic search strategy. After assessment and extraction, 27 studies met the eligibility criteria for this review. These studies demonstrated inconsistent results; 14 appeared successful in effecting positive attitude change toward older adults after an intervention, and 13 appeared unsuccessful. Attitude change results differed in line with the content of the intervention. Of the 27 studies, 11 interventions contained solely knowledge-building content. Three of these studies demonstrated positive changes in doctors’ or medical students’ attitudes toward older adults after the intervention. The remaining 16 interventions incorporated an empathy-building component, such as an aging simulation exercise or contact with a healthy older adult. Of these, 11 successfully demonstrated positive attitude change after the intervention. The inclusion of an empathy-building task in an intervention appears to be associated with positive attitude change in medical students’ and doctors’ attitudes toward older adults. PMID:23750821

  13. Prevalence of self-medication in the adult population of Brazil: a systematic review

    PubMed Central

    Domingues, Paulo Henrique Faria; Galvão, Taís Freire; de Andrade, Keitty Regina Cordeiro; de Sá, Pedro Terra Teles; Silva, Marcus Tolentino; Pereira, Mauricio Gomes

    2015-01-01

    OBJECTIVE To evaluate the prevalence of self-medication in Brazil’s adult population. METHODS Systematic review of cross-sectional population-based studies. The following databases were used: Medline, Embase, Scopus, ISI, CINAHL, Cochrane Library, CRD, Lilacs, SciELO, the Banco de teses brasileiras (Brazilian theses database) (Capes) and files from the Portal Domínio Público (Brazilian Public Domain). In addition, the reference lists from relevant studies were examined to identify potentially eligible articles. There were no applied restrictions in terms of the publication date, language or publication status. Data related to publication, population, methods and prevalence of self-medication were extracted by three independent researchers. Methodological quality was assessed following eight criteria related to sampling, measurement and presentation of results. The prevalences were measured from participants who used at least one medication during the recall period of the studies. RESULTS The literature screening identified 2,778 records, from which 12 were included for analysis. Most studies were conducted in the Southeastern region of Brazil, after 2000 and with a 15-day recall period. Only five studies achieved high methodological quality, of which one study had a 7-day recall period, in which the prevalence of self-medication was 22.9% (95%CI 14.6;33.9). The prevalence of self-medication in three studies of high methodological quality with a 15-day recall period was 35.0% (95%CI 29.0;40.0, I2 = 83.9%) in the adult Brazilian population. CONCLUSIONS Despite differences in the methodologies of the included studies, the results of this systematic review indicate that a significant proportion of the adult Brazilian population self-medicates. It is suggested that future research projects that assess self-medication in Brazil standardize their methods. PMID:26083944

  14. Confounding factors in using upward feedback to assess the quality of medical training: a systematic review

    PubMed Central

    2014-01-01

    Purpose: Upward feedback is becoming more widely used in medical training as a means of quality control. Multiple biases exist, thus the accuracy of upward feedback is debatable. This study aims to identify factors that could influence upward feedback, especially in medical training. Methods: A systematic review using a structured search strategy was performed. Thirty-five databases were searched. Results were reviewed and relevant abstracts were shortlisted. All studies in English, both medical and non-medical literature, were included. A simple pro-forma was used initially to identify the pertinent areas of upward feedback, so that a focused pro-forma could be designed for data extraction. Results: A total of 204 articles were reviewed. Most studies on upward feedback bias were evaluative studies and only covered Kirkpatrick level 1-reaction. Most studies evaluated trainers or training, were used for formative purposes and presented quantitative data. Accountability and confidentiality were the most common overt biases, whereas method of feedback was the most commonly implied bias within articles. Conclusion: Although different types of bias do exist, upward feedback does have a role in evaluating medical training. Accountability and confidentiality were the most common biases. Further research is required to evaluate which types of bias are associated with specific survey characteristics and which are potentially modifiable. PMID:25112445

  15. Systematic review of adherence rates by medication class in type 2 diabetes: a study protocol

    PubMed Central

    McGovern, Andrew; Tippu, Zayd; Hinton, William; Munro, Neil; Whyte, Martin; de Lusignan, Simon

    2016-01-01

    Introduction Treatment options for type 2 diabetes are becoming increasingly complex with people often prescribed multiple medications, and may include both oral and injectable therapies. There is ongoing debate about which drug classes provide the optimum second-line and third-line treatment options. In the real world, patient adherence and persistence determines medication effectiveness. A better understanding of adherence may help inform the choice of second-line and third-line drug classes. Methods and analysis This systematic review will compare adherence and persistence rates across the different classes of medication available to people with type 2 diabetes. It will include all identified studies comparing medication adherence or persistence between two or more glucose-lowering medications in people with type 2 diabetes. Research databases (MEDLINE, EMBASE, The Cochrane Library, The Register of Controlled Trials, PsychINFO and CINAHL) will be searched for relevant articles, using a comprehensive search strategy. All identified medication trials and observational studies will be included which compare adherence or persistence across classes of diabetes medication. The characteristics and outcomes of all the included studies will be reported along with a study quality grade, assessed using the Cochrane Risk Assessment Tool. The quality of adjustment for confounders of adherence or persistence will be reported for each study. Where multiple (n ≥3) studies provide compare adherence or persistence across the same 2 medication classes, a meta-analysis will be performed. Ethics and dissemination No ethics approval is required. This review and meta-analysis (where possible) will provide important information on the relative patient adherence and persistence, with the different classes of diabetes therapies. Once complete, the results will be made available by peer-reviewed publication. Trial registration number CRD42015027865. PMID:26928029

  16. Medical Student Research: An Integrated Mixed-Methods Systematic Review and Meta-Analysis

    PubMed Central

    Amgad, Mohamed; Man Kin Tsui, Marco; Liptrott, Sarah J.; Shash, Emad

    2015-01-01

    Importance Despite the rapidly declining number of physician-investigators, there is no consistent structure within medical education so far for involving medical students in research. Objective To conduct an integrated mixed-methods systematic review and meta-analysis of published studies about medical students' participation in research, and to evaluate the evidence in order to guide policy decision-making regarding this issue. Evidence Review We followed the PRISMA statement guidelines during the preparation of this review and meta-analysis. We searched various databases as well as the bibliographies of the included studies between March 2012 and September 2013. We identified all relevant quantitative and qualitative studies assessing the effect of medical student participation in research, without restrictions regarding study design or publication date. Prespecified outcome-specific quality criteria were used to judge the admission of each quantitative outcome into the meta-analysis. Initial screening of titles and abstracts resulted in the retrieval of 256 articles for full-text assessment. Eventually, 79 articles were included in our study, including eight qualitative studies. An integrated approach was used to combine quantitative and qualitative studies into a single synthesis. Once all included studies were identified, a data-driven thematic analysis was performed. Findings and Conclusions Medical student participation in research is associated with improved short- and long- term scientific productivity, more informed career choices and improved knowledge about-, interest in- and attitudes towards research. Financial worries, gender, having a higher degree (MSc or PhD) before matriculation and perceived competitiveness of the residency of choice are among the factors that affect the engagement of medical students in research and/or their scientific productivity. Intercalated BSc degrees, mandatory graduation theses and curricular research components may help in standardizing research education during medical school. PMID:26086391

  17. Medical device procurement in low- and middle-income settings: protocol for a systematic review

    PubMed Central

    2014-01-01

    Background Medical device procurement processes for low- and middle-income countries (LMICs) are a poorly understood and researched topic. To support LMIC policy formulation in this area, international public health organizations and research institutions issue a large body of predominantly grey literature including guidelines, manuals and recommendations. We propose to undertake a systematic review to identify and explore the medical device procurement methodologies suggested within this and further literature. Procurement facilitators and barriers will be identified, and methodologies for medical device prioritization under resource constraints will be discussed. Methods/design Searches of both bibliographic and grey literature will be conducted to identify documents relating to the procurement of medical devices in LMICs. Data will be extracted according to protocol on a number of pre-specified issues and variables. First, data relating to the specific settings described within the literature will be noted. Second, information relating to medical device procurement methodologies will be extracted, including prioritization of procurement under resource constraints, the use of evidence (e.g. cost-effectiveness evaluations, burden of disease data) as well as stakeholders participating in procurement processes. Information relating to prioritization methodologies will be extracted in the form of quotes or keywords, and analysis will include qualitative meta-summary. Narrative synthesis will be employed to analyse data otherwise extracted. The PRISMA guidelines for reporting will be followed. Discussion The current review will identify recommended medical device procurement methodologies for LMICs. Prioritization methods for medical device acquisition will be explored. Relevant stakeholders, facilitators and barriers will be discussed. The review is aimed at both LMIC decision makers and the international research community and hopes to offer a first holistic conceptualization of this topic. PMID:25336161

  18. Written informed consent and selection bias in observational studies using medical records: systematic review

    PubMed Central

    Duffett, Mark; Willison, Donald J; Cook, Deborah J; Brouwers, Melissa C

    2009-01-01

    Objectives To determine whether informed consent introduces selection bias in prospective observational studies using data from medical records, and consent rates for such studies. Design Systematic review. Data sources Embase, Medline, and the Cochrane Library up to March 2008, reference lists from pertinent articles, and searches of electronic citations. Study selection Prospective observational studies reporting characteristics of participants and non-participants approached for informed consent to use their medical records. Studies were selected independently in duplicate; a third reviewer resolved disagreements. Data extraction Age, sex, race, education, income, or health status of participants and non-participants, the participation rate in each study, and susceptibility of these calculations to threats of selection and reporting bias. Results Of 1650 citations 17 unique studies met inclusion criteria and had analysable data. Across all outcomes there were differences between participants and non-participants; however, there was a lack of consistency in the direction and the magnitude of effect. Of 161?604 eligible patients, 66.9% consented to use of data from their medical records. Conclusions Significant differences between participants and non-participants may threaten the validity of results from observational studies that require consent for use of data from medical records. To ensure that legislation on privacy does not unduly bias observational studies using medical records, thoughtful decision making by research ethics boards on the need for mandatory consent is necessary. PMID:19282440

  19. Medication adherence in schizophrenia: factors influencing adherence and consequences of nonadherence, a systematic literature review

    PubMed Central

    Medic, Goran; Littlewood, Kavi J.; Diez, Teresa; Granstrm, Ola; De Hert, Marc

    2013-01-01

    Background: Nonadherence to medication is a recognized problem and may be the most challenging aspect of treatment. Methods: We performed a systematic review of factors that influence adherence and the consequences of nonadherence to the patient, healthcare system and society, in patients with schizophrenia. Particular attention was given to the effect of nonadherence on hospitalization rates, as a key driver of increased costs of care. A qualitative systematic literature review was conducted using a broad search strategy using disease and adherence terms. Due to the large number of abstracts identified, article selection was based on studies with larger sample sizes published after 2001. Thirty-seven full papers were included: 15 studies on drivers and 22 on consequences, of which 12 assessed the link between nonadherence and hospitalization. Results: Key drivers of nonadherence included lack of insight, medication beliefs and substance abuse. Key consequences of nonadherence included greater risk of relapse, hospitalization and suicide. Factors positively related to adherence were a good therapeutic relationship with physician and perception of benefits of medication. The most frequently reported driver and consequence were lack of insight and greater risk of hospitalization respectively. Conclusions: Improving adherence in schizophrenia may have a considerable positive impact on patients and society. This can be achieved by focusing on the identified multitude of factors driving nonadherence. PMID:24167693

  20. Medication reviews for nursing home residents to reduce mortality and hospitalization: systematic review and meta-analysis

    PubMed Central

    Wallerstedt, Susanna M; Kindblom, Jenny M; Nylén, Karin; Samuelsson, Ola; Strandell, Annika

    2014-01-01

    Aims Medication reviews by a third party have been introduced as a method to improve drug treatment in older people. We assessed whether this intervention reduces mortality and hospitalization for nursing home residents. Methods Systematic literature searches were performed (from January 1990 to June 2012) in Medline, EMBASE, Cochrane Library, ProQuest Nursing & Allied Health Sources and Health Technology Assessment databases. We included randomized and nonrandomized controlled trials (RCTs and non-RCTs) of medication reviews compared with standard care or other types of medication reviews in nursing home residents. The outcome variables were mortality and hospitalization. Study quality was assessed systematically. We performed meta-analyses using random-effects models. Results Seven RCTs and five non-RCTs fulfilled the inclusion criteria. The mean age of included patients varied between 78 and 86 years. They were treated with a mean of 4–12 drugs. The study quality was assessed as high (n = 1), moderate (n = 4) or low (n = 7). Eight studies compared medication reviews with standard care. In six of them, pharmacists were involved in the intervention. Meta-analyses of RCTs revealed a risk ratio (RR) for mortality of 1.03 [medication reviews vs. standard care; five trials; 95% confidence interval (CI) 0.85–1.23]. The corresponding RR for hospitalization was 1.07 (two trials; 95% CI 0.61–1.87). Conclusions Our findings indicate that medication reviews for nursing home residents do not reduce mortality or hospitalization. More research in the setting of controlled trials remains to be done in order to clarify how drug treatment can be optimized for these patients. PMID:24548138

  1. Psychosocial predictors of non-adherence to chronic medication: systematic review of longitudinal studies

    PubMed Central

    Zwikker, Hanneke E; van den Bemt, Bart J; Vriezekolk, Johanna E; van den Ende, Cornelia H; van Dulmen, Sandra

    2014-01-01

    Objectives Several cross-sectional studies suggest that psychosocial factors are associated with non-adherence to chronic preventive maintenance medication (CPMM); however, results from longitudinal associations have not yet been systematically summarized. Therefore, the objective of this study was to systematically synthesize evidence of longitudinal associations between psychosocial predictors and CPMM non-adherence. Materials and methods PUBMED, EMBASE, CINAHL, and PsychINFO databases were searched for studies meeting our inclusion criteria. The reference lists and the ISI Web of Knowledge of the included studies were checked. Studies were included if they had an English abstract, involved adult populations using CPMM living in Western countries, and if they investigated associations between psychosocial predictors and medication non-adherence using longitudinal designs. Data were extracted according to a literature-based extraction form. Study quality was independently judged by two researchers using a framework comprising six bias domains. Studies were considered to be of high quality if ≥four domains were free of bias. Psychosocial predictors for non-adherence were categorized into five pre-defined categories: beliefs/cognitions; coping styles; social influences and social support; personality traits; and psychosocial well-being. A qualitative best evidence synthesis was performed to synthesize evidence of longitudinal associations between psychosocial predictors and CPMM non-adherence. Results Of 4,732 initially-identified studies, 30 (low-quality) studies were included in the systematic review. The qualitative best evidence synthesis demonstrated limited evidence for absence of a longitudinal association between CPMM non-adherence and the psychosocial categories. The strength of evidence for the review’s findings is limited by the low quality of included studies. Conclusion The results do not provide psychosocial targets for the development of new interventions in clinical practice. This review clearly demonstrates the need for high-quality, longitudinal research to identify psychosocial predictors of medication non-adherence. PMID:24851043

  2. Factor Analysis Methods and Validity Evidence: A Systematic Review of Instrument Development across the Continuum of Medical Education

    ERIC Educational Resources Information Center

    Wetzel, Angela Payne

    2011-01-01

    Previous systematic reviews indicate a lack of reporting of reliability and validity evidence in subsets of the medical education literature. Psychology and general education reviews of factor analysis also indicate gaps between current and best practices; yet, a comprehensive review of exploratory factor analysis in instrument development across…

  3. Retention in medication-assisted treatment for opiate dependence: A systematic review.

    PubMed

    Timko, Christine; Schultz, Nicole R; Cucciare, Michael A; Vittorio, Lisa; Garrison-Diehn, Christina

    2016-01-01

    Retention in medication-assisted treatment among opiate-dependent patients is associated with better outcomes. This systematic review (55 articles, 2010-2014) found wide variability in retention rates (i.e., 19%-94% at 3-month, 46%-92% at 4-month, 3%-88% at 6-month, and 37%-91% at 12-month follow-ups in randomized controlled trials), and identified medication and behavioral therapy factors associated with retention. As expected, patients who received naltrexone or buprenorphine had better retention rates than patients who received a placebo or no medication. Consistent with prior research, methadone was associated with better retention than buprenorphine/naloxone. And, heroin-assisted treatment was associated with better retention than methadone among treatment-refractory patients. Only a single study examined retention in medication-assisted treatment for longer than 1 year, and studies of behavioral therapies may have lacked statistical power; thus, studies with longer-term follow-ups and larger samples are needed. Contingency management showed promise to increase retention, but other behavioral therapies to increase retention, such as supervision of medication consumption, or additional counseling, education, or support, failed to find differences between intervention and control conditions. Promising behavioral therapies to increase retention have yet to be identified. PMID:26467975

  4. Mental health issues amongst medical students in Asia: a systematic review [2000–2015

    PubMed Central

    Sayampanathan, Andrew Arjun; Ho, Roger Chun-Man

    2016-01-01

    Background Studies have shown that the stress experienced by medical students is far greater than that experienced by other university students. In this study, we aim to understand the consequent mental health issues that are experienced by medical students, particularly in Asia, via a systematic review of the current literature. Methods Initial searches on MEDLINE, Embase and SpringerLink came up with a total of 1,033 unique articles. Studies not focusing on medical students alone, not mentioning mental health issues or not containing prevalence values were excluded. Results We included 14 articles in our analysis. ADs had a prevalence of 7.04% (100/1,420). Depression was prevalent in 11.0% (1,115/10,147) of students. A total of 12.9% (54/420) and 12.9% (41/319) of male and female medical students respectively were screened for depression. Preclinical students were also 1.63 times more likely to be depressed compared to clinical students, with 98.0% (48/49) pre-clinical students having screened for depression, compared to 60% (27/45) clinical students. Home staying medical students are 1.33 times more likely to be depressed compared to hostel-stayers, with 12.1% (29/239) of home stayers being depressed compared to 9.2% (37/402) of hostel stayers. Conclusions We found that mental health issues affect a significant proportion of medical students and they are more prevalent in certain subpopulations of medical students. Our data revealed that preclinical and home staying students can be more susceptible to depression. More research should be done regarding this issue. With such information, it is hoped that appropriate interventions can be designed to improve the mental health of medical students. PMID:27004219

  5. Micro-costing studies in the health and medical literature: protocol for a systematic review

    PubMed Central

    2014-01-01

    Background Micro-costing is a cost estimation method that allows for precise assessment of the economic costs of health interventions. It has been demonstrated to be particularly useful for estimating the costs of new interventions, for interventions with large variability across providers, and for estimating the true costs to the health system and to society. However, existing guidelines for economic evaluations do not provide sufficient detail of the methods and techniques to use when conducting micro-costing analyses. Therefore, the purpose of this study is to review the current literature on micro-costing studies of health and medical interventions, strategies, and programs to assess the variation in micro-costing methodology and the quality of existing studies. This will inform current practice in conducting and reporting micro-costing studies and lead to greater standardization in methodology in the future. Methods/Design We will perform a systematic review of the current literature on micro-costing studies of health and medical interventions, strategies, and programs. Using rigorously designed search strategies, we will search Ovid MEDLINE, EconLit, BIOSIS Previews, Embase, Scopus, and the National Health Service Economic Evaluation Database (NHS EED) to identify relevant English-language articles. These searches will be supplemented by a review of the references of relevant articles identified. Two members of the review team will independently extract detailed information on the design and characteristics of each included article using a standardized data collection form. A third reviewer will be consulted to resolve discrepancies. We will use checklists that have been developed for critical appraisal of health economics studies to evaluate the quality and potential risk of bias of included studies. Discussion This systematic review will provide useful information to help standardize the methods and techniques for conducting and reporting micro-costing studies in research, which can improve the quality and transparency of future studies and enhance comparability and interpretation of findings. In the long run, these efforts will facilitate clinical and health policy decision-making about resource allocation. Trial registration Systematic review registration: PROSPERO CRD42014007453. PMID:24887208

  6. A systematic review of cardiovascular effects after atypical antipsychotic medication overdose.

    PubMed

    Tan, Hock Heng; Hoppe, Jason; Heard, Kennon

    2009-06-01

    As the use of atypical antipsychotic medications (AAPMs) increases, the number of overdoses continues to grow. Cardiovascular toxicity was common with older psychiatric medications but seems uncommon with AAPM. We conducted a systematic literature review to describe the cardiovascular effects reported after overdose of 5 common AAPM: aripiprazole, olanzapine, quetiapine, risperidone, and ziprasidone. We included case reports and case series describing overdose of these 5 medications identified in a search of MEDLINE, EMBASE, and abstracts from major toxicology meetings. We found 13 pediatric cases (age, <7 years), 22 adolescent cases (age, 7-16 years), and 185 adult cases. No pediatric case described a ventricular dysrhythmia or a cardiovascular death. In the adolescent and adult cases, we found numerous reports of prolonged corrected QT interval and hypotension, but there were only 3 cases of ventricular dysrhythmia and 3 deaths that may have been due to direct cardiovascular toxicity. The results from case series reports were similar to the single case report data. Our review suggests that overdose of AAPM is unlikely to cause significant cardiovascular toxicity. PMID:19497468

  7. A systematic review of cardiovascular effects following atypical antipsychotic medication overdose

    PubMed Central

    Tan, Hock Heck; Hoppe, Jason; Heard, Kennon

    2009-01-01

    As the use of atypical antipsychotic medications (AAPM) increases, the number of overdoses continues to grow. Cardiovascular toxicity was common with older psychiatric medications, but appears uncommon with AAPM. We conducted a systematic literature review to describe the cardiovascular effects reported following overdose of 5 common AAPM: Aripiprazole, olanzapine, quetiapine, risperidone and ziprasidone. We included case reports and case series describing overdose of these 5 medications identified in a search of MEDLINE, EMBASE and abstracts from major toxicology meetings. We found 13 pediatric cases (<7 yr), 22 adolescent cases (7–16 years) and 185 adult cases. No pediatric case described a ventricular dysrhythmia or a cardiovascular death. In the adolescent and adult cases we found numerous reports of prolonged QTC interval and hypotension, but there were only three cases of ventricular dysrhythmia and three deaths that may have been due to direct cardiovascular toxicity. The results from case series reports were similar to the single case report data. Our review suggests that overdose of AAPM is unlikely to cause significant cardiovascular toxicity. PMID:19497468

  8. Systematic review: Efficacy and safety of medical marijuana in selected neurologic disorders

    PubMed Central

    Koppel, Barbara S.; Brust, John C.M.; Fife, Terry; Bronstein, Jeff; Youssof, Sarah; Gronseth, Gary; Gloss, David

    2014-01-01

    Objective: To determine the efficacy of medical marijuana in several neurologic conditions. Methods: We performed a systematic review of medical marijuana (1948–November 2013) to address treatment of symptoms of multiple sclerosis (MS), epilepsy, and movement disorders. We graded the studies according to the American Academy of Neurology classification scheme for therapeutic articles. Results: Thirty-four studies met inclusion criteria; 8 were rated as Class I. Conclusions: The following were studied in patients with MS: (1) Spasticity: oral cannabis extract (OCE) is effective, and nabiximols and tetrahydrocannabinol (THC) are probably effective, for reducing patient-centered measures; it is possible both OCE and THC are effective for reducing both patient-centered and objective measures at 1 year. (2) Central pain or painful spasms (including spasticity-related pain, excluding neuropathic pain): OCE is effective; THC and nabiximols are probably effective. (3) Urinary dysfunction: nabiximols is probably effective for reducing bladder voids/day; THC and OCE are probably ineffective for reducing bladder complaints. (4) Tremor: THC and OCE are probably ineffective; nabiximols is possibly ineffective. (5) Other neurologic conditions: OCE is probably ineffective for treating levodopa-induced dyskinesias in patients with Parkinson disease. Oral cannabinoids are of unknown efficacy in non–chorea-related symptoms of Huntington disease, Tourette syndrome, cervical dystonia, and epilepsy. The risks and benefits of medical marijuana should be weighed carefully. Risk of serious adverse psychopathologic effects was nearly 1%. Comparative effectiveness of medical marijuana vs other therapies is unknown for these indications. PMID:24778283

  9. Veterinary homeopathy: systematic review of medical conditions studied by randomised placebo-controlled trials.

    PubMed

    Mathie, Robert T; Clausen, Jürgen

    2014-10-18

    A systematic review of randomised controlled trials (RCTs) of veterinary homeopathy has not previously been undertaken. Using Cochrane methods, this review aims to assess risk of bias and to quantify the effect size of homeopathic intervention compared with placebo for each eligible peer-reviewed trial. Judgement in seven assessment domains enabled a trial's risk of bias to be designated as low, unclear or high. A trial was judged to comprise reliable evidence if its risk of bias was low or was unclear in specified domains. A trial was considered to be free of vested interest if it was not funded by a homeopathic pharmacy. The 18 eligible RCTs were disparate in nature, representing four species and 11 different medical conditions. Reliable evidence, free from vested interest, was identified in two trials: homeopathic Coli had a prophylactic effect on porcine diarrhoea (odds ratio 3.89, 95 per cent confidence interval [CI], 1.19 to 12.68, P=0.02); and individualised homeopathic treatment did not have a more beneficial effect on bovine mastitis than placebo intervention (standardised mean difference -0.31, 95 per cent CI, -0.97 to 0.34, P=0.35). Mixed findings from the only two placebo-controlled RCTs that had suitably reliable evidence precluded generalisable conclusions about the efficacy of any particular homeopathic medicine or the impact of individualised homeopathic intervention on any given medical condition in animals. PMID:25324413

  10. Evaluating the effectiveness of clinical medical librarian programs: a systematic review of the literature*

    PubMed Central

    Wagner, Kay Cimpl; Byrd, Gary D.

    2004-01-01

    Objective: This study was undertaken to determine if a systematic review of the evidence from thirty years of literature evaluating clinical medical librarian (CML) programs could help clarify the effectiveness of this outreach service model. Methods: A descriptive review of the CML literature describes the general characteristics of these services as they have been implemented, primarily in teaching-hospital settings. Comprehensive searches for CML studies using quantitative or qualitative evaluation methods were conducted in the medical, allied health, librarianship, and social sciences literature. Findings: Thirty-five studies published between 1974 and 2001 met the review criteria. Most (30) evaluated single, active programs and used descriptive research methods (e.g., use statistics or surveys/questionnaires). A weighted average of 89% of users in twelve studies found CML services useful and of high quality, and 65% of users in another overlapping, but not identical, twelve studies said these services contributed to improved patient care. Conclusions: The total amount of research evidence for CML program effectiveness is not great and most of it is descriptive rather than comparative or analytically qualitative. Standards are needed to consistently evaluate CML or informationist programs in the future. A carefully structured multiprogram study including three to five of the best current programs is needed to define the true value of these services. PMID:14762460

  11. Sustainability of professionals’ adherence to clinical practice guidelines in medical care: a systematic review

    PubMed Central

    Ament, Stephanie M C; de Groot, Jeanny J A; Maessen, José M C; Dirksen, Carmen D; van der Weijden, Trudy; Kleijnen, Jos

    2015-01-01

    Objectives To evaluate (1) the state of the art in sustainability research and (2) the outcomes of professionals’ adherence to guideline recommendations in medical practice. Design Systematic review. Data sources Searches were conducted until August 2015 in MEDLINE, CINAHL, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and the Guidelines International Network (GIN) library. A snowball strategy, in which reference sections of other reviews and of included papers were searched, was used to identify additional papers. Eligibility criteria Studies needed to be focused on sustainability and on professionals’ adherence to clinical practice guidelines in medical care. Studies had to include at least 2 measurements: 1 before (PRE) or immediately after implementation (EARLY POST) and 1 measurement longer than 1 year after active implementation (LATE POST). Results The search retrieved 4219 items, of which 14 studies met the inclusion criteria, involving 18 sustainability evaluations. The mean timeframe between the end of active implementation and the sustainability evaluation was 2.6 years (minimum 1.5–maximum 7.0). The studies were heterogeneous with respect to their methodology. Sustainability was considered to be successful if performance in terms of professionals’ adherence was fully maintained in the late postimplementation phase. Long-term sustainability of professionals’ adherence was reported in 7 out of 18 evaluations, adherence was not sustained in 6 evaluations, 4 evaluations showed mixed sustainability results and in 1 evaluation it was unclear whether the professional adherence was sustained. Conclusions (2) Professionals’ adherence to a clinical practice guideline in medical care decreased after more than 1 year after implementation in about half of the cases. (1) Owing to the limited number of studies, the absence of a uniform definition, the high risk of bias, and the mixed results of studies, no firm conclusion about the sustainability of professionals’ adherence to guidelines in medical practice can be drawn. PMID:26715477

  12. A Systematic Review and Meta-Analysis of Medical Students’ Perspectives on the Engagement in Research

    PubMed Central

    Naing, Cho; Wai, Victor Nyunt; Durham, Jo; Whittaker, Maxine A.; Win, Ni Ni; Aung, Kyan; Mak, Joon Wah

    2015-01-01

    Abstract Engaging students in active learning lies at the center of effective higher education. In medical schools, students’ engagement in learning and research has come under increasing attention. The objective of this study was to synthesize evidence on medical students’ perspectives on the engagement in research. We performed a systematic review and meta-analysis. Relevant studies were searched in electronic databases. The methodological quality of the included studies was assessed. Overall, 14 observational studies (with 17 data sets) were included. In general, many studies did not use the same questionnaires and the outcome measurements were not consistently reported; these presented some difficulties in pooling the results. Whenever data permitted, we performed pooled analysis for the 4 education outcomes. A Bayesian meta-analytical approach was supplemented as a measure of uncertainty. A pooled analysis showed that 74% (95% confidence interval [CI]: 1.57%–11.07%; I2: 95.2%) of those students who engaged in research (while at the medical school) had positive attitudes toward their research experiences, whereas 49.5% (95% CI: 36.4%–62.7%; I2: 93.4%) had positive attitudes toward the study of medical sciences, 62.3% (95% CI: 46.7%–77.9%; I2: 96.3%) had self-reported changes in their practices, and 64% (95% CI: 30.8%–96.6%; I2: 98.5%) could have published their work. There was substantial heterogeneity among studies. We acknowledged the caveats and the merit of the current review. Findings showed that engagement in research resulted in favorable reactions toward research and academic learning. Future well-designed studies using standardized research tools on how to engage students in research are recommended. PMID:26181541

  13. A Systematic Review and Meta-Analysis of Medical Students' Perspectives on the Engagement in Research.

    PubMed

    Naing, Cho; Wai, Victor Nyunt; Durham, Jo; Whittaker, Maxine A; Win, Ni Ni; Aung, Kyan; Mak, Joon Wah

    2015-07-01

    Engaging students in active learning lies at the center of effective higher education. In medical schools, students' engagement in learning and research has come under increasing attention. The objective of this study was to synthesize evidence on medical students' perspectives on the engagement in research. We performed a systematic review and meta-analysis. Relevant studies were searched in electronic databases. The methodological quality of the included studies was assessed. Overall, 14 observational studies (with 17 data sets) were included. In general, many studies did not use the same questionnaires and the outcome measurements were not consistently reported; these presented some difficulties in pooling the results. Whenever data permitted, we performed pooled analysis for the 4 education outcomes. A Bayesian meta-analytical approach was supplemented as a measure of uncertainty. A pooled analysis showed that 74% (95% confidence interval [CI]: 1.57%-11.07%; I2: 95.2%) of those students who engaged in research (while at the medical school) had positive attitudes toward their research experiences, whereas 49.5% (95% CI: 36.4%-62.7%; I2: 93.4%) had positive attitudes toward the study of medical sciences, 62.3% (95% CI: 46.7%-77.9%; I2: 96.3%) had self-reported changes in their practices, and 64% (95% CI: 30.8%-96.6%; I2: 98.5%) could have published their work. There was substantial heterogeneity among studies. We acknowledged the caveats and the merit of the current review. Findings showed that engagement in research resulted in favorable reactions toward research and academic learning. Future well-designed studies using standardized research tools on how to engage students in research are recommended. PMID:26181541

  14. Interventions to improve adherence and persistence with osteoporosis medications: a systematic literature review

    PubMed Central

    Gleeson, T.; Iversen, M. D.; Avorn, J.; Brookhart, A. M.; Katz, J. N.; Losina, E.; May, F.; Patrick, A. R.; Shrank, W. H.

    2012-01-01

    Summary Adherence and persistence with osteoporosis medications are poor. We conducted a systematic literature review of interventions to improve adherence and persistence with osteoporosis medications. Seven studies met eligibility requirements and were included in the review. Few interventions were efficacious, and no clear trends regarding successful intervention techniques were identified. However, periodic follow-up interaction between patients and health professionals appeared to be beneficial. Introduction Adherence and persistence with pharmacologic therapy for osteoporosis are suboptimal. Our goal was to examine the design and efficacy of published interventions to improve adherence and persistence. Methods We searched medical literature databases for English-language papers published between January 1990 and July 2008. We selected papers that described interventions and provided results for control and intervention subjects. We assessed the design and methods of each study, including randomization, blinding, and reporting of drop-outs. We summarized the results and calculated effect sizes for each trial. Results Seven studies met eligibility requirements and were included in the review. Five of the seven studies provided adherence data. Of those five studies, three showed a statistically significant (p≤0.05) improvement in adherence by the intervention group, with effect sizes from 0.17 to 0.58. Five of the seven studies provided persistence data. Of those five, one reported statistically significant improvement in persistence by the intervention group, with an effect size of 0.36. Conclusions Few interventions were efficacious, and no clear trends regarding successful intervention techniques were identified in this small sample of studies. However, periodic follow-up interaction between patients and health professionals appeared to be beneficial. PMID:19499273

  15. Medications for Adolescents and Young Adults With Autism Spectrum Disorders: A Systematic Review

    PubMed Central

    Dove, Dwayne; Warren, Zachary; McPheeters, Melissa L.; Taylor, Julie Lounds; Sathe, Nila A.

    2012-01-01

    BACKGROUND AND OBJECTIVE: Although many treatments have been studied in children with autism spectrum disorders (ASDs), less attention has focused on interventions that may be helpful in adolescents and young adults with ASD. The goal of this study was to systematically review evidence regarding medication treatments for individuals between the ages of 13 and 30 years with ASD. METHODS: The Medline, PsycINFO, and ERIC databases were searched (1980–December 2011), as were reference lists of included articles. Two investigators independently assessed studies against predetermined inclusion/exclusion criteria. Two investigators independently extracted data regarding participant and intervention characteristics, assessment techniques, and outcomes and assigned overall quality and strength of evidence ratings on the basis of predetermined criteria. RESULTS: Eight studies of medications were identified that focused on 13- to 30-year-olds with ASD; 4 of the studies were of fair quality. The strength of evidence was insufficient for all outcomes associated with medications tested in this population; however, the 2 available studies of the atypical antipsychotic medication risperidone in this age range were consistent with the moderate evidence in children with ASD for treating problem behavior, including aggression, and high strength of evidence for adverse events, including sedation and weight gain. CONCLUSIONS: There is a marked lack of data on use of medication treatments for adolescents and young adults with ASD. The evidence on the use of risperidone in this age range is insufficient when considered alone but is consistent with the data in the population of children with ASD. PMID:23008452

  16. A Systematic Literature Review: Workplace Violence Against Emergency Medical Services Personnel

    PubMed Central

    Pourshaikhian, Majid; Abolghasem Gorji, Hassan; Aryankhesal, Aidin; Khorasani-Zavareh, Davood; Barati, Ahmad

    2016-01-01

    Context In spite of the high prevalence and consequences of much workplace violence against emergency medical services personnel, this phenomenon has been given insufficient attention. A systematic review can aid the development of guidelines to reduce violence. Objectives The research question addressed by this paper is, “What are the characteristics and findings of studies on workplace violence against emergency medical services personnel”? Data Sources A systematic literature review was conducted using online databases (PubMed, Scopus, Google Scholar, and Magiran) with the help of experienced librarians. Study Selection Inclusion criteria comprised studies in the English or Persian language and researcher’s access to the full text. There was no limit to the entry of the study design. Exclusion criteria included lack of access to the full text of the article, studies published in unreliable journals or conferences, and studies in which the results were shared with other medical or relief groups and there was no possibility of breaking down the results. Data Extraction A “Data extraction form” was designed by the researchers based on the goals of the study that included the title and author(s), study method (type, place of study, sample size, sampling method, and data collection/analysis tool), printing location, information related to the frequency of types of violence, characteristics of victims /perpetrators, and related factors. Results The papers reviewed utilized a variety of locations and environments, methods, and instrument samplings. The majority of the studies were performed using the quantitative method. No intervention study was found. Most studies focused on the prevalence of violence, and their results indicated that exposure to violence was high. The results are presented in six major themes. Conclusions Workplace violence and injuries incurred from it are extensive throughout the world. The important causes of violence include the shortage of training programs dealing with violence, lack of violence management protocols, and delays in response times. Therefore, afterthought and resolve are more crucial than ever. Workplace violence reduction strategies and suggestions for future studies are also discussed. PMID:27169096

  17. Endovascular treatment versus medical care alone for ischaemic stroke: systematic review and meta-analysis

    PubMed Central

    Neves, Joana Briosa; Caldeira, Daniel; Ferro, José M; Ferreira, Joaquim J; Costa, João

    2016-01-01

    Objectives To evaluate the efficacy and safety of endovascular treatment, particularly adjunctive intra-arterial mechanical thrombectomy, in patients with ischaemic stroke. Design Systematic review and meta-analysis. Data sources Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, SciELO, LILACS, and clinical trial registries from inception to December 2015. Reference lists were crosschecked. Eligibility criteria for selecting studies Randomised controlled trials in adults aged 18 or more with ischaemic stroke comparing endovascular treatment, including thrombectomy, with medical care alone, including intravenous recombinant tissue plasminogen activator (rt-PA). Trial endpoints were functional outcome (modified Rankin scale scores of ≤2) and mortality at 90 days after onset of symptoms. No language or time restrictions applied. Results 10 randomised controlled trials (n=2925) were included. In pooled analysis endovascular treatment, including thrombectomy, was associated with a higher proportion of patients experiencing good (modified Rankin scale scores ≤2) and excellent (scores ≤1) outcomes 90 days after stroke, without differences in mortality or rates for symptomatic intracranial haemorrhage, compared with patients randomised to medical care alone, including intravenous rt-PA. Heterogeneity was high among studies. The more recent studies (seven randomised controlled trials, published or presented in 2015) proved better suited to evaluate the effect of adjunctive intra-arterial mechanical thrombectomy on its index disease owing to more accurate patient selection, intravenous rt-PA being administered at a higher rate and earlier, and the use of more efficient thrombectomy devices. In most of these studies, more than 86% of the patients were treated with stent retrievers, and rates of recanalisation were higher (>58%) than previously reported. Subgroup analysis of these seven studies yielded a risk ratio of 1.56 (95% confidence interval 1.38 to 1.75) for good functional outcomes and 0.86 (0.69 to 1.06) for mortality, without heterogeneity among the results of the studies. All trials were open label. Risk of bias was moderate across studies. The full results of two trials are yet to be published. Conclusions Moderate to high quality evidence suggests that compared with medical care alone in a selected group of patients endovascular thrombectomy as add-on to intravenous thrombolysis performed within six to eight hours after large vessel ischaemic stroke in the anterior circulation provides beneficial functional outcomes, without increased detrimental effects. Systematic review registration PROSPERO CRD42015019340. PMID:27091337

  18. Efficacy and safety of medical cannabinoids in older subjects: a systematic review.

    PubMed

    van den Elsen, G A H; Ahmed, A I A; Lammers, M; Kramers, C; Verkes, R J; van der Marck, M A; Rikkert, M G M Olde

    2014-03-01

    This systematic review aims to integrate the evidence on indications, efficacy, safety and pharmacokinetics of medical cannabinoids in older subjects. The literature search was conducted using PubMed, EMBASE, CINAHL and Cochrane Library. We selected controlled trials including solely older subjects (≥65 years) or reporting data on older subgroups. 105 (74%) papers, on controlled intervention trials, reported the inclusion of older subjects. Five studies reported data on older persons separately. These were randomized controlled trials, including in total 267 participants (mean age 47-78 years). Interventions were oral tetrahydrocannabinol (THC) (n=3) and oral THC combined with cannabidiol (n=2). The studies showed no efficacy on dyskinesia, breathlessness and chemotherapy induced nausea and vomiting. Two studies showed that THC might be useful in treatment of anorexia and behavioral symptoms in dementia. Adverse events were more common during cannabinoid treatment compared to the control treatment, and were most frequently sedation like symptoms. Although trials studying medical cannabinoids included older subjects, there is a lack of evidence of its use specifically in older patients. Adequately powered trials are needed to assess the efficacy and safety of cannabinoids in older subjects, as the potential symptomatic benefit is especially attractive in this age group. PMID:24509411

  19. Quotation accuracy in medical journal articles—a systematic review and meta-analysis

    PubMed Central

    Jergas, Hannah

    2015-01-01

    Background. Quotations and references are an indispensable element of scientific communication. They should support what authors claim or provide important background information for readers. Studies indicate, however, that quotations not serving their purpose—quotation errors—may be prevalent. Methods. We carried out a systematic review, meta-analysis and meta-regression of quotation errors, taking account of differences between studies in error ascertainment. Results. Out of 559 studies screened we included 28 in the main analysis, and estimated major, minor and total quotation error rates of 11,9%, 95% CI [8.4, 16.6] 11.5% [8.3, 15.7], and 25.4% [19.5, 32.4]. While heterogeneity was substantial, even the lowest estimate of total quotation errors was considerable (6.7%). Indirect references accounted for less than one sixth of all quotation problems. The findings remained robust in a number of sensitivity and subgroup analyses (including risk of bias analysis) and in meta-regression. There was no indication of publication bias. Conclusions. Readers of medical journal articles should be aware of the fact that quotation errors are common. Measures against quotation errors include spot checks by editors and reviewers, correct placement of citations in the text, and declarations by authors that they have checked cited material. Future research should elucidate if and to what degree quotation errors are detrimental to scientific progress. PMID:26528420

  20. The Effectiveness of Antidepressant Medication in the Management of Behaviour Problems in Adults with Intellectual Disabilities: A Systematic Review

    ERIC Educational Resources Information Center

    Sohanpal, S. K.; Deb, S.; Thomas, C.; Soni, R.; Lenotre, L.; Unwin, G.

    2007-01-01

    Background: A comprehensive systematic review was performed to establish the current evidence base regarding the effectiveness of antidepressant medication for the management of behaviour problems in adults with intellectual disabilities. Method: An electronic search of PsycInfo, Embase, Medline and Cinahl databases was conducted spanning the time…

  1. Medication reviews.

    PubMed

    Blenkinsopp, Alison; Bond, Christine; Raynor, David K

    2012-10-01

    Recent years have seen a formalization of medication review by pharmacists in all settings of care. This article describes the different types of medication review provided in primary care in the UK National Health Service (NHS), summarizes the evidence of effectiveness and considers how such reviews might develop in the future. Medication review is, at heart, a diagnostic intervention which aims to identify problems for action by the prescriber, the clinician conducting the review, the patient or all three but can also be regarded as an educational intervention to support patient knowledge and adherence. There is good evidence that medication review improves process outcomes of prescribing including reduced polypharmacy, use of more appropriate medicines formulation and more appropriate choice of medicine. When 'harder' outcome measures have been included, such as hospitalizations or mortality in elderly patients, available evidence indicates that whilst interventions could improve knowledge and adherence they did not reduce mortality or hospital admissions with one study showing an increase in hospital admissions. Robust health economic studies of medication reviews remain rare. However a review of cost-effectiveness analyses of medication reviews found no studies in which the cost of the intervention was greater than the benefit. The value of medication reviews is now generally accepted despite lack of robust research evidence consistently demonstrating cost or clinical effectiveness compared with traditional care. Medication reviews can be more effectively deployed in the future by targeting, multi-professional involvement and paying greater attention to medicines which could be safely stopped. PMID:22607195

  2. Oral health promotion interventions on oral yeast in hospitalised and medically compromised patients: a systematic review.

    PubMed

    Lam, Otto L T; Bandara, H M H N; Samaranayake, Lakshman P; McGrath, Colman; Li, Leonard S W

    2012-03-01

    Yeast are major aetiological agents of localised oral mucosal lesions, and are also leading causes of nosocomial bloodstream infections. The purpose of this systematic review was to examine the effectiveness of oral health promotion interventions on the prevalence and incidence of these opportunistic oral pathogens in hospitalised and medically compromised patients. The PubMed, ISI Web of Science and Cochrane Library databases were searched for clinical trials assessing the effect of oral health promotion interventions on oral yeast. Chlorhexidine delivered in a variety of oral hygiene products appeared to have some effect on oral yeast, although some studies found equivocal effects. Although a wide array of other compounds have also been investigated, their clinical effectiveness remains to be substantiated. Likewise, the utility of mechanical oral hygiene interventions and other oral health promotion measures such as topical application of salivary substitute, remains unsettled. Although many chemical agents contained in oral hygiene products have proven in vitro activity against oral yeast, their clinical effectiveness and potential role as adjuncts or alternative therapies to conventional treatment remains to be confirmed by further high-quality randomised controlled trials. This is pertinent, given the recent emergence of yeast resistance to conventional antifungal agents. PMID:21749481

  3. Preventing sexual abusers of children from reoffending: systematic review of medical and psychological interventions

    PubMed Central

    Enebrink, Pia; Laurén, Eva-Marie; Lindblom, Jonas; Werkö, Sophie; Hanson, R Karl

    2013-01-01

    Objective To evaluate the effectiveness of current medical and psychological interventions for individuals at risk of sexually abusing children, both in known abusers and those at risk of abusing. Design Systematic review of interventions designed to prevent reoffending among known abusers and prevention for individuals at risk of sexually abusing children. Randomised controlled trials and prospective observational studies were eligible. Primary outcomes were arrests, convictions, breaches of conditions, and self reported sexual abuse of children after one year or more. Results After review of 1447 abstracts, we retrieved 167 full text studies, and finally included eight studies with low to moderate risk of bias. We found weak evidence for interventions aimed at reducing reoffending in identified sexual abusers of children. For adults, evidence from five trials was insufficient regarding both benefits and risks with psychological treatment and pharmacotherapy. For adolescents, limited evidence from one trial suggested that multisystemic therapy prevented reoffence (relative risk 0.18, 95% confidence interval 0.04 to 0.73); lack of adequate research prevented conclusions about effects of other treatments. Evidence was also inadequate regarding effectiveness of treatment for children with sexual behavioural problems in the one trial identified. Finally, we found no eligible research on preventive methods for adults and adolescents who had not sexually abused children but were at higher risk of doing so (such as those with paedophilic sexual preference). Conclusion There are major weaknesses in the scientific evidence, particularly regarding adult men, the main category of sexual abusers of children. Better coordinated and funded high quality studies including several countries are urgently needed. Until conclusive evidence is available, realistic clinical strategies might involve reduction of specific risk factors for sex crimes, such as sexual preoccupation, in abusers at risk of reoffending. PMID:23935058

  4. Perceptions of generic medication in the general population, doctors and pharmacists: a systematic review

    PubMed Central

    Colgan, Sarah; Faasse, Kate; Martin, Leslie R; Stephens, Melika H; Grey, Andrew; Petrie, Keith J

    2015-01-01

    Objective To investigate negative perceptions about generic medicines and evaluate the proportions of lay people, doctors and pharmacists who hold these perceptions. Design A systematic review of observational studies. Data sources MEDLINE, EMBASE, PsycInfo and Scopus. Eligibility criteria Quantitative data from cross-sectional and prospective studies published in English after 1980, using self-report measures to evaluate perceptions about generic medicines, presented as percentages of the total sample assessed. Results After screening 2737 articles, 52 articles were included in the final analysis. A high proportion of doctors, pharmacists and lay people had negative perceptions of generics. Lay people were significantly more likely to view generics as less effective than branded medication (35.6%, 95% CI 34.8% to 36.4%) compared to doctors (28.7%, 27.5% to 29.9%) and pharmacists (23.6%, 21.2% to 26.2%), p<0.0001. Pharmacists (33.4%, 31.0% to 35.9%) were significantly more likely to believe generics were of inferior quality compared to branded medication than were doctors (28.0%, 26.3% to 29.9%), p=0.0006, and lay people (25.1%, 24.2% to 26.0%), p<0.0001. Doctors believed generics caused more side effects than branded medication (24.4%, 22.2% to 26.9%), compared to pharmacists (17.6%, 15.3% to 20.1%) and lay people (18.8%, 17.8% to 19.8%), p<0.0001. Doctors (28.5%, 26.9% to 30.2%) and pharmacists (25.4%, 21.4% to 29.9%) had significantly more safety concerns about generics than did lay people (18.0%, 17.0% to 19.0%), p≤0.0002. A greater proportion of lay people felt negatively about generic substitution (34.0%, 33.2% to 34.9%), compared to doctors (24.1%, 22.0% to 26.4%) and pharmacists (11.0%, 9.6% to 12.7%), p<0.0001. Rates of negative perceptions of generics do not appear to have changed substantially over time in the general population or among physician groups, p≥0.431, but such negative beliefs show a decreasing trend in pharmacists over the study period, p=0.034. Conclusions A significant proportion of doctors, pharmacists and lay people hold negative perceptions of generic medicines. It is likely these attitudes present barriers to the wider use of generics. PMID:26671954

  5. Medications and substances as a cause of headache: a systematic review of the literature.

    PubMed

    Toth, Cory

    2003-01-01

    Medication- or substance-induced headache is probably an underrecognized entity with numerous etiologies, including prescribed medication, over-the-counter medication, illicit drugs, anesthetic agents, foods, food additives, beverages, vitamins, inhaled substances, and substances used in diagnostic procedures. The author performs a systemic review of the literature to provide an exhaustive description of the relationship between medications and substances and headaches of various types, along with pathophysiologic mechanisms whenever possible. Suggestions for improved identification of this phenomenon and its avoidance are provided. More scientific evaluation of substances and their possible association with headache is required with almost all substances indicated herein. PMID:12782914

  6. Cost-effectiveness of interventions to enhance medication adherence in psychiatric patients: a systematic review.

    PubMed

    García-Pérez, Lidia; Serrano-Aguilar, Pedro

    2011-05-01

    It was conducted a systematic review of economic evaluations that assessed the cost-effectiveness of interventions to enhance the medication adherence in psychiatric patients. Several bibliographic databases were searched: MEDLINE, MEDLINE in process, PSYCINFO, EMBASE, Cochrane Controlled Trials Register, CINAHL, CRD, EconLit, Science Citation Index and Social Science Citation Index. Full economic evaluations which assessed interventions to enhance the adherence to drug therapy in adult patients with a mental illness were included. Data were extracted and the methodological quality of selected studies was assessed. The information was synthesized through narrative procedures. Four clinical trials and two ongoing studies fulfilled the selection criteria. Two studies did not find significant differences in adherence between the interventions (a compliance-enhancing program, a therapeutic drug monitoring and a pharmacy-based intervention) and the control groups; one study found that a compliance program was more effective than a non-specific counselling intervention over 18 months in psychotic patients; another study found better results in terms of adherence among high-severity depressed patients receiving a stepped collaborative care during 12 months in comparison to a control group; in moderate-severity patients the differences disappeared after the first 6 months. None of the four studies found significant differences in costs between groups because of the low statistical power. In summary, adherence enhancing programs could be cost-effective in psychiatric patients although this statement is based on few studies with limited methodological quality. It is necessary more and better research on the cost-effectiveness of interventions in the field of mental health. PMID:21592066

  7. A Systematic Review of the Reporting of Adverse Events Associated With Medical Herb Use Among Children

    PubMed Central

    Adams, Denise; Filippelli, Amanda C.; Nasser, Hafsa; Saper, Robert; White, Laura; Vohra, Sunita

    2013-01-01

    Purpose: Information about the safety of herbal medicine often comes from case reports published in the medical literature, thus necessitating good quality reporting of these adverse events. The purpose of this study was to perform a systematic review of the comprehensiveness of reporting of published case reports of adverse events associated with herb use in the pediatric population. Methods: Electronic literature search included 7 databases and a manual search of retrieved articles from inception through 2010. We included published case reports and case series that reported an adverse event associated with exposure to an herbal product by children under the age of 18 years old. We used descriptive statistics. Based on the International Society of Epidemiology's “Guidelines for Submitting Adverse Events Reports for Publication,” we developed and assigned a guideline adherence score (0-17) to each case report. Results: Ninety-six unique journal papers were identified and represented 128 cases. Of the 128 cases, 37% occurred in children under 2 years old, 38% between the ages of 2 and 8 years old, and 23% between the ages of 9 and 18 years old. Twenty-nine percent of cases were the result of an intentional ingestion while 36% were from an unintentional ingestion. Fifty-two percent of cases documented the Latin binomial of the herb ingredients; 41% documented plant part. Thirty-two percent of the cases reported laboratory testing of the herb, 20% documented the manufacturer of the product, and 22% percent included an assessment of the potential concomitant therapies that could have been influential in the adverse events. Mean guideline adherence score was 12.5 (range 6-17). Conclusions: There is considerable need for improvement in reporting adverse events in children following herb use. Without better quality reporting, adverse event reports cannot be interpreted reliably and do not contribute in a meaningful way to guiding recommendations for medicinal herb use. PMID:24416663

  8. Defining Non-Medical Use Of Prescription Opioids within Health Care Claims: A Systematic Review

    PubMed Central

    Cochran, Gerald; Woo, Bongki; Lo-Ciganic, Wei-Hsuan; Gordon, Adam J.; Donohue, Julie M.; Gellad, Walid F.

    2016-01-01

    Background Health insurance claims data may play an important role for healthcare systems and payers in monitoring the non-medical use of prescription opioids (NMPO) among patients. However, these systems require valid methods for identifying NMPO if they are to target individuals for intervention. Limited efforts have been made to define NMPO using administrative data available to health systems and payers. We conducted a systematic review of publications that defined and measured NMPO within health insurance claims databases in order to describe definitions of NMPO and identify areas for improvement. Methods We searched eight electronic databases for articles that included terms related to NMPO and health insurance claims. A total of 2,613 articles were identified in our search. Titles, abstracts, and article full texts were assessed according to predetermined inclusion/exclusion criteria. Following article selection, we extracted general information, conceptual and operational definitions of NMPO, methods used to validate operational definitions of NMPO, and rates of NMPO. Results A total of seven studies met all inclusion criteria. A range of conceptual NMPO definitions emerged, from concrete concepts of abuse to qualified definitions of probable misuse. Operational definitions also varied, ranging from variables that rely on diagnostic codes to those that rely on opioid dosage and/or filling patterns. Quantitative validation of NMPO definitions was reported in three studies (e.g., receiver operating curves or logistic regression), with each study indicating adequate validity. Three studies reported qualitative validation, using face and content validity. One study reported no validation efforts. Rates of NMPO among the studies’ populations ranged from 0.75–10.32%. Conclusions Disparate definitions of NMPO emerged from the literature, with little uniformity in conceptualization and operationalization. Validation approaches were also limited, and rates of NMPO varied across studies. Future research should prospectively test and validate a construct of NMPO to disseminate to payers and health officials. PMID:25671499

  9. The outcomes of recent patient safety education interventions for trainee physicians and medical students: a systematic review

    PubMed Central

    Kirkman, Matthew A; Sevdalis, Nick; Arora, Sonal; Baker, Paul; Vincent, Charles; Ahmed, Maria

    2015-01-01

    Objective To systematically review the latest evidence for patient safety education for physicians in training and medical students, updating, extending and improving on a previous systematic review on this topic. Design A systematic review. Data sources Embase, Ovid Medline and PsycINFO databases. Study selection Studies including an evaluation of patient safety training interventions delivered to trainees/residents and medical students published between January 2009 and May 2014. Data extraction The review was performed using a structured data capture tool. Thematic analysis also identified factors influencing successful implementation of interventions. Results We identified 26 studies reporting patient safety interventions: 11 involving students and 15 involving trainees/residents. Common educational content included a general overview of patient safety, root cause/systems-based analysis, communication and teamwork skills, and quality improvement principles and methodologies. The majority of courses were well received by learners, and improved patient safety knowledge, skills and attitudes. Moreover, some interventions were shown to result in positive behaviours, notably subsequent engagement in quality improvement projects. No studies demonstrated patient benefit. Availability of expert faculty, competing curricular/service demands and institutional culture were important factors affecting implementation. Conclusions There is an increasing trend for developing educational interventions in patient safety delivered to trainees/residents and medical students. However, significant methodological shortcomings remain and additional evidence of impact on patient outcomes is needed. While there is some evidence of enhanced efforts to promote sustainability of such interventions, further work is needed to encourage their wider adoption and spread. PMID:25995240

  10. Feature Engineering and a Proposed Decision-Support System for Systematic Reviewers of Medical Evidence

    PubMed Central

    Bekhuis, Tanja; Tseytlin, Eugene; Mitchell, Kevin J.; Demner-Fushman, Dina

    2014-01-01

    Objectives Evidence-based medicine depends on the timely synthesis of research findings. An important source of synthesized evidence resides in systematic reviews. However, a bottleneck in review production involves dual screening of citations with titles and abstracts to find eligible studies. For this research, we tested the effect of various kinds of textual information (features) on performance of a machine learning classifier. Based on our findings, we propose an automated system to reduce screeing burden, as well as offer quality assurance. Methods We built a database of citations from 5 systematic reviews that varied with respect to domain, topic, and sponsor. Consensus judgments regarding eligibility were inferred from published reports. We extracted 5 feature sets from citations: alphabetic, alphanumeric+, indexing, features mapped to concepts in systematic reviews, and topic models. To simulate a two-person team, we divided the data into random halves. We optimized the parameters of a Bayesian classifier, then trained and tested models on alternate data halves. Overall, we conducted 50 independent tests. Results All tests of summary performance (mean F3) surpassed the corresponding baseline, P<0.0001. The ranks for mean F3, precision, and classification error were statistically different across feature sets averaged over reviews; P-values for Friedman's test were .045, .002, and .002, respectively. Differences in ranks for mean recall were not statistically significant. Alphanumeric+ features were associated with best performance; mean reduction in screening burden for this feature type ranged from 88% to 98% for the second pass through citations and from 38% to 48% overall. Conclusions A computer-assisted, decision support system based on our methods could substantially reduce the burden of screening citations for systematic review teams and solo reviewers. Additionally, such a system could deliver quality assurance both by confirming concordant decisions and by naming studies associated with discordant decisions for further consideration. PMID:24475099

  11. Quality of published Iranian medical education research studies: a systematic review

    PubMed Central

    Golnari, Pedram; Sodagari, Faezeh; Baradaran, Hamid Reza

    2014-01-01

    Background: Research in medical education has been paid more attention than before; however the quality of research reporting has not been comprehensively appraised. To evaluate the methodological and reporting quality of Iranian published medical education articles. Methods: Articles describing medical students, residents, fellows or program evaluation were included. Articles related to continuing medical education or faculty development, review articles and reports, and studies considering both medical and nonmedical students were excluded. We searched MEDLINE through PubMed in addition to major Iranian medical education search engines and databases including Scientific Information Database (SID) from March 2003 to March 2008. The Medical Education Research Quality Index (MERSQI) scale and the Consolidated Standards of Reporting Trials (CONSORT 2001) were used for experimental studies and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was utilized for observational studies. Results: Ninety five articles were found to be related to the medical education research in Iran including 16 (16.8%) experimental studies. Total MERSQI scores ranged between 3.82 and 13.09 with the mean of 8.39 points. Mean domain scores were highest for data analysis (1.85) and lowest for validity (0.61). The most frequently reported item was background (96%) and the least reported was the study limitations (16%). Conclusion: The quality of published medical education research in Iran seems to be suboptimal. PMID:25405144

  12. Elective courses for medical students during the preclinical curriculum: a systematic review and evaluation

    PubMed Central

    Agarwal, Ankit; Wong, Stephanie; Sarfaty, Suzanne; Devaiah, Anand; Hirsch, Ariel E.

    2015-01-01

    Objective Preclinical medical student electives are prevalent at medical schools across the United States, but the range of electives available and their impact on medical student education are not well described in the literature. The objective of this article is to review the literature relating to preclinical medical student electives and their impact on medical student educational outcomes. Methods We reviewed studies that met the following criteria: English-language articles describing preclinical US-based medical electives. We used PubMed journal databases and limited our search for the time period 1999–2014. We excluded electives based in other countries or electives designed for third or fourth year students. Data abstracted included the topic of the elective, qualitative descriptions of the electives, and any associated surveys or exam data associated with the electives. Data were synthesized using descriptive tables sorting electives by broad topic. Reported outcomes and statistical methods were analyzed to assess study quality. Results We found a wide range of subjects taught in the form of preclinical medical school electives. We identified electives in clinical skills, the humanities, student lifestyle, specialty-specific electives, and an assortment of other miscellaneous electives. Surveys and exams administered to students showed that the electives were universally well received by students. Of the 37 electives identified, 15 electives used quantitative objective assessments, such as knowledge exams, while the remaining tended to use student self-reported results. Conclusions Preclinical medical student electives are prevalent at medical schools across the United States and have a significant impact on medical student education. PMID:25968131

  13. A Systematic Review on the Use of Psychosocial Interventions in Conjunction With Medications for the Treatment of Opioid Addiction.

    PubMed

    Dugosh, Karen; Abraham, Amanda; Seymour, Brittany; McLoyd, Keli; Chalk, Mady; Festinger, David

    2016-01-01

    Opioid use and overdose rates have risen to epidemic levels in the United States during the past decade. Fortunately, there are effective medications (ie, methadone, buprenorphine, and oral and injectable naltrexone) available for the treatment of opioid addiction. Each of these medications is approved for use in conjunction with psychosocial treatment; however, there is a dearth of empirical research on the optimal psychosocial interventions to use with these medications. In this systematic review, we outline and discuss the findings of 3 prominent prior reviews and 27 recent publications of empirical studies on this topic. The most widely studied psychosocial interventions examined in conjunction with medications for opioid addiction were contingency management and cognitive behavioral therapy, with the majority focusing on methadone treatment. The results generally support the efficacy of providing psychosocial interventions in combination with medications to treat opioid addictions, although the incremental utility varied across studies, outcomes, medications, and interventions. The review highlights significant gaps in the literature and provides areas for future research. Given the enormity of the current opioid problem in the United States, it is critical to gain a better understanding of the most effective ways to deliver psychosocial treatments in conjunction with these medications to improve the health and well-being of individuals suffering from opioid addiction. PMID:26808307

  14. Factor analysis methods and validity evidence: A systematic review of instrument development across the continuum of medical education

    NASA Astrophysics Data System (ADS)

    Wetzel, Angela Payne

    Previous systematic reviews indicate a lack of reporting of reliability and validity evidence in subsets of the medical education literature. Psychology and general education reviews of factor analysis also indicate gaps between current and best practices; yet, a comprehensive review of exploratory factor analysis in instrument development across the continuum of medical education had not been previously identified. Therefore, the purpose for this study was critical review of instrument development articles employing exploratory factor or principal component analysis published in medical education (2006--2010) to describe and assess the reporting of methods and validity evidence based on the Standards for Educational and Psychological Testing and factor analysis best practices. Data extraction of 64 articles measuring a variety of constructs that have been published throughout the peer-reviewed medical education literature indicate significant errors in the translation of exploratory factor analysis best practices to current practice. Further, techniques for establishing validity evidence tend to derive from a limited scope of methods including reliability statistics to support internal structure and support for test content. Instruments reviewed for this study lacked supporting evidence based on relationships with other variables and response process, and evidence based on consequences of testing was not evident. Findings suggest a need for further professional development within the medical education researcher community related to (1) appropriate factor analysis methodology and reporting and (2) the importance of pursuing multiple sources of reliability and validity evidence to construct a well-supported argument for the inferences made from the instrument. Medical education researchers and educators should be cautious in adopting instruments from the literature and carefully review available evidence. Finally, editors and reviewers are encouraged to recognize this gap in best practices and subsequently to promote instrument development research that is more consistent through the peer-review process.

  15. Computerised clinical decision support systems to improve medication safety in long-term care homes: a systematic review

    PubMed Central

    Marasinghe, Keshini Madara

    2015-01-01

    Objectives Computerised clinical decision support systems (CCDSS) are used to improve the quality of care in various healthcare settings. This systematic review evaluated the impact of CCDSS on improving medication safety in long-term care homes (LTC). Medication safety in older populations is an important health concern as inappropriate medication use can elevate the risk of potentially severe outcomes (ie, adverse drug reactions, ADR). With an increasing ageing population, greater use of LTC by the growing ageing population and increasing number of medication-related health issues in LTC, strategies to improve medication safety are essential. Methods Databases searched included MEDLINE, EMBASE, Scopus and Cochrane Library. Three groups of keywords were combined: those relating to LTC, medication safety and CCDSS. One reviewer undertook screening and quality assessment. Results Overall findings suggest that CCDSS in LTC improved the quality of prescribing decisions (ie, appropriate medication orders), detected ADR, triggered warning messages (ie, related to central nervous system side effects, drug-associated constipation, renal insufficiency) and reduced injury risk among older adults. Conclusions CCDSS have received little attention in LTC, as attested by the limited published literature. With an increasing ageing population, greater use of LTC by the ageing population and increased workload for health professionals, merely relying on physicians’ judgement on medication safety would not be sufficient. CCDSS to improve medication safety and enhance the quality of prescribing decisions are essential. Analysis of review findings indicates that CCDSS are beneficial, effective and have potential to improve medication safety in LTC; however, the use of CCDSS in LTC is scarce. Careful assessment on the impact of CCDSS on medication safety and further modifications to existing CCDSS are recommended for wider acceptance. Due to scant evidence in the current literature, further research on implementation and effectiveness of CCDSS is required. PMID:25967986

  16. Survey and Systematic Literature Review of Probiotics Stocked in Academic Medical Centers within the United States

    PubMed Central

    Gregory, Philip J.; Hein, Darren J.; Cochrane, Zara Risoldi; Wilson, Amy F.

    2013-01-01

    Background: Probiotics have a wide variation in their effectiveness in preventing or treating conditions due to the varying beneficial effects of specific probiotic strains. In other words, there is no “generic equivalency” between different probiotic species. However, it is has been noted that many practitioners consider probiotics in generic terms and may not realize the impact of these differences between probiotics. Objective: The aims of this study were to identify probiotics used in US academic medical centers and to determine whether those probiotics were supported by a reliable evidence base. Methods: A phone survey of 126 inpatient pharmacies in US academic medical centers was conducted to determine which probiotics were stocked. A systematic search was conducted to identify relevant studies that were then critically evaluated to determine whether the identified probiotics are supported by a reliable evidence base. Results: There was a 90.5% (114/126) response rate of academic medical centers that were contacted through the phone survey. Ten probiotic products were identified through the phone survey. The probiotic most often stocked in academic medical centers was Culturelle (27.2%) followed by Lactinex (25.4%). The systematic search identified evidence that evaluated Culturelle, Florastor, Lactinex, and VSL #3. Of those 4 probiotics, none were supported by a strong evidence base. However, the results suggested that both Culturelle and Florastor appear to be supported by more evidence compared to other probiotics. Conclusion: A majority of academic medical centers did not stock a probiotic that was supported by a reliable evidence base. PMID:24421437

  17. A systematic review of best practices in teaching ophthalmology to medical students.

    PubMed

    Succar, Tony; Grigg, John; Beaver, Hilary A; Lee, Andrew G

    2016-01-01

    Ophthalmic medical student education is a cornerstone to improving eye health care globally. We review the current state of the literature, listing barriers to potential best practices for undergraduate ophthalmology teaching and learning within medical curricula. We describe recent advances and pedagogical approaches in ophthalmic education and propose specific recommendations for further improvements and research. Future research should concentrate on developing teaching and learning innovations that may result in a more time- and resource-effective models for interactive and integrated learning. As well as demonstrating that a competency-based approach results not just in better eye health, but also improvements in patient care, education, and medical care in general. By optimizing teaching available through improved evidence-based education, the ultimate goal is to increase medical students' knowledge and produce graduates who are highly trained in eye examination skills, resulting in improved patient eye care through timely diagnosis, referrals, and treatment. PMID:26363187

  18. Quality Indicators for Safe Medication Preparation and Administration: A Systematic Review

    PubMed Central

    Maaskant, Jolanda M.; de Boer, Monica; Krediet, C. T. Paul; Nieveen van Dijkum, Els J. M.

    2015-01-01

    Background One-third of all medication errors causing harm to hospitalized patients occur in the medication preparation and administration phase, which is predominantly a nursing activity. To monitor, evaluate and improve the quality and safety of this process, evidence-based quality indicators can be used. Objectives The aim of study was to identify evidence-based quality indicators (structure, process and outcome) for safe in-hospital medication preparation and administration. Methods MEDLINE, EMBASE and CINAHL were searched for relevant studies published up to January 2015. Additionally, nine databases were searched to identify relevant grey literature. Two reviewers independently selected studies if (1) the method for quality indicator development combined a literature search with expert panel opinion, (2) the study contained quality indicators on medication safety, and (3) any of the quality indicators were applicable to hospital medication preparation and administration. A multidisciplinary team appraised the studies independently using the AIRE instrument, which contains four domains and 20 items. Quality indicators applicable to in-hospital medication preparation and administration were extracted using a structured form. Results The search identified 1683 studies, of which 64 were reviewed in detail and five met the inclusion criteria. Overall, according to the AIRE domains, all studies were clear on purpose; most of them applied stakeholder involvement and used evidence reasonably; usage of the indicator in practice was scarcely described. A total of 21 quality indicators were identified: 5 structure indicators (e.g. safety management and high alert medication), 11 process indicators (e.g. verification and protocols) and 5 outcome indicators (e.g. harm and death). These quality indicators partially cover the 7 rights. Conclusion Despite the relatively small number of included studies, the identified quality indicators can serve as an excellent starting point for further development of nursing specific quality indicators for medication safety. Especially on the right patient, right route, right time and right documentation there is room future development of quality indicators. PMID:25884623

  19. Antiepileptic medications in autism spectrum disorder: a systematic review and meta-analysis.

    PubMed

    Hirota, Tomoya; Veenstra-Vanderweele, Jeremy; Hollander, Eric; Kishi, Taro

    2014-04-01

    Electroencephalogram-recorded epileptiform activity is common in children with autism spectrum disorder (ASD), even without clinical seizures. A systematic literature search identified 7 randomized, placebo-controlled trials of antiepileptic drugs (AEDs) in ASD (total n = 171), including three of valproate, and one each of lamotrigine, levetiracetam, and topiramate. Meta-analysis revealed no significant difference between medication and placebo in four studies targeting irritability/agitation and three studies investigating global improvement, although limitations include lack of power and different medications with diverse actions. Across all seven studies, there was no significant difference in discontinuation rate between two groups. AEDs do not appear to have a large effect size to treat behavioral symptoms in ASD, but further research is needed, particularly in the subgroup of patients with epileptiform abnormalities. PMID:24077782

  20. Medical versus surgical methods of early abortion: protocol for a systematic review and environmental scan of patient decision aids

    PubMed Central

    Donnelly, Kyla Z; Thompson, Rachel

    2015-01-01

    Introduction Currently, we lack understanding of the content, quality and impact of patient decision aids to support decision-making between medical and surgical methods of early abortion. We plan to undertake a systematic review of peer-reviewed literature to identify, appraise and describe the impact of early abortion method decision aids evaluated quantitatively (Part I), and an environmental scan to identify and appraise other early abortion method decision aids developed in the US (Part II). Methods and analysis For the systematic review, we will search PubMed, Cochrane Library, CINAHL, EMBASE and PsycINFO databases for articles describing experimental and observational studies evaluating the impact of an early abortion method decision aid on women's decision-making processes and outcomes. For the environmental scan, we will identify decision aids by supplementing the systematic review search with Internet-based searches and key informant consultation. The primary reviewer will assess all studies and decision aids for eligibility, and a second reviewer will also assess a subset of these. Both reviewers will independently assess risk of bias in the studies and abstract data using a piloted form. Finally, both reviewers will assess decision aid quality using the International Patient Decision Aid Standards criteria, ease of readability using Flesch/Flesch-Kincaid tests, and informational content using directed content analysis. Ethics and dissemination As this study does not involve human subjects, ethical approval will not be sought. We aim to disseminate the findings in a scientific journal, via academic and/or professional conferences and among the broader community to contribute knowledge about current early abortion method decision-making support. Trial registration number This protocol is registered in the International Prospective Register of Systematic Reviews (CRD42015016717). PMID:26173718

  1. Prevalence and Cause of Self-Medication in Iran: A Systematic Review and Meta-Analysis Article

    PubMed Central

    AZAMI-AGHDASH, Saber; MOHSENI, Mohammad; ETEMADI, Manal; ROYANI, Sanaz; MOOSAVI, Ahmad; NAKHAEE, Majid

    2015-01-01

    Background: Nowadays self-medication is one of the most common public health issues in many countries, as well as in Iran. According to need to epidemiological information about self-medication, the aim of this study was to systematic review and meta-analysis of prevalence and cause of self-medication in community setting of Iran. Methods: Required data were collected searching following key words: medication, self-medication, over-the-counter, non-prescription, prevalence, epidemiology, etiology, occurrence and Iran in Google Scholar, PubMed, Scopus, Magiran, SID and IranMedex (from 2000 to 2015). To estimate the overall self-medication prevalence, computer software CMA: 2 applied. In order to report the results, forest plot was employed. Results: Out of 1256 articles, 25 articles entered to study. The overall prevalence of self-medication based on the random effect model was estimated to be 53% (95% CI, lowest= 42%, highest=67%). The prevalence of self-medication in students was 67% (95% CI, lowest=55%, highest=81%), in the household 36% (95% CI, lowest=17%, highest= 77%) and in the elderly people 68% (95% CI, lowest=54%, highest=84%). The most important cause of self-medication was mild symptoms of disease. The most important group of disease in which patients self-medicated was respiratory diseases and the most important group of medication was analgesics. Conclusion: The results show a relatively higher prevalence of self-medication among the Iranian community setting as compared to other countries. Raising public awareness, culture building and control of physicians and pharmacies’ performance can have beneficial effects in reduce of prevalence of self-medication. PMID:26811809

  2. The economic value of enteral medical nutrition in the management of disease-related malnutrition: a systematic review.

    PubMed

    Freijer, Karen; Bours, Martijn J L; Nuijten, Mark J C; Poley, Marten J; Meijers, Judith M M; Halfens, Ruud J G; Schols, Jos M G A

    2014-01-01

    Economic evaluations for medical nutrition, such as oral nutritional supplements (ONS), are relatively uncommon compared with other health technologies, and represent an area that has not been reviewed so far. In this systematic review, economic evaluations of enteral medical nutrition in the management of disease-related malnutrition (DRM) were reviewed and qualified to estimate the economic value. Initially, 481 studies were found, of which 37 full-text articles were assessed for eligibility and were rated on their quality using the Quality of Health Economic Studies (QHES) instrument. The final review focused on the high QHES quality economic evaluation studies. As both the studied medical nutrition intervention and the form of the economic evaluation varied, a quantitative synthesis (meta-analysis) was not attempted but a critical analysis and comparison of the individual study results were performed. ONS was the most studied intervention, covering several patient populations and different health care settings. Outcomes included cost savings (n = 3), no significant extra costs per unit of clinical and/or functional improvement (n = 1), or significantly higher costs per unit of clinical and/or functional improvement but still cost-effective for the used threshold (n = 4). This review shows that the use of enteral medical nutrition in the management of DRM can be efficient from a health economic perspective. PMID:24239013

  3. Effectiveness, Medication Patterns, and Adverse Events of Traditional Chinese Herbal Patches for Osteoarthritis: A Systematic Review

    PubMed Central

    Wang, Xuezong; Liu, Ting; Gao, Ningyang; Ding, Daofang; Duan, Tieli; Cao, Yuelong; Zheng, Yuxin

    2014-01-01

    Objective. The aim of this study is to systematically evaluate the evidence whether traditional Chinese herbal patches (TCHPs) for osteoarthritis (OA) are effective and safe and analyze their medication patterns. Methods. A systematic literature search was performed using all the possible Medical Subject Headings (MeSH) and keywords from January 1979 to July 2013. Both randomized controlled trials (RCTs) and observational studies were included. Estimated effects were analyzed using mean difference (MD) or relative risk (RR) with 95% confidence intervals (CI) and meta-analysis. Results. 86 kinds of TCHPs were identified. RCTs and controlled clinical trials (CCTs) which were mostly of low quality favored TCHPs for local pain and dysfunction relief. TCHPs, compared with diclofenac ointment, had significant effects on global effectiveness rate (RR = 0.50; 95% CI (0.29, 0.87)). Components of formulae were mainly based on the compounds “Xiao Huo Luo Dan” (Minor collateral-freeing pill) and “Du Huo Ji Sheng Tang” (Angelicae Pubescentis and Loranthi decoction). Ten kinds of adverse events (AEs), mainly consisting of itching and/or local skin rashes, were identified after 3-4 weeks of follow-up. Conclusions. TCHPs have certain evidence in improving global effectiveness rate for OA; however, more rigorous studies are warranted to support their use. PMID:24527043

  4. Adherence to cardiovascular medications in the South Asian population: A systematic review of current evidence and future directions

    PubMed Central

    Akeroyd, Julia M; Chan, Winston J; Kamal, Ayeesha K; Palaniappan, Latha; Virani, Salim S

    2015-01-01

    AIM: To review methods of assessing adherence and strategies to improve adherence to cardiovascular disease (CVD) medications, among South Asian CVD patients. METHODS: We conducted a systematic review of English language studies that examined CVD medication adherence in South Asian populations from 1966 to April 1, 2015 in SCOPUS and PubMed. Working in duplicate, we identified 61 studies. After exclusions, 26 studies were selected for full text review. Of these, 17 studies were included in the final review. We abstracted data on several factors including study design, study population, method of assessing adherence and adherence rate. RESULTS: These studies were conducted in India (n = 11), Pakistan (n = 3), Bangladesh (n = 1), Nepal (n = 1) and Sri Lanka (n = 1). Adherence rates ranged from 32%-95% across studies. Of the 17 total publications included, 10 focused on assessing adherence to CVD medications and 7 focused on assessing the impact of interventions on medication adherence. The validated Morisky Medication Adherence Scale (MMAS) was used as the primary method of assessing adherence in five studies. Three studies used validated questionnaires similar to the MMAS, and one study utilized Medication Event Monitoring System caps, with the remainder of the studies utilizing pill count and self-report measures. As expected, studies using non-validated self-report measures described higher rates of adherence than studies using validated scale measurements and pill count. The included intervention studies examined the use of polypill therapy, provider education and patient counseling to improve medication adherence. CONCLUSION: The overall medication adherence rates were low in the region, which suggest a growing need for future interventions to improve adherence. PMID:26730300

  5. The current provision of community-based teaching in UK medical schools: an online survey and systematic review

    PubMed Central

    Lee, Sandra W W; Clement, Naomi; Tang, Natalie; Atiomo, William

    2014-01-01

    Objective To evaluate the current provision and outcome of community-based education (CBE) in UK medical schools. Design and data sources An online survey of UK medical school websites and course prospectuses and a systematic review of articles from PubMed and Web of Science were conducted. Articles in the systematic review were assessed using Rossi, Lipsey and Freeman's approach to programme evaluation. Study selection Publications from November 1998 to 2013 containing information related to community teaching in undergraduate medical courses were included. Results Out of the 32 undergraduate UK medical schools, one was excluded due to the lack of course specifications available online. Analysis of the remaining 31 medical schools showed that a variety of CBE models are utilised in medical schools across the UK. Twenty-eight medical schools (90.3%) provide CBE in some form by the end of the first year of undergraduate training, and 29 medical schools (93.5%) by the end of the second year. From the 1378 references identified, 29 papers met the inclusion criteria for assessment. It was found that CBE mostly provided advantages to students as well as other participants, including GP tutors and patients. However, there were a few concerns regarding the lack of GP tutors’ knowledge in specialty areas, the negative impact that CBE may have on the delivery of health service in education settings and the cost of CBE. Conclusions Despite the wide variations in implementation, community teaching was found to be mostly beneficial. To ensure the relevance of CBE for ‘Tomorrow's Doctors’, a national framework should be established, and solutions sought to reduce the impact of the challenges within CBE. Strengths and limitations of this study This is the first study to review how community-based education is currently provided throughout Medical Schools in the UK. The use of Rossi, Lipsey and Freeman's method of programme evaluation means that the literature was analysed in a consistent and comprehensive way. However, a weakness is that data from the online survey was obtained from online medical school prospectuses. This means the data may be incomplete or out of date. Data in the literature review may also be skewed by publication bias. PMID:25448625

  6. Barriers to the acceptance of electronic medical records by physicians from systematic review to taxonomy and interventions

    PubMed Central

    2010-01-01

    Background The main objective of this research is to identify, categorize, and analyze barriers perceived by physicians to the adoption of Electronic Medical Records (EMRs) in order to provide implementers with beneficial intervention options. Methods A systematic literature review, based on research papers from 1998 to 2009, concerning barriers to the acceptance of EMRs by physicians was conducted. Four databases, "Science", "EBSCO", "PubMed" and "The Cochrane Library", were used in the literature search. Studies were included in the analysis if they reported on physicians' perceived barriers to implementing and using electronic medical records. Electronic medical records are defined as computerized medical information systems that collect, store and display patient information. Results The study includes twenty-two articles that have considered barriers to EMR as perceived by physicians. Eight main categories of barriers, including a total of 31 sub-categories, were identified. These eight categories are: A) Financial, B) Technical, C) Time, D) Psychological, E) Social, F) Legal, G) Organizational, and H) Change Process. All these categories are interrelated with each other. In particular, Categories G (Organizational) and H (Change Process) seem to be mediating factors on other barriers. By adopting a change management perspective, we develop some barrier-related interventions that could overcome the identified barriers. Conclusions Despite the positive effects of EMR usage in medical practices, the adoption rate of such systems is still low and meets resistance from physicians. This systematic review reveals that physicians may face a range of barriers when they approach EMR implementation. We conclude that the process of EMR implementation should be treated as a change project, and led by implementers or change managers, in medical practices. The quality of change management plays an important role in the success of EMR implementation. The barriers and suggested interventions highlighted in this study are intended to act as a reference for implementers of Electronic Medical Records. A careful diagnosis of the specific situation is required before relevant interventions can be determined. PMID:20691097

  7. Direct medical cost of overweight and obesity in the United States: a quantitative systematic review

    PubMed Central

    Tsai, Adam Gilden; Williamson, David F.; Glick, Henry A.

    2010-01-01

    Objectives To estimate per-person and aggregate direct medical costs of overweight and obesity and to examine the effect of study design factors. Methods PubMed (19682009), EconLit (19692009), and Business Source Premier (19952009) were searched for original studies. Results were standardized to compute the incremental cost per overweight person and per obese person, and to compute the national aggregate cost. Results A total of 33 U.S. studies met review criteria. Among the 4 highest quality studies, the 2008 per-person direct medical cost of overweight was $266 and of obesity was $1723. The aggregate national cost of overweight and obesity combined was $113.9 billion. Study design factors that affected cost estimate included: use of national samples versus more selected populations; age groups examined; inclusion of all medical costs versus obesity-related costs only; and BMI cutoffs for defining overweight and obesity. Conclusions Depending on the source of total national health care expenditures used, the direct medical cost of overweight and obesity combined is approximately 5.0% to 10% of U.S. health care spending. Future studies should include nationally representative samples, evaluate adults of all ages, report all medical costs, and use standard BMI cutoffs. PMID:20059703

  8. Hyperprolactinemia and medications for bipolar disorder: systematic review of a neglected issue in clinical practice.

    PubMed

    Pacchiarotti, Isabella; Murru, Andrea; Kotzalidis, Georgios D; Bonnin, C Mar; Mazzarini, Lorenzo; Colom, Francesc; Vieta, Eduard

    2015-08-01

    Drug-induced changes in serum prolactin (sPrl) levels constitute a relevant issue due to the potentially severe consequences on physical health of psychiatric patients such as sexual dysfunctions, osteoporosis and Prl-sensitive tumors. Several drugs have been associated to sPrl changes. Only antipsychotics have been extensively studied as sPrl-elevating agents in schizophrenia, but the extent to which bipolar disorder (BD) treatments affect sPrl levels is much less known. The objective of this systematic review is to summarize the evidence of the effects of drugs used in BD on Prl. This review followed the PRISMA statement. The MEDLINE/PubMed/Index Medicus, EMBASE, and Cochrane Library databases were systematically searched for articles in English appearing from any time to May 30, 2014. Twenty-six studies were included. These suggest that treatments for BD are less likely to be associated with Prl elevations, with valproate, quetiapine, lurasidone, mirtazapine, and bupropion reported not to change PRL levels significantly and lithium and aripiprazole to lower them in some studies. Taking into account the effects of the different classes of drugs on Prl may improve the care of BD patients requiring long-term pharmacotherapy. Based on the results of this review, lithium and valproate appear to be safer due to their low potential to elevate sPrL; among antipsychotics, quetiapine, lurasidone and aripiprazole appear to be similarly safe. PMID:25937241

  9. Prevention of medication-related osteonecrosis of the jaws secondary to tooth extractions. A systematic review

    PubMed Central

    Limeres, Jacobo

    2016-01-01

    Background A study was made to identify the most effective protocol for reducing the risk of osteonecrosis of the jaws (ONJ) following tooth extraction in patients subjected to treatment with antiresorptive or antiangiogenic drugs. Material and Methods A MEDLINE and SCOPUS search (January 2003 - March 2015) was made with the purpose of conducting a systematic literature review based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. All articles contributing information on tooth extractions in patients treated with oral or intravenous antiresorptive or antiangiogenic drugs were included. Results Only 13 of the 380 selected articles were finally included in the review: 11 and 5 of them offered data on patients treated with intravenous and oral bisphosphonates, respectively. No randomized controlled trials were found – all publications corresponding to case series or cohort studies. The prevalence of ONJ in the patients treated with intravenous and oral bisphosphonates was 6,9% (range 0-34.7%) and 0.47% (range 0-2.5%), respectively. The main preventive measures comprised local and systemic infection control. Conclusions No conclusive scientific evidence is available to date on the efficacy of ONJ prevention protocols in patients treated with antiresorptive or antiangiogenic drugs subjected to tooth extraction. Key words:Bisphosphonates, angiogenesis inhibitors, antiresorptive drugs, extraction, osteonecrosis. PMID:26827065

  10. Are interventions to reduce interruptions and errors during medication administration effective?: a systematic review

    PubMed Central

    Raban, Magdalena Z; Westbrook, Johanna I

    2014-01-01

    Background Medication administration errors are frequent and lead to patient harm. Interruptions during medication administration have been implicated as a potential contributory factor. Objective To assess evidence of the effectiveness of interventions aimed at reducing interruptions during medication administration on interruption and medication administration error rates. Methods In September 2012 we searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Effective Practice and Organisation of Care Group reviews, Google and Google Scholar, and hand searched references of included articles. Intervention studies reporting quantitative data based on direct observations of at least one outcome (interruptions, or medication administration errors) were included. Results Ten studies, eight from North America and two from Europe, met the inclusion criteria. Five measured significant changes in interruption rates pre and post interventions. Four found a significant reduction and one an increase. Three studies measured changes in medication administration error rates and showed reductions, but all implemented multiple interventions beyond those targeted at reducing interruptions. No study used a controlled design pre and post. Definitions for key outcome indicators were reported in only four studies. Only one study reported κ scores for inter-rater reliability and none of the multi-ward studies accounted for clustering in their analyses. Conclusions There is weak evidence of the effectiveness of interventions to significantly reduce interruption rates and very limited evidence of their effectiveness to reduce medication administration errors. Policy makers should proceed with great caution in implementing such interventions until controlled trials confirm their value. Research is also required to better understand the complex relationship between interruptions and error to support intervention design. PMID:23980188

  11. Packaging interventions to increase medication adherence: systematic review and meta-analysis

    PubMed Central

    Conn, Vicki S.; Ruppar, Todd M.; Chan, Keith C.; Dunbar-Jacob, Jacqueline; Pepper, Ginette A.; De Geest, Sabina

    2015-01-01

    Objective Inadequate medication adherence is a widespread problem that contributes to increase chronic disease complications and health care expenditures. Packaging interventions using pill boxes and blister packs have been widely recommended to address the medication adherence issue. This meta-analysis review determined the overall effect of packaging interventions on medication adherence and health outcomes. In addition, we tested whether effects vary depending on intervention, sample, and design characteristics. Research design and methods Extensive literature search strategies included examination of 13 computerized databases and 19 research registries, hand searches of 57 journal, and author and ancestry searches. Eligible studies included either pill-boxes or blister packaging interventions to increase medication adherence. Primary study characteristics and outcomes were reliably coded. Random-effects analyses were used to calculate overall effect sizes and conduct moderator analyses. Results Data were synthesized across 22,858 subjects from 52 reports. The overall mean weighted standardized difference effect size for two-group comparisons was 0.593 (favoring treatment over control), which is consistent with the mean of 71% adherence for treatment subjects compared to 63% among control subjects. We found using moderator analyses that interventions were most effective when they used blister packs and were delivered in pharmacies, while interventions were less effective when studies included older subjects and those with cognitive impairment. Methodological moderator analyses revealed significantly larger effect sizes in studies reporting continuous data outcomes instead of dichotomous results and in studies using pharmacy refill medication adherence measures as compared to studies with self-report measures. Conclusions Overall, meta-analysis findings support the use of packaging interventions to effectively increase medication adherence. Limitations of the study include the exclusion of packaging interventions other than pill boxes and blister packs, evidence of publication bias, and primary study sparse reporting of health outcomes and potentially interesting moderating variables such as the number of prescribed medications. PMID:25333709

  12. A systematic review and meta-analysis of pharmacist-led fee-for-services medication review

    PubMed Central

    Hatah, Ernieda; Braund, Rhiannon; Tordoff, June; Duffull, Stephen B

    2014-01-01

    Aim The aim was to examine the impact of fee-for-service pharmacist-led medication review on patient outcomes and quantify this according to the type of review undertaken, e.g. adherence support and clinical medication review. Methods Relevant published studies were identified from Medline, Embase and International Pharmaceutical Abstract databases (from inception to February 2011). Study inclusion criteria were fee-for-service medication review, presence of a control group and pre-specified patient outcomes. Outcomes were grouped into primary (changes in biomarkers, hospitalization, and mortality) and secondary outcomes (medication adherence, economic implications and quality of life). Meta-analyses for primary outcomes were conducted using random effects models and secondary outcomes were summarized using descriptive statistics. Results Of the 135 relevant articles located, 21 studies met the inclusion criteria for primary outcomes and 32 for secondary outcomes. Significant results favouring pharmacists' intervention were found for blood pressure (OR 3.50, 95% CI 1.58, 7.75, P = 0.002) and low density lipoprotein (OR 2.35, 95% CI 1.17, 4.72, P = 0.02). Outcomes on hospitalization (OR 0.69, 95% CI 0.39, 1.21, P = 0.19) and mortality (OR 1.50, 95% CI 0.65 to 3.46, P = 0.34) indicated no differences between the groups. On subgroup analysis, clinical medication review (OR 0.46, 95% CI 0.26, 0.83, P = 0.01) but not adherence support review (OR 0.88, 95% CI 0.59, 1.32, P = 0.54) reduced hospitalization. Conclusions The majority of the studies (57.9%) showed improvement in medication adherence. Fee-for-service pharmacist-led medication reviews showed positive benefits on patient outcomes. Interventions that include a clinical review had a significant impact on patient outcomes by attainment of target clinical biomarkers and reduced hospitalization. PMID:23594037

  13. Towards Web 3.0: Taxonomies and ontologies for medical education - a systematic review

    PubMed Central

    Blaum, Wolf E.; Jarczweski, Anne; Balzer, Felix; Stötzner, Philip; Ahlers, Olaf

    2013-01-01

    Introduction: Both for curricular development and mapping, as well as for orientation within the mounting supply of learning resources in medical education, the Semantic Web ("Web 3.0") poses a low-threshold, effective tool that enables identification of content related items across system boundaries. Replacement of the currently required manual with an automatically generated link, which is based on content and semantics, requires the use of a suitably structured vocabulary for a machine-readable description of object content. Aim of this study is to compile the existing taxonomies and ontologies used for the annotation of medical content and learning resources, to compare those using selected criteria, and to verify their suitability in the context described above. Methods: Based on a systematic literature search, existing taxonomies and ontologies for the description of medical learning resources were identified. Through web searches and/or direct contact with the respective editors, each of the structured vocabularies thus identified were examined in regards to topic, structure, language, scope, maintenance, and technology of the taxonomy/ontology. In addition, suitability for use in the Semantic Web was verified. Results: Among 20 identified publications, 14 structured vocabularies were identified, which differed rather strongly in regards to language, scope, currency, and maintenance. None of the identified vocabularies fulfilled the necessary criteria for content description of medical curricula and learning resources in the German-speaking world. Discussion: While moving towards Web 3.0, a significant problem lies in the selection and use of an appropriate German vocabulary for the machine-readable description of object content. Possible solutions include development, translation and/or combination of existing vocabularies, possibly including partial translations of English vocabularies. PMID:23467484

  14. The Efficacy of Traditional Chinese Medical Exercise for Parkinson’s Disease: A Systematic Review and Meta-analysis

    PubMed Central

    Hao, Yan Lei; Lv, Zhan Yun; Jiao, Shu Ji; Teng, Jun Feng

    2015-01-01

    Background and Objective Several studies assessed the efficacy of traditional Chinese medical exercise in the management of Parkinson’s disease (PD), but its role remained controversial. Therefore, the purpose of this systematic review is to evaluate the evidence on the effect of traditional Chinese medical exercise for PD. Methods Seven English and Chinese electronic databases, up to October 2014, were searched to identify relevant studies. The PEDro scale was employed to assess the methodological quality of eligible studies. Meta-analysis was performed by RevMan 5.1 software. Results Fifteen trials were included in the review. Tai Chi and Qigong were used as assisting pharmacological treatments of PD in the previous studies. Tai Chi plus medication showed greater improvements in motor function (standardized mean difference, SMD, -0.57; 95% confidence intervals, CI, -1.11 to -0.04), Berg balance scale (BBS, SMD, -1.22; 95% CI -1.65 to -0.80), and time up and go test (SMD, -1.06; 95% CI -1.44 to -0.68). Compared with other therapy plus medication, Tai Chi plus medication also showed greater gains in motor function (SMD, -0.78; 95% CI -1.46 to -0.10), BBS (SMD, -0.99; 95% CI -1.44 to -0.54), and functional reach test (SMD, -0.77; 95% CI -1.51 to -0.03). However, Tai Chi plus medication did not showed better improvements in gait or quality of life. There was not sufficient evidence to support or refute the effect of Qigong plus medication for PD. Conclusions In the previous studies, Tai Chi and Qigong were used as assisting pharmacological treatments of PD. The current systematic review showed positive evidence of Tai Chi plus medication for PD of mild-to-moderate severity. So Tai Chi plus medication should be recommended for PD management, especially in improving motor function and balance. Qigong plus medication also showed potential gains in the management of PD. However, more high quality studies with long follow-up are warrant to confirm the current findings. PMID:25830664

  15. Adherence, persistence, and medication discontinuation in patients with attention-deficit/hyperactivity disorder – a systematic literature review

    PubMed Central

    Gajria, Kavita; Lu, Mei; Sikirica, Vanja; Greven, Peter; Zhong, Yichen; Qin, Paige; Xie, Jipan

    2014-01-01

    Untreated attention-deficit/hyperactivity disorder (ADHD) can lead to substantial adverse social, economic, and emotional outcomes for patients. The effectiveness of current pharmacologic treatments is often reduced, due to low treatment adherence and medication discontinuation. This current systematic literature review analyzes the current state of knowledge surrounding ADHD medication discontinuation, focusing on: 1) the extent of patient persistence; 2) adherence; and 3) the underlying reasons for patients’ treatment discontinuation and how discontinuation rates and reasons vary across patient subgroups. We selected 91 original studies (67 with persistence/discontinuation results, 26 with adherence results, and 41 with reasons for discontinuation, switching, or nonadherence) and 36 expert opinion reviews on ADHD medication discontinuation, published from 1990 to 2013. Treatment persistence on stimulants, measured by treatment duration during the 12-month follow-up periods, averaged 136 days for children and adolescents and 230 days for adults. Owing to substantial study heterogeneity, comparisons across age or medication type subgroups were generally inconclusive; however, long-acting formulations and amphetamines were associated with longer treatment duration than short-acting formulations and methylphenidates. The medication possession ratio, used to measure adherence, was <0.7 for all age groups and medication classes during a 12-month period. Adverse effects were the most commonly cited reason for discontinuation in all studies. Original research studies reported the lack of symptom control as a common discontinuation reason, followed by dosing inconvenience, social stigma associated with ADHD medication, and the patient’s attitude. In summary, although there was a lack of consistency in the measurement of adherence and persistence, these findings indicate that drug adherence and persistence are generally poor among patients with ADHD. Clinicians may be able to help improve adherence and persistence to ADHD treatment by educating caregivers and patients on treatment goals, administering long-acting medications, and following-up with patients to verify if medication is still effective and well-tolerated. PMID:25187718

  16. What matters to patients? A systematic review of preferences for medication-associated outcomes in mental disorders

    PubMed Central

    Eiring, Øystein; Landmark, Brynjar Fowels; Aas, Endre; Salkeld, Glenn; Nylenna, Magne

    2015-01-01

    Objective To investigate patients’ preferences for outcomes associated with psychoactive medications. Setting/design Systematic review of stated preference studies. No settings restrictions were applied. Participants/eligibility criteria We included studies containing quantitative data regarding the relative value adults with mental disorders place on treatment outcomes. Studies with high risk of bias were excluded. Primary and secondary outcome measures We restricted the scope of our review to preferences for outcomes, including the consequences from, attributes of, and health states associated with particular medications or medication classes, and process outcomes. Results After reviewing 11 215 citations, 16 studies were included in the systematic review. These studies reported the stated preferences from patients with schizophrenia (n=9), depression (n=4), bipolar disorder (n=2) and attention deficit hyperactive disorder (n=1). The median sample size was 81. Side effects and symptom outcomes outnumbered functioning and process outcomes. Severe disease and hospitalisation were reported to be least desirable. Patients with schizophrenia tended to value disease states as higher and side effects as lower, compared to other stakeholder groups. In depression, the ability to cope with activities was found to be more important than a depressed mood, per se. Patient preferences could not consistently be predicted from demographic or disease variables. Only a limited number of potentially important outcomes had been investigated. Benefits to patients were not part of the purpose in 9 of the 16 studies, and in 10 studies patients were not involved when the outcomes to present were selected. Conclusions Insufficient evidence exists on the relative value patients with mental disorders place on medication-associated outcomes. To increase patient-centredness in decisions involving psychoactive drugs, further research—with outcomes elicited from patients, and for a larger number of conditions—should be undertaken. Trial registration number PROSPERO CRD42013005685. PMID:25854979

  17. A systematic review and thematic analysis of cinema in medical education.

    PubMed

    Darbyshire, Daniel; Baker, Paul

    2012-06-01

    The use of cinema in medical education has the potential to teach students about a variety of subjects, for instance by illustrating a lecture on communication skills with a clip of Sir Lancelot Spratt (Doctor In The House, 1954) demonstrating a paternalistic, doctor-centred approach to medicine or nurturing an ethical discussion around palliative care and dying using the cinematic adaptation of American playwright Margaret Edson's Wit (2001). Much has been written about this teaching method across several medical academic disciplines. It is the aim of this review to assimilate the various experiences in order to gain an insight into current expertise. The results are presented by the following headings under which the articles were examined: the source journal, year of publication, article type, theme, content, target, authors, if a clip or the entire film was used, and if any feedback was documented. This is followed by a chronological account of the development of the literature. Such an approach will allow the reader to gather specific information and contextualise it. This review does not critically appraise the quality of the evidence nor does it determine its validity, rather it is hoped that having read the review educators will know where to locate previous accounts of work that will help them develop more engaging pedagogy. PMID:22282424

  18. Failure or success of search strategies to identify adverse effects of medical devices: a feasibility study using a systematic review

    PubMed Central

    2014-01-01

    Background Research has indicated that adverse effects terms are increasingly prevalent in the title, abstract or indexing terms of articles that contain adverse drug effects data in MEDLINE and Embase. However, it is unknown whether adverse effects terms are present in the database records of articles that contain adverse effects data of medical devices, and thus, to what extent the development of an adverse effects search filter for medical devices may be feasible. Methods A case study systematic review of a medical device was selected. The included studies from a systematic review of the safety of recombinant human bone morphogenetic protein-2 (rhBMP-2) for spinal fusion were used in the analysis. For each included study, the corresponding database record on MEDLINE and Embase was assessed to measure the presence or absence of adverse effects terms in the title, abstract or indexing. The performance of each potential adverse effects search term was also measured and compared. Results There were 82 publications (49 studies) included in the systematic review with 51 of these indexed on MEDLINE and 55 on Embase. Ninety-four percent (48/51) of the records on MEDLINE and 95% (52/55) of the records on Embase contained at least one adverse effects related search term. The wide variety of adverse effects terms included in the title, abstract or indexing of bibliographic records, and the lack of any individual high-performing search terms suggests that a combination of terms in different fields is required to identify adverse effects of medical devices. In addition, the most successful search terms differed from the most successful terms for identifying adverse drug effects. Conclusions The search filters currently available for adverse drug effects are not necessarily useful for searching adverse effects data of medical devices. The presence of adverse effects terms in the bibliographic records of articles on medical devices, however, indicates that combinations of adverse effects search terms may be useful in search strategies in MEDLINE and Embase. The results, therefore, suggest that not only a search filter for the adverse effects of medical devices is feasible, but also that it should be a research priority. PMID:25312884

  19. Screening nonrandomized studies for medical systematic reviews: a comparative study of classifiers

    PubMed Central

    Bekhuis, Tanja; Demner-Fushman, Dina

    2012-01-01

    Objectives To investigate whether (1) machine learning classifiers can help identify nonrandomized studies eligible for full-text screening by systematic reviewers; (2) classifier performance varies with optimization; and (3) the number of citations to screen can be reduced. Methods We used an open-source, data-mining suite to process and classify biomedical citations that point to mostly nonrandomized studies from 2 systematic reviews. We built training and test sets for citation portions and compared classifier performance by considering the value of indexing, various feature sets, and optimization. We conducted our experiments in 2 phases. The design of phase I with no optimization was: 4 classifiers × 3 feature sets × 3 citation portions. Classifiers included k-nearest neighbor, naïve Bayes, complement naïve Bayes, and evolutionary support vector machine. Feature sets included bag of words, and 2- and 3-term n-grams. Citation portions included titles, titles and abstracts, and full citations with metadata. Phase II with optimization involved a subset of the classifiers, as well as features extracted from full citations, and full citations with overweighted titles. We optimized features and classifier parameters by manually setting information gain thresholds outside of a process for iterative grid optimization with 10-fold cross-validations. We independently tested models on data reserved for that purpose and statistically compared classifier performance on 2 types of feature sets. We estimated the number of citations needed to screen by reviewers during a second pass through a reduced set of citations. Results In phase I, the evolutionary support vector machine returned the best recall for bag of words extracted from full citations; the best classifier with respect to overall performance was k-nearest neighbor. No classifier attained good enough recall for this task without optimization. In phase II, we boosted performance with optimization for evolutionary support vector machine and complement naïve Bayes classifiers. Generalization performance was better for the latter in the independent tests. For evolutionary support vector machine and complement naïve Bayes classifiers, the initial retrieval set was reduced by 46% and 35%, respectively. Conclusions Machine learning classifiers can help identify nonrandomized studies eligible for full-text screening by systematic reviewers. Optimization can markedly improve performance of classifiers. However, generalizability varies with the classifier. The number of citations to screen during a second independent pass through the citations can be substantially reduced. PMID:22677493

  20. Adherence to medication in adults with attention deficit hyperactivity disorder and pro re nata dosing of psychostimulants: a systematic review.

    PubMed

    Caisley, H; Müller, U

    2012-07-01

    Adherence to a regular medication regimen may be challenging for adults with attention deficit hyperactivity disorder (ADHD). Some report taking psychostimulants on a pro re nata (PRN) basis. This review aims to establish the rate of adherence, and reasons for and consequences of non-adherence to medication for ADHD in adults, and to review literature on PRN dosing of psychostimulants in these patients. A systematic literature search was conducted. Four primary research studies have investigated the rate of adherence to medication in adults with ADHD. Mean adherence rate in two studies ranged from 52% to 87%. A number of possible reasons for poor adherence have been suggested. Prospective studies are needed to further define the rate of adherence and causes of poor adherence. Evidence examining whether differences in adherence affect clinical outcomes is equivocal. Therefore, caution should be applied to the assumption that maximising adherence to regular medication regimens will improve clinical outcomes. Two articles acknowledge that patients take medication on a PRN basis. Studies comparing the effectiveness of a regular and PRN regimen of psychostimulants are needed. If PRN dosing is as effective as a regular regimen, advantages might include enhanced doctor-patient communication, reduced side effects and cost savings. PMID:22521805

  1. Medication-related burden and patients’ lived experience with medicine: a systematic review and metasynthesis of qualitative studies

    PubMed Central

    Mohammed, Mohammed A; Moles, Rebekah J; Chen, Timothy F

    2016-01-01

    Objective To explore medication-related burden (MRB) and patients’ lived experience with medicines (PLEM) without regard to particular medication therapies or medical conditions. Design Systematic review and metasynthesis of qualitative studies. Data sources MEDLINE, EMBASE, International Pharmaceutical Abstracts, PsycINFO, Global health, CINAHL and Web of Science were searched from January 2000 to August 2014 using medication burden and patients’ lived experience terms. Synthesis methods Synthesis was undertaken following metaethnography methods and a comparative thematic analysis technique. Results 34 articles from 12 countries with a total of 1144 participants were included. 3 major inter-related themes emerged central to PLEM: MRB, medication related beliefs and medication taking practice. The negative impact of MRB, due to its interference on patients’ daily lives and effects on well-being, its influence on patients’ beliefs and behaviours, and a potential risk for drug-related problems (DRPs) was evident. This resulted in non-adherence and poorer outcomes (unachieved therapeutic goals and damage to patients’ health). Patients who experienced MRB interference in their life over time begin to juggle their medicines. Others continue their medicines despite experiencing MRB resulting in compromised physical, social or psychological well-being. Conclusions There is a shared commonality of PLEM among the studies. MRB plays a central role in influencing patients’ health and well-being, beliefs and behaviour towards medicines. Given the complexity of MRB and its impact evident from this review, there is a need for healthcare practitioners to have insight into PLEM in therapeutic care plans. Understanding PLEM is an opportunity for practitioners to identify particular MRBs that patients encounter, and provide individualised care through selection of therapeutic care plans that suit a patient's life. This may assist in helping to achieve patients’ medication-related needs, and improve medication therapy and health outcomes. PMID:26839015

  2. Assessing Communication Skills of Medical Students in Objective Structured Clinical Examinations (OSCE) - A Systematic Review of Rating Scales

    PubMed Central

    Cömert, Musa; Zill, Jördis Maria; Christalle, Eva; Dirmaier, Jörg; Härter, Martin; Scholl, Isabelle

    2016-01-01

    Background Teaching and assessment of communication skills have become essential in medical education. The Objective Structured Clinical Examination (OSCE) has been found as an appropriate means to assess communication skills within medical education. Studies have demonstrated the importance of a valid assessment of medical students’ communication skills. Yet, the validity of the performance scores depends fundamentally on the quality of the rating scales used in an OSCE. Thus, this systematic review aimed at providing an overview of existing rating scales, describing their underlying definition of communication skills, determining the methodological quality of psychometric studies and the quality of psychometric properties of the identified rating scales. Methods We conducted a systematic review to identify psychometrically tested rating scales, which have been applied in OSCE settings to assess communication skills of medical students. Our search strategy comprised three databases (EMBASE, PsycINFO, and PubMed), reference tracking and consultation of experts. We included studies that reported psychometric properties of communication skills assessment rating scales used in OSCEs by examiners only. The methodological quality of included studies was assessed using the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. The quality of psychometric properties was evaluated using the quality criteria of Terwee and colleagues. Results Data of twelve studies reporting on eight rating scales on communication skills assessment in OSCEs were included. Five of eight rating scales were explicitly developed based on a specific definition of communication skills. The methodological quality of studies was mainly poor. The psychometric quality of the eight rating scales was mainly intermediate. Discussion Our results reveal that future psychometric evaluation studies focusing on improving the methodological quality are needed in order to yield psychometrically sound results of the OSCEs assessing communication skills. This is especially important given that most OSCE rating scales are used for summative assessment, and thus have an impact on medical students’ academic success. PMID:27031506

  3. Patients’ perspectives on the medical primary–secondary care interface: systematic review and synthesis of qualitative research

    PubMed Central

    Sampson, Rod; Cooper, Jamie; Barbour, Rosaline; Polson, Rob; Wilson, Philip

    2015-01-01

    Objectives To synthesise the published literature on the patient experience of the medical primary–secondary care interface and to determine priorities for future work in this field aimed at improving clinical outcomes. Design Systematic review and metaethnographic synthesis of primary studies that used qualitative methods to explore patients’ perspectives of the medical primary–secondary care interface. Setting International primary–secondary care interface. Data sources EMBASE, MEDLINE, CINAHL Plus with Full text, PsycINFO, Psychology and Behavioural Sciences Collection, Health Business Elite, Biomedica Reference Collection: Comprehensive Library, Information Science & Technology Abstracts, eBook Collection, Web of Science Core Collection: Citation Indexes and Social Sciences Citation Index, and grey literature. Eligibility criteria for selecting studies Studies were eligible for inclusion if they were full research papers employing qualitative methodology to explore patients’ perspectives of the medical primary–secondary care interface. Review methods The 7-step metaethnographic approach described by Noblit and Hare, which involves cross-interpretation between studies while preserving the context of the primary data. Results The search identified 690 articles, of which 39 were selected for full-text review. 20 articles were included in the systematic review that encompassed a total of 689 patients from 10 countries. 4 important areas specific to the primary–secondary care interface from the patients’ perspective emerged: barriers to care, communication, coordination, and ‘relationships and personal value’. Conclusions and implications of key findings Patients should be the focus of any transfer of care between primary and secondary systems. From their perspective, areas for improvement may be classified into four domains that should usefully guide future work aimed at improving quality at this important interface. Trial registration number PROSPERO CRD42014009486. PMID:26474939

  4. Systematic review automation technologies

    PubMed Central

    2014-01-01

    Systematic reviews, a cornerstone of evidence-based medicine, are not produced quickly enough to support clinical practice. The cost of production, availability of the requisite expertise and timeliness are often quoted as major contributors for the delay. This detailed survey of the state of the art of information systems designed to support or automate individual tasks in the systematic review, and in particular systematic reviews of randomized controlled clinical trials, reveals trends that see the convergence of several parallel research projects. We surveyed literature describing informatics systems that support or automate the processes of systematic review or each of the tasks of the systematic review. Several projects focus on automating, simplifying and/or streamlining specific tasks of the systematic review. Some tasks are already fully automated while others are still largely manual. In this review, we describe each task and the effect that its automation would have on the entire systematic review process, summarize the existing information system support for each task, and highlight where further research is needed for realizing automation for the task. Integration of the systems that automate systematic review tasks may lead to a revised systematic review workflow. We envisage the optimized workflow will lead to system in which each systematic review is described as a computer program that automatically retrieves relevant trials, appraises them, extracts and synthesizes data, evaluates the risk of bias, performs meta-analysis calculations, and produces a report in real time. PMID:25005128

  5. The impact of African Americans' beliefs about HIV medical care on treatment adherence: a systematic review and recommendations for interventions.

    PubMed

    Gaston, Gina B; Alleyne-Green, Binta

    2013-01-01

    Disparities in access to and retention of regular HIV medical treatment persist among African Americans living with HIV. Many scholars believe that the mistrust of health care held by many African Americans stems from a legacy of abuse, from medical experimentation on slaves to the unethical practices with patients in the Tuskegee Syphilis study. We performed a systematic appraisal of the literature, using several key terms, in order to understand how attitudes about HIV-related health care influence African Americans' engagement in care. We examined peer-reviewed studies published during the period January 2001 through May 2012. An initial search generated 326 studies. Sixteen descriptive studies met our inclusion criteria. Experiences of racism, conspiracy beliefs and the quality of provider relationships appeared to impact engagement. Providers should openly investigate personal beliefs that adversely affect their treatment decisions, listen to patient narratives, and share treatment decisions in order to create a transparent environment. PMID:23010941

  6. Impact of family medicine clerkships in undergraduate medical education: a systematic review

    PubMed Central

    Turkeshi, Eralda; Michels, Nele R; Hendrickx, Kristin; Remmen, Roy

    2015-01-01

    Objective Synthesise evidence about the impact of family medicine/general practice (FM) clerkships on undergraduate medical students, teaching general/family practitioners (FPs) and/or their patients. Data sources Medline, ERIC, PsycINFO, EMBASE and Web of Knowledge searched from 21 November to 17 December 2013. Primary, empirical, quantitative or qualitative studies, since 1990, with abstracts included. No country restrictions. Full text languages: English, French, Spanish, German, Dutch or Italian. Review methods Independent selection and data extraction by two authors using predefined data extraction fields, including Kirkpatrick’s levels for educational intervention outcomes, study quality indicators and Best Evidence Medical Education (BEME) strength of findings’ grades. Descriptive narrative synthesis applied. Results Sixty-four included articles: impact on students (48), teaching FPs (12) and patients (8). Sample sizes: 16-1095 students, 3-146 FPs and 94-2550 patients. Twenty-six studies evaluated at Kirkpatrick level 1, 26 at level 2 and 6 at level 3. Only one study achieved BEME’s grade 5. The majority was assessed as grade 4 (27) and 3 (33). Students reported satisfaction with content and process of teaching as well as learning in FM clerkships. They enhanced previous learning, and provided unique learning on dealing with common acute and chronic conditions, health maintenance, disease prevention, communication and problem-solving skills. Students’ attitudes towards FM were improved, but new or enhanced interest in FM careers did not persist without change after graduation. Teaching FPs reported increased job satisfaction and stimulation for professional development, but also increased workload and less productivity, depending on the setting. Overall, student’s presence and participation did not have a negative impact on patients. Conclusions Research quality on the impact of FM clerkships is still limited, yet across different settings and countries, positive impact is reported on students, FPs and patients. Future studies should involve different stakeholders, medical schools and countries, and use standardised and validated evaluation tools. PMID:26243553

  7. A Systematic Review of the Level of Evidence in Economic Evaluations of Medical Devices: The Example of Vertebroplasty and Kyphoplasty

    PubMed Central

    van den Brink, Hélène; Pineau, Judith; Prognon, Patrice; Borget, Isabelle

    2015-01-01

    Context Economic evaluations are far less frequently reported for medical devices than for drugs. In addition, little is known about the quality of existing economic evaluations, particularly for innovative devices, such as those used in vertebroplasty and kyphoplasty. Objective To assess the level of evidence provided by the available economic evaluations for vertebroplasty and kyphoplasty. Data Sources A systematic review of articles in English or French listed in the MEDLINE, PASCAL, COCHRANE and National Health Service Economic Evaluation databases, with limits on publication date (up to the date of the review, March 2014). Study Selection We included only economic evaluations of vertebroplasty or kyphoplasty. Editorial and methodological articles were excluded. Data Extraction Data were extracted from articles by two authors working independently and using two analysis grids to measure the quality of economic evaluations. Data Synthesis Twenty-one studies met our inclusion criteria. All were published between 2008 and 2014. Eighteen (86%) were full economic evaluations. Cost-effectiveness analysis (CEA) was the most frequent type of economic evaluation, and was present in 11 (52%) studies. Only three CEAs complied fully with the British Medical Journal checklist. The quality of the data sources used in the 21 studies was high, but the CEAs conforming to methodological guidelines did not use high-quality data sources for all components of the analysis. Conclusions This systematic review shows that the level of evidence in economic evaluations of vertebroplasty and kyphoplasty is low, despite the recent publication of a large number of studies. This finding highlights the challenges to be faced to improve the quality of economic evaluations of medical devices. PMID:26661078

  8. Medical causes of admissions to hospital among adults in Africa: a systematic review

    PubMed Central

    Etyang, Anthony O.; Scott, John Anthony Gerard

    2013-01-01

    Background Despite the publication of several studies on the subject, there is significant uncertainty regarding the burden of disease among adults in sub-Saharan Africa (sSA). Objectives To describe the breadth of available data regarding causes of admission to hospital, to systematically analyze the methodological quality of these studies, and to provide recommendations for future research. Design We performed a systematic online and hand-based search for articles describing patterns of medical illnesses in patients admitted to hospitals in sSA between 1950 and 2010. Diseases were grouped into bodily systems using International Classification of Disease (ICD) guidelines. We compared the proportions of admissions and deaths by diagnostic category using χ2. Results Thirty articles, describing 86,307 admissions and 9,695 deaths, met the inclusion criteria. The leading causes of admission were infectious and parasitic diseases (19.8%, 95% confidence interval [CI] 19.6–20.1), respiratory (16.2%, 95% CI 16.0–16.5) and circulatory (11.3%, 95% CI 11.1–11.5) illnesses. The leading causes of death were infectious and parasitic (17.1%, 95% CI 16.4–17.9), circulatory (16%, 95% CI 15.3–16.8) and digestive (16.2%, 95% CI 15.4–16.9). Circulatory diseases increased from 3.9% of all admissions in 1950–59 to 19.9% in 2000–2010 (RR 5.1, 95% CI 4.5–5.8, test for trend p<0.00005). The most prevalent methodological deficiencies, present in two-thirds of studies, were failures to use standardized case definitions and ICD guidelines for classifying illnesses. Conclusions Cardiovascular and infectious diseases are currently the leading causes of admissions and in-hospital deaths in sSA. Methodological deficiencies have limited the usefulness of previous studies in defining national patterns of disease in adults. As African countries pass through demographic and health transition, they need to significantly invest in clinical research capacity to provide an accurate description of the disease burden among adults for public health policy. PMID:23336616

  9. Efficacy of Atypical Antipsychotic Medication in the Management of Behaviour Problems in Children with Intellectual Disabilities and Borderline Intelligence: A Systematic Review

    ERIC Educational Resources Information Center

    Unwin, Gemma L.; Deb, Shoumitro

    2011-01-01

    The use of medications to manage problem behaviours is widespread. However, robust evidence to support their use seems to be lacking. The aim was to review research evidence into the efficacy of atypical antipsychotic medication in managing problem behaviour in children with intellectual disabilities and borderline intelligence. A systematic

  10. The Effectiveness of Mood Stabilizers and Antiepileptic Medication for the Management of Behaviour Problems in Adults with Intellectual Disability: A Systematic Review

    ERIC Educational Resources Information Center

    Deb, S.; Chaplin, R.; Sohanpal, S.; Unwin, G.; Soni, R.; Lenotre, L.

    2008-01-01

    Background: Psychotropic medications are used to manage behaviour problems in adults with intellectual disability (ID). One group of psychotropic medication are mood stabilizers such as lithium and some antiepileptic drugs. Method: A comprehensive systematic review was performed to determine the evidence base for the effectiveness of mood…

  11. Treating tobacco use disorder in pregnant women in medication-assisted treatment for an opioid use disorder: a systematic review.

    PubMed

    Akerman, Sarah C; Brunette, Mary F; Green, Alan I; Goodman, Daisy J; Blunt, Heather B; Heil, Sarah H

    2015-05-01

    Smoking is associated with adverse effects on pregnancy and fetal development, yet 88-95% of pregnant women in medication-assisted treatment for an opioid use disorder smoke cigarettes. This review summarizes existing knowledge about smoking cessation treatments for pregnant women on buprenorphine or methadone, the two forms of medication-assisted treatment for opioid use disorder indicated for prenatal use. We performed a systematic review of the literature using indexed terms and key words to capture the concepts of smoking, pregnancy, and opioid substitution and found that only three studies met search criteria. Contingency management, an incentive based treatment, was the most promising intervention: 31% of participants achieved abstinence within the 12-week study period, compared to 0% in a non-contingent behavior incentive group and a group receiving usual care. Two studies of brief behavioral interventions resulted in reductions in smoking but not cessation. Given the growing number of pregnant women in medication-assisted treatment for an opioid use disorder and the negative consequences of smoking on pregnancy, further research is needed to develop and test effective cessation strategies for this group. PMID:25592332

  12. Inappropriate medication use among the elderly: a systematic review of administrative databases

    PubMed Central

    2011-01-01

    Background Inappropriate medication use (IMU) by elderly people is a public health problem associated with adverse effects on health. There are a number of methods for identifying IMU, some involving clinical judgment and others, consensually generated lists of drugs to be avoided. This review aims to describe studies that used information from insurance company and social security administrative databases to assess IMU among community-dwelling elderly and to present the risk factors most often associated with IMU. Methods The paper search was conducted in Medline and Embase, using descriptors combined with free terms in the title or abstract. The limits applied were: publication date from January 1990 to June 2010, species (human) and publication type (excluding editorials, letters and reviews). Excluded were: case studies; studies in hospitals, nursing homes, or hospital emergency departments; studies of specific drugs or groups of drugs; studies exclusively of subgroups of ill, frail elderly or rural populations. Additional studies were identified from reference lists. Data were selected and extracted after independent reading by two of the authors, with disagreements resolved by a third author. The primary outcome assessed was prevalence of IMU, defined as the proportion of elderly who received at least one inappropriate medication. Results Of the 628 studies, 19 met the inclusion criteria, 78.9% of them conducted in the USA. All papers included used explicit criteria of inappropriateness, most commonly Beers criteria (73.7%) in their three versions (1991, 1997 and 2002). Other methods used included Zhan, which is derived from on Beers criteria and was applied in 21% of the papers selected. The study found that prevalence of IMU ranged from 11.5% to 62.5%. Only 68.4% of the studies included examined inappropriate use-related factors, the most important being female sex, advanced age and larger number of drugs. Conclusions The results show that the prevalence of IMU among community-dwelling elderly is high and depends partly on the method used to evaluate improper use. Besides the diversity of methods, other factors, such as patient sex, age and number of drugs used concurrently, appear to have influenced the estimates of IMU. PMID:22129458

  13. Sleep-Related Violence and Sexual Behavior in Sleep: A Systematic Review of Medical-Legal Case Reports

    PubMed Central

    Ingravallo, Francesca; Poli, Francesca; Gilmore, Emma V.; Pizza, Fabio; Vignatelli, Luca; Schenck, Carlos H.; Plazzi, Giuseppe

    2014-01-01

    Objective: To review systematically medical-legal cases of sleep-related violence (SRV) and sexual behavior in sleep (SBS). Search Methods: We searched Pubmed and PsychINFO (from 1980 to 2012) with pre-specified terms. We also searched reference lists of relevant articles. Selection Criteria: Case reports in which a sleep disorder was purported as the defense during a criminal trial and in which information about the forensic evaluation of the defendant was provided. Data Extraction and Analysis: Information about legal issues, defendant and victim characteristics, circumstantial factors, and forensic evaluation was extracted from each case. A qualitative-comparative assessment of cases was performed. Results: Eighteen cases (9 SRV and 9 SBS) were included. The charge was murder or attempted murder in all SRV cases, while in SBS cases the charge ranged from sexual touching to rape. The defense was based on sleepwalking in 11 of 18 cases. The trial outcome was in favor of the defendant in 14 of 18 cases. Defendants were relatively young males in all cases. Victims were usually adult relatives of the defendants in SRV cases and unrelated young girls or adolescents in SBS cases. In most cases the criminal events occurred 1-2 hours after the defendant's sleep onset, and both proximity and other potential triggering factors were reported. The forensic evaluations widely differed from case to case. Conclusion: SRV and SBS medical-legal cases did not show apparent differences, except for the severity of the charges and the victim characteristics. An international multidisciplinary consensus for the forensic evaluation of SRV and SBS should be developed as an urgent priority. Citation: Ingravallo F, Poli F, Gilmore EV, Pizza F, Vignatelli L, Schenck CH, Plazzi G. Sleep-related violence and sexual behavior in sleep: a systematic review of medical-legal case reports. J Clin Sleep Med 2014;10(8):927-935. PMID:25126042

  14. Cytocompatibility of medical biomaterials containing nickel by osteoblasts: a systematic literature review.

    TOXLINE Toxicology Bibliographic Information

    Mikulewicz M; Chojnacka K

    2011-09-01

    The present review is based on a survey of 21 studies on the cytocompatibility of medical biomaterials containing nickel, as assessed by cell culture of human and animal osteoblasts or osteoblast-like cells. Among the biomaterials evaluated were stainless steel, NiTi alloys, pure Ni, Ti, and other pure metals. The materials were either commercially available, prepared by the authors, or implanted by various techniques to generate a protective layer of oxides, nitrides, acetylides. The observation that the layers significantly reduced the initial release of metal ions and increased cytocompatibility was confirmed in cell culture experiments. Physical and chemical characterization of the materials was performed. This included, e.g., surface characterization (roughness, wettability, corrosion behavior, quantity of released ions, microhardness, and characterization of passivation layer). Cytocompatibility tests of the materials were conducted in the cultures of human or animal osteoblasts and osteoblast-like cells. The following assays were carried out: cell proliferation and viability test, adhesion test, morphology (by fluorescent microscopy or SEM). Also phenotypic and genotypic markers were investigated. In the majority of works, it was found that the most cytocompatible materials were stainless steel and NiTi alloy. Pure Ni was rendered and less cytocompatible. All the papers confirmed that the consequence of the formation of protective layers was in significant increase of cytocompatibility of the materials. This indicates the possible further modifications of the manufacturing process (formation of the passivation layer).

  15. Autonomic nervous system dysfunction in psychiatric disorders and the impact of psychotropic medications: a systematic review and meta-analysis

    PubMed Central

    Alvares, Gail A.; Quintana, Daniel S.; Hickie, Ian B.; Guastella, Adam J.

    2016-01-01

    Background Autonomic nervous system (ANS) dysfunction is a putative underlying mechanism for increased cardiovascular disease risk in individuals with psychiatric disorders. Previous studies suggest that this risk may be related to psychotropic medication use. In the present study we systematically reviewed and analyzed published studies of heart rate variability (HRV), measuring ANS output, to determine the effect of psychiatric illness and medication use. Methods We searched for studies comparing HRV in physically healthy adults with a diagnosed psychiatric disorder to controls and comparing HRV pre- and post-treatment with a psychotropic medication. Results In total, 140 case–control (mood, anxiety, psychosis, dependent disorders, k = 151) and 30 treatment (antidepressants, antipsychotics; k = 43) studies were included. We found that HRV was reduced in all patient groups compared to controls (Hedges g = −0.583) with a large effect for psychotic disorders (Hedges g = −0.948). Effect sizes remained highly significant for medication-free patients compared to controls across all disorders. Smaller and significant reductions in HRV were observed for specific antidepressants and antipsychotics. Limitations Study quality significantly moderated effect sizes in case–control analyses, underscoring the importance of assessing methodological quality when interpreting HRV findings. Conclusion Combined findings confirm substantial reductions in HRV across psychiatric disorders, and these effects remained significant even in medication-free individuals. Reductions in HRV may therefore represent a significant mechanism contributing to elevated cardiovascular risk in individuals with psychiatric disorders. The negative impact of specific medications on HRV suggest increased risk for cardiovascular disease in these groups, highlighting a need for treatment providers to consider modifiable cardiovascular risk factors to attenuate this risk. PMID:26447819

  16. A Systematic Review of Teamwork Training Interventions in Medical Student and Resident Education

    PubMed Central

    Boonyasai, Romsai T.; Wright, Scott M.; Kern, David E.

    2008-01-01

    Background Teamwork is important for improving care across transitions between providers and for increasing patient safety. Objective This review’s objective was to assess the characteristics and efficacy of published curricula designed to teach teamwork to medical students and house staff. Design The authors searched MEDLINE, Education Resources Information Center, Excerpta Medica Database, PsychInfo, Cumulative Index of Nursing and Allied Health Literature, and Scopus for original data articles published in English between January 1980 and July 2006 that reported descriptions of teamwork training and evaluation results. Measurements Two reviewers independently abstracted information about curricular content (using Baker’s framework of teamwork competencies), educational methods, evaluation design, outcomes measured, and results. Results Thirteen studies met inclusion criteria. All curricula employed active learning methods; the majority (77%) included multidisciplinary training. Ten curricula (77%) used an uncontrolled pre/post design and 3 (23%) used controlled pre/post designs. Only 3 curricula (23%) reported outcomes beyond end of program, and only 1 (8%) >6weeks after program completion. One program evaluated a clinical outcome (patient satisfaction), which was unchanged after the intervention. The median effect size was 0.40 (interquartile range (IQR) 0.29, 0.61) for knowledge, 0.38 (IQR 0.32, 0.41) for attitudes, 0.41 (IQR 0.35, 0.49) for skills and behavior. The relationship between the number of teamwork principles taught and effect size achieved a Spearman’s correlation of .74 (p = .01) for overall effect size and .64 (p = .03) for median skills/behaviors effect size. Conclusions Reported curricula employ some sound educational principles and appear to be modestly effective in the short term. Curricula may be more effective when they address more teamwork principles. PMID:18386100

  17. A Systematic Review of Stress-Management Programs for Medical Students

    ERIC Educational Resources Information Center

    Shiralkar, Malan T.; Harris, Toi B.; Eddins-Folensbee, Florence F.; Coverdale, John H.

    2013-01-01

    Objective: Because medical students experience a considerable amount of stress during training, academic leaders have recognized the importance of developing stress-management programs for medical students. The authors set out to identify all controlled trials of stress-management interventions and determine the efficacy of those interventions.

  18. A Systematic Review of Stress-Management Programs for Medical Students

    ERIC Educational Resources Information Center

    Shiralkar, Malan T.; Harris, Toi B.; Eddins-Folensbee, Florence F.; Coverdale, John H.

    2013-01-01

    Objective: Because medical students experience a considerable amount of stress during training, academic leaders have recognized the importance of developing stress-management programs for medical students. The authors set out to identify all controlled trials of stress-management interventions and determine the efficacy of those interventions.…

  19. Adherence to Antiretroviral Medications among Persons who Inject Drugs in Transitional, Low and Middle Income Countries: An International Systematic Review

    PubMed Central

    Feelemyer, Jonathan; Jarlais, Don Des; Arasteh, Kamyar; Uuskula, Anneli

    2014-01-01

    Adherence to antiretroviral (ART) medication is vital to reducing morbidity and mortality among HIV positive persons. People who inject drugs (PWID) are at high risk for HIV infection in transitional/low/middle income countries (TLMIC). We conducted a systematic review of studies reporting adherence to ARTs among persons with active injection drug use and/or histories of injection drug use in TLMIC. Meta-regression was performed to examine relationships between location, adherence measurements, and follow-up period. Fifteen studies were included from seven countries. Adherence levels ranged from 33% to 97%; mean weighted adherence was 72%. ART adherence was associated with different methods of measuring adherence and studies conducted in Eastern Europe and East Asia. The great heterogeneity observed precludes generalization to TLMIC as a whole. Given the critical importance of ART adherence more research is needed on ART adherence among PWID in TLMIC, including the use of standardized methods for reporting adherence to ARTs. PMID:25331268

  20. Adherence to antiretroviral medications among persons who inject drugs in transitional, low and middle income countries: an international systematic review.

    PubMed

    Feelemyer, Jonathan; Des Jarlais, Don; Arasteh, Kamyar; Uusküla, Anneli

    2015-04-01

    Adherence to antiretroviral (ART) medication is vital to reducing morbidity and mortality among HIV positive persons. People who inject drugs (PWID) are at high risk for HIV infection in transitional/low/middle income countries (TLMIC). We conducted a systematic review of studies reporting adherence to ART among persons with active injection drug use and/or histories of injection drug use in TLMIC. Meta-regression was performed to examine relationships between location, adherence measurements, and follow-up period. Fifteen studies were included from seven countries. Adherence levels ranged from 33 to 97 %; mean weighted adherence was 72 %. ART adherence was associated with different methods of measuring adherence and studies conducted in Eastern Europe and East Asia. The great heterogeneity observed precludes generalization to TLMIC as a whole. Given the critical importance of ART adherence more research is needed on ART adherence among PWID in TLMIC, including the use of standardized methods for reporting adherence to ART. PMID:25331268

  1. Antiepileptic Medications in Autism Spectrum Disorder: A Systematic Review and Meta-Analysis

    ERIC Educational Resources Information Center

    Hirota, Tomoya; Veenstra-VanderWeele, Jeremy; Hollander, Eric; Kishi, Taro

    2014-01-01

    Electroencephalogram-recorded epileptiform activity is common in children with autism spectrum disorder (ASD), even without clinical seizures. A systematic literature search identified 7 randomized, placebo-controlled trials of antiepileptic drugs (AEDs) in ASD (total n = 171), including three of valproate, and one each of lamotrigine,…

  2. Antiepileptic Medications in Autism Spectrum Disorder: A Systematic Review and Meta-Analysis

    ERIC Educational Resources Information Center

    Hirota, Tomoya; Veenstra-VanderWeele, Jeremy; Hollander, Eric; Kishi, Taro

    2014-01-01

    Electroencephalogram-recorded epileptiform activity is common in children with autism spectrum disorder (ASD), even without clinical seizures. A systematic literature search identified 7 randomized, placebo-controlled trials of antiepileptic drugs (AEDs) in ASD (total n=171), including three of valproate, and one each of lamotrigine,

  3. Ethnicity and academic performance in UK trained doctors and medical students: systematic review and meta-analysis

    PubMed Central

    Potts, Henry W W; McManus, I C

    2011-01-01

    Objective To determine whether the ethnicity of UK trained doctors and medical students is related to their academic performance. Design Systematic review and meta-analysis. Data sources Online databases PubMed, Scopus, and ERIC; Google and Google Scholar; personal knowledge; backwards and forwards citations; specific searches of medical education journals and medical education conference abstracts. Study selection The included quantitative reports measured the performance of medical students or UK trained doctors from different ethnic groups in undergraduate or postgraduate assessments. Exclusions were non-UK assessments, only non-UK trained candidates, only self reported assessment data, only dropouts or another non-academic variable, obvious sampling bias, or insufficient details of ethnicity or outcomes. Results 23 reports comparing the academic performance of medical students and doctors from different ethnic groups were included. Meta-analyses of effects from 22 reports (n=23 742) indicated candidates of “non-white” ethnicity underperformed compared with white candidates (Cohen’s d=−0.42, 95% confidence interval −0.50 to −0.34; P<0.001). Effects in the same direction and of similar magnitude were found in meta-analyses of undergraduate assessments only, postgraduate assessments only, machine marked written assessments only, practical clinical assessments only, assessments with pass/fail outcomes only, assessments with continuous outcomes only, and in a meta-analysis of white v Asian candidates only. Heterogeneity was present in all meta-analyses. Conclusion Ethnic differences in academic performance are widespread across different medical schools, different types of exam, and in undergraduates and postgraduates. They have persisted for many years and cannot be dismissed as atypical or local problems. We need to recognise this as an issue that probably affects all of UK medical and higher education. More detailed information to track the problem as well as further research into its causes is required. Such actions are necessary to ensure a fair and just method of training and of assessing current and future doctors. PMID:21385802

  4. Medical Utilization of Kiosks in the Delivery of Patient Education: A Systematic Review

    PubMed Central

    Yvonne Chan, Yu-Feng; Nagurka, Roxanne; Bentley, Suzanne; Ordonez, Edgardo; Sproule, William

    2014-01-01

    Background: The utilization of kiosks has previously been shown to be effective for collecting information, delivering educational modules, and providing access to health information. We discuss a review of current literature for the utilization of kiosks for the delivery of patient education. Methods: The criteria for inclusion in this literature review were: (1) study discusses the utilization of kiosks for patient health education; (2) study discusses the use of touch screens for patient health information; (3) published in English. Our review includes searches via MEDLINE databases and Google Scholar for the years 1996-2014. Results: Overall, 167 articles were screened for final eligibility, and after discarding duplicates and non-eligible studies with abstract. Full-text review of 28 articles was included in the final analysis. Conclusion: The review of available literature demonstrates the effectiveness of touch screen kiosks to educate patients and to improve healthcare, both at a performance and cost advantage over other modes of patient education. PMID:25097831

  5. THE ASSOCIATION OF DEPRESSION WITH ADHERENCE TO ANTIHYPERTENSIVE MEDICATIONS: A SYSTEMATIC REVIEW

    PubMed Central

    Eze-Nliam, Chete M.; Thombs, Brett D.; Lima, Bruno B.; Smith, Cheri G.; Ziegelstein, Roy C.

    2010-01-01

    Objective To examine the strength and consistency of the evidence on the relationship between depression and adherence to antihypertensive medications. Methods The MEDLINE, CINAHL, PsycINFO, Embase, SCOPUS, and ISI databases were searched from inception until December 11, 2009 for published studies of original research that assessed adherence to antihypertensive medications and used a standardized interview, validated questionnaire or International Classification of Diseases Ninth Revision (ICD-9) code to assess depression or symptoms of depression in patients with hypertension. Manual searching was conducted on 22 selected journals. Citations of included articles were tracked using Web of Science and Google Scholar. Two investigators independently extracted data from the selected articles and discrepancies were resolved by consensus. Results Eight studies were identified that included a total of 42,790 patients. 95% of these patients were from one study. Only 4 of the studies had the assessment of this relationship as a primary objective. Adherence rates varied from 29% to 91%. There were widely varying results within and across studies. All 8 studies reported at least one significant bivariate or multivariate negative relationship between depression and adherence to antihypertensive medications. Insignificant findings in bivariate or multivariate analyses were reported in 6 of 8 studies. Conclusions All studies reported statistically significant relationships between depression and poor adherence to antihypertensive medications, but definitive conclusions cannot be drawn because of substantial heterogeneity between studies with respect to the assessment of depression and adherence, as well as inconsistencies in results both within and between studies. Additional studies would help clarify this relationship. PMID:20531223

  6. Effect of thromboprophylaxis with anticoagulant drugs on the incidence of arterial thrombotic events in medical inpatients: a systematic review.

    PubMed

    Squizzato, Alessandro; Lussana, Federico; Ageno, Walter; Cattaneo, Marco

    2016-04-01

    Pharmacological prophylaxis of venous thromboembolism (VTE) is recommended for medical inpatients. Since arterial thrombosis (AT) shares some risk factors with VTE, it would be reasonable to assess the efficacy of thromboprophylaxis by considering both VTE and AT as outcome events. We performed a systematic review and meta-analysis of phase III RCTs on thromboprophylaxis in medical inpatients, to evaluate the quality of reporting and the incidence of AT, and the effect of thromboprophylaxis with anticoagulants on AT incidence. Studies were identified by a combined search strategy until May 2015. Differences in outcomes among groups were expressed as pooled odds ratios (OR) and 95 % confidence intervals (CI). Statistical heterogeneity was assessed by I (2) statistic. Twenty phase III RCTs, encompassing 54,742 patients, were included; of these, 3 (15 %) reported on AT as a pre-defined secondary outcome and 8 (40 %) on at least one AT outcome. Raw-unweighed incidence of fatal MI in the three RCTs is 0.37 % in patients receiving unfractionated heparin or enoxaparin, and 0.38 % in controls (OR 0.97, 95 % CI 0.62-1.52; I (2) = 0 %). A non-statistically significant increase in AT is reported in patients on enoxaparin compared to control (OR 1.95, 95 % CI 0.89-4.27; I (2) = 13 %). AT is underreported in RCTs on VTE prophylaxis in medical inpatients. Published data suggest that incidence of fatal MI in these patients may be clinically relevant. Insufficient data are available to draw firm conclusions on the effects of thromboprophylaxis with anticoagulants on AT incidence in this setting. PMID:26980086

  7. Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis

    PubMed Central

    Anderson, Kristen; Stowasser, Danielle; Freeman, Christopher; Scott, Ian

    2014-01-01

    Objective To synthesise qualitative studies that explore prescribers perceived barriers and enablers to minimising potentially inappropriate medications (PIMs) chronically prescribed in adults. Design A qualitative systematic review was undertaken by searching PubMed, EMBASE, Scopus, PsycINFO, CINAHL and INFORMIT from inception to March 2014, combined with an extensive manual search of reference lists and related citations. A quality checklist was used to assess the transparency of the reporting of included studies and the potential for bias. Thematic synthesis identified common subthemes and descriptive themes across studies from which an analytical construct was developed. Study characteristics were examined to explain differences in findings. Setting All healthcare settings. Participants Medical and non-medical prescribers of medicines to adults. Outcomes Prescribers perspectives on factors which shape their behaviour towards continuing or discontinuing PIMs in adults. Results 21 studies were included; most explored primary care physicians perspectives on managing older, community-based adults. Barriers and enablers to minimising PIMs emerged within four analytical themes: problem awareness; inertia secondary to lower perceived value proposition for ceasing versus continuing PIMs; self-efficacy in regard to personal ability to alter prescribing; and feasibility of altering prescribing in routine care environments given external constraints. The first three themes are intrinsic to the prescriber (eg, beliefs, attitudes, knowledge, skills, behaviour) and the fourth is extrinsic (eg, patient, work setting, health system and cultural factors). The PIMs examined and practice setting influenced the themes reported. Conclusions A multitude of highly interdependent factors shape prescribers behaviour towards continuing or discontinuing PIMs. A full understanding of prescriber barriers and enablers to changing prescribing behaviour is critical to the development of targeted interventions aimed at deprescribing PIMs and reducing the risk of iatrogenic harm. PMID:25488097

  8. Mentoring Programs for Underrepresented Minority Faculty in Academic Medical Centers: A Systematic Review of the Literature

    PubMed Central

    Beech, Bettina M.; Calles-Escandon, Jorge; Hairston, Kristen G.; Langdon, Sarah E.; Latham-Sadler, Brenda A.; Bell, Ronny A.

    2013-01-01

    Purpose Mentoring is critical for career advancement in academic medicine. However, underrepresented minority (URM) faculty often receive less mentoring than their nonminority peers. The authors conducted a comprehensive review of published mentoring programs designed for URM faculty to identify “promising practices.” Method Databases (PubMed, PsycINFO, ERIC, PsychLit, Google Scholar, Dissertations Abstracts International, CINHAL, Sociological Abstracts) were searched for articles describing URM faculty mentoring programs. The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance) formed the model for analyzing programs. Results The search identified 73 citations. Abstract reviews led to retrieval of 38 full-text articles for assessment; 18 articles describing 13 programs were selected for review. The reach of these programs ranged from 7 to 128 participants. Most evaluated programs on the basis of the number of grant applications and manuscripts produced or satisfaction with program content. Programs offered a variety of training experiences, and adoption was relatively high, with minor changes made for implementing the intended content. Barriers included time-restricted funding, inadequate evaluation due to few participants, significant time commitments required from mentors, and difficulty in addressing institutional challenges faced by URM faculty. Program sustainability was a concern because programs were supported through external funds, with minimal institutional support. Conclusions Mentoring is an important part of academic medicine, particularly for URM faculty who often experience unique career challenges. Despite this need, relatively few publications exist to document mentoring programs for this population. Institutionally supported mentoring programs for URM faculty are needed, along with detailed plans for program sustainability. PMID:23425989

  9. A Systematic Review of Glomerular Hyperfiltration Assessment and Definition in the Medical Literature

    PubMed Central

    Combescure, Christophe; Cauderay, Michel; Girardin, Eric; Chehade, Hassib

    2015-01-01

    Background and objectives Evaluation of glomerular hyperfiltration (GH) is difficult; the variable reported definitions impede comparisons between studies. A clear and universal definition of GH would help in comparing results of trials aimed at reducing GH. This study assessed how GH is measured and defined in the literature. Design, setting, participants, & measurements Three databases (Embase, MEDLINE, CINAHL) were systematically searched using the terms “hyperfiltration” or “glomerular hyperfiltration”. All studies reporting a GH threshold or studying the effect of a high GFR in a continuous manner against another outcome of interest were included. Results The literature search was performed from November 2012 to February 2013 and updated in August 2014. From 2013 retrieved studies, 405 studies were included. Threshold use to define GH was reported in 55.6% of studies. Of these, 88.4% used a single threshold and 11.6% used numerous thresholds adapted to participant sex or age. In 29.8% of the studies, the choice of a GH threshold was not based on a control group or literature references. After 2004, the use of GH threshold use increased (P<0.001), but the use of a control group to precisely define that GH threshold decreased significantly (P<0.001); the threshold did not differ among pediatric, adult, or mixed-age studies. The GH threshold ranged from 90.7 to 175 ml/min per 1.73 m2 (median, 135 ml/min per 1.73 m2). Conclusion Thirty percent of studies did not justify the choice of threshold values. The decrease of GFR in the elderly was rarely considered in defining GH. From a methodologic point of view, an age- and sex-matched control group should be used to define a GH threshold. PMID:25568216

  10. Why Are Medical and Health-Related Studies Not Being Published? A Systematic Review of Reasons Given by Investigators

    PubMed Central

    Song, Fujian; Loke, Yoon; Hooper, Lee

    2014-01-01

    Objective About half of medical and health-related studies are not published. We conducted a systematic review of reports on reasons given by investigators for not publishing their studies in peer-reviewed journals. Methods MEDLINE, EMBASE, PsycINFO, and SCOPUS (until 13/09/2013), and references of identified articles were searched to identify reports of surveys that provided data on reasons given by investigators for not publishing studies. The proportion of non-submission and reasons for non-publication was calculated using the number of unpublished studies as the denominator. Because of heterogeneity across studies, quantitative pooling was not conducted. Exploratory subgroup analyses were conducted. Results We included 54 survey reports. Data from 38 included reports were available to estimate proportions of at least one reason given for not publishing studies. The proportion of non-submission among unpublished studies ranged from 55% to 100%, with a median of 85%. The reasons given by investigators for not publishing their studies included: lack of time or low priority (median 33%), studies being incomplete (median 15%), study not for publication (median 14%), manuscript in preparation or under review (median 12%), unimportant or negative result (median 12%), poor study quality or design (median 11%), fear of rejection (median 12%), rejection by journals (median 6%), author or co-author problems (median 10%), and sponsor or funder problems (median 9%). In general, the frequency of reasons given for non-publication was not associated with the source of unpublished studies, study design, or time when a survey was conducted. Conclusions Non-submission of studies for publication remains the main cause of non-publication of studies. Measures to reduce non-publication of studies and alternative models of research dissemination need to be developed to address the main reasons given by investigators for not publishing their studies, such as lack of time or low priority and fear of being rejected by journals. PMID:25335091

  11. Systematic literature reviews.

    PubMed

    White, Adrian; Schmidt, Katja

    2005-03-01

    Systematic reviews retrieve, appraise and summarise all the available evidence on a specific health question. They are designed to reduce the effect of the reviewers' own bias, and a full protocol should be written to define and guide the process. The appropriate resources should be in place before undertaking a review. The steps of the review are: frame the question and choose appropriate methods; identify relevant work; extract relevant data on outcomes and quality; summarise the evidence; and, interpret the evidence. Reviews that combine valid, homogeneous studies of treatments that are relevant to health care, in patients who are typical, can provide good evidence to guide health care decisions. PMID:15907679

  12. Cognition of and Demand for Education and Teaching in Medical Statistics in China: A Systematic Review and Meta-Analysis

    PubMed Central

    Li, Gaoming; Yi, Dali; Wu, Xiaojiao; Liu, Xiaoyu; Zhang, Yanqi; Liu, Ling; Yi, Dong

    2015-01-01

    Background Although a substantial number of studies focus on the teaching and application of medical statistics in China, few studies comprehensively evaluate the recognition of and demand for medical statistics. In addition, the results of these various studies differ and are insufficiently comprehensive and systematic. Objectives This investigation aimed to evaluate the general cognition of and demand for medical statistics by undergraduates, graduates, and medical staff in China. Methods We performed a comprehensive database search related to the cognition of and demand for medical statistics from January 2007 to July 2014 and conducted a meta-analysis of non-controlled studies with sub-group analysis for undergraduates, graduates, and medical staff. Results There are substantial differences with respect to the cognition of theory in medical statistics among undergraduates (73.5%), graduates (60.7%), and medical staff (39.6%). The demand for theory in medical statistics is high among graduates (94.6%), undergraduates (86.1%), and medical staff (88.3%). Regarding specific statistical methods, the cognition of basic statistical methods is higher than of advanced statistical methods. The demand for certain advanced statistical methods, including (but not limited to) multiple analysis of variance (ANOVA), multiple linear regression, and logistic regression, is higher than that for basic statistical methods. The use rates of the Statistical Package for the Social Sciences (SPSS) software and statistical analysis software (SAS) are only 55% and 15%, respectively. Conclusion The overall statistical competence of undergraduates, graduates, and medical staff is insufficient, and their ability to practically apply their statistical knowledge is limited, which constitutes an unsatisfactory state of affairs for medical statistics education. Because the demand for skills in this area is increasing, the need to reform medical statistics education in China has become urgent. PMID:26053876

  13. Systematic reviews. Some examples.

    PubMed Central

    Knipschild, P.

    1994-01-01

    Reviewing the literature is a scientific inquiry that needs a clear design to preclude bias. It is a real enterprise if one aims at completeness of the literature on a certain subject. Going through refereed English language journals is not enough. On line databases are helpful, but mainly as a starting point. This article gives examples of systematic reviews on vitamin C and the common cold, pyridoxine against the premenstrual syndrome, homeopathy, and physiotherapy. Images p720-a PMID:7950526

  14. The Association of HIV-Related Stigma to HIV Medication Adherence: A Systematic Review and Synthesis of the Literature.

    PubMed

    Sweeney, Shannon M; Vanable, Peter A

    2016-01-01

    This paper provides a review of the quantitative literature on HIV-related stigma and medication adherence, including: (1) synthesis of the empirical evidence linking stigma to adherence, (2) examination of proposed causal mechanisms of the stigma and adherence relationship, and (3) methodological critique and guidance for future research. We reviewed 38 studies reporting either cross-sectional or prospective analyses of the association of HIV-related stigma to medication adherence since the introduction of antiretroviral therapies (ART). Although there is substantial empirical evidence linking stigma to adherence difficulties, few studies provided data on psychosocial mechanisms that may account for this relationship. Proposed mechanisms include: (a) enhanced vulnerability to mental health difficulties, (b) reduction in self-efficacy, and (c) concerns about inadvertent disclosure of HIV status. Future research should strive to assess the multiple domains of stigma, use standardized measures of adherence, and include prospective analyses to test mediating variables. PMID:26303196

  15. Identification of Evidence-Based Interventions for Promoting HIV Medication Adherence: Findings from a Systematic Review of U.S.-Based Studies, 1996–2011

    PubMed Central

    Charania, Mahnaz R.; Marshall, Khiya J.; Crepaz, Nicole; Kay, Linda S.; Koenig, Linda J.; Weidle, Paul J.; Purcell, David W.

    2015-01-01

    A systematic review was conducted to identify evidence-based interventions (EBIs) for increasing HIV medication adherence behavior or decreasing HIV viral load among persons living with HIV (PLWH). We conducted automated searches of electronic databases (i.e., MEDLINE, EMBASE, PsycINFO, CINAHL) and manual searches of journals, reference lists, and listservs. Interventions were eligible for the review if they were U.S.-based, published between 1996 and 2011, intended to improve HIV medication adherence behaviors of PLWH, evaluated the intervention using a comparison group, and reported outcome data on adherence behaviors or HIV viral load. Each intervention was evaluated on the quality of study design, implementation, analysis, and strength of findings. Of the 65 eligible interventions, 10 are EBIs. The remaining 55 interventions failed to meet the efficacy criteria primarily due to null findings, small sample sizes, or low retention rates. Research gaps and future directions for development of adherence EBIs are discussed. PMID:24043269

  16. Factors influencing the effectiveness of multisource feedback in improving the professional practice of medical doctors: a systematic review

    PubMed Central

    2014-01-01

    Background Multisource feedback (MSF) is currently being introduced in the UK as part of a cycle of performance review for doctors. However, although it is suggested that the provision of feedback can lead to a positive change in performance and learning for medical professionals, the evidence supporting these assumptions is unclear. The aim of this review, therefore, was to identify the key factors that influence the effectiveness of multisource feedback in improving the professional practice of medical doctors. Method Relevant electronic bibliographic databases were searched for studies that aimed to assess the impact of MSF on professional practice. Two reviewers independently selected and quality assessed the studies and abstracted data regarding study design, setting, MSF instrument, behaviour changes identified and influencing factors using a standard data extraction form. Results A total of 16 studies met the inclusion criteria and quality assessment criteria. While seven studies reported only a general change in professional practice, a further seven studies identified specific changes in behaviour. The main professional behaviours that were found to be influenced by the feedback were communication, both with colleagues and patients and an improvement in clinical competence/skills. The main factors found to influence the acceptance and use of MSF were the format of the feedback, specifically in terms of whether it was facilitated, or if narrative comments were included in the review, and if the feedback was from sources that the physician believed to be knowledgeable and credible. Conclusions While there is limited evidence suggesting that MSF can influence professional performance, the quality of this evidence is variable. Further research is necessary to establish how this type of feedback actually influences behaviours and what factors have greatest influence. PMID:24725268

  17. Clarifying the abstracts of systematic literature reviews*

    PubMed Central

    Hartley, James

    2000-01-01

    Background: There is a small body of research on improving the clarity of abstracts in general that is relevant to improving the clarity of abstracts of systematic reviews. Objectives: To summarize this earlier research and indicate its implications for writing the abstracts of systematic reviews. Method: Literature review with commentary on three main features affecting the clarity of abstracts: their language, structure, and typographical presentation. Conclusions: The abstracts of systematic reviews should be easier to read than the abstracts of medical research articles, as they are targeted at a wider audience. The aims, methods, results, and conclusions of systematic reviews need to be presented in a consistent way to help search and retrieval. The typographic detailing of the abstracts (type-sizes, spacing, and weights) should be planned to help, rather than confuse, the reader. PMID:11055300

  18. Differences between immigrant and non-immigrant groups in the use of primary medical care; a systematic review

    PubMed Central

    Uiters, Ellen; Devill, Walter; Foets, Marleen; Spreeuwenberg, Peter; Groenewegen, Peter P

    2009-01-01

    Background Studies on differences between immigrant and non-immigrant groups in health care utilization vary with respect to the extent and direction of differences in use. Therefore, our study aimed to provide a systematic overview of the existing research on differences in primary care utilization between immigrant groups and the majority population. Methods For this review PubMed, PsycInfo, Cinahl, Sociofile, Web of Science and Current Contents were consulted. Study selection and quality assessment was performed using a predefined protocol by 2 reviewers independently of each other. Only original, quantitative, peer-reviewed papers were taken into account. To account for this hierarchical structure, logistic multilevel analyses were performed to examine the extent to which differences are found across countries and immigrant groups. Differences in primary care use were related to study characteristics, strength of the primary care system and methodological quality. Results A total of 37 studies from 7 countries met all inclusion criteria. Remarkably, studies performed within the US more often reported a significant lower use among immigrant groups as compared to the majority population than the other countries. As studies scored higher on methodological quality, the likelihood of reporting significant differences increased. Adjustment for health status and use of culture-/language-adjusted procedures during the data collection were negatively related to reporting significant differences in the studies. Conclusion Our review underlined the need for careful design in studies of differences in health care use between immigrant groups and the majority population. The results from studies concerning differences between immigrant and the majority population in primary health care use performed within the US might be interpreted as a reflection of a weaker primary care system in the US compared to Europe and Canada. PMID:19426567

  19. Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic review and meta-analysis

    PubMed Central

    Mekonnen, Alemayehu B; McLachlan, Andrew J; Brien, Jo-anne E

    2016-01-01

    Objectives Pharmacists play a role in providing medication reconciliation. However, data on effectiveness on patients’ clinical outcomes appear inconclusive. Thus, the aim of this study was to systematically investigate the effect of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions. Design Systematic review and meta-analysis. Methods We searched PubMed, MEDLINE, EMBASE, IPA, CINHAL and PsycINFO from inception to December 2014. Included studies were all published studies in English that compared the effectiveness of pharmacist-led medication reconciliation interventions to usual care, aimed at improving medication reconciliation programmes. Meta-analysis was carried out using a random effects model, and subgroup analysis was conducted to determine the sources of heterogeneity. Results 17 studies involving 21 342 adult patients were included. Eight studies were randomised controlled trials (RCTs). Most studies targeted multiple transitions and compared comprehensive medication reconciliation programmes including telephone follow-up/home visit, patient counselling or both, during the first 30 days of follow-up. The pooled relative risks showed a more substantial reduction of 67%, 28% and 19% in adverse drug event-related hospital revisits (RR 0.33; 95% CI 0.20 to 0.53), emergency department (ED) visits (RR 0.72; 95% CI 0.57 to 0.92) and hospital readmissions (RR 0.81; 95% CI 0.70 to 0.95) in the intervention group than in the usual care group, respectively. The pooled data on mortality (RR 1.05; 95% CI 0.95 to 1.16) and composite readmission and/or ED visit (RR 0.95; 95% CI 0.90 to 1.00) did not differ among the groups. There was significant heterogeneity in the results related to readmissions and ED visits, however. Subgroup analyses based on study design and outcome timing did not show statistically significant results. Conclusion Pharmacist-led medication reconciliation programmes are effective at improving post-hospital healthcare utilisation. This review supports the implementation of pharmacist-led medication reconciliation programmes that include some component aimed at improving medication safety. PMID:26908524

  20. Efficacy and Safety of Alfuzosin as Medical Expulsive Therapy for Ureteral Stones: A Systematic Review and Meta-Analysis

    PubMed Central

    Liu, Chenli; Zeng, Guohua; Kang, Ran; Wu, Wenqi; Li, Jiasheng; Chen, Kang; Wan, Show P.

    2015-01-01

    Background Alfuzosin has been widely used to treat benign prostatic hyperplasia and prostatitis, and is claimed to be a selective agent for the lower urinary tract with low incidence of adverse side-effects and hypotensive changes. Recently, several randomized controlled trials have reported using Alfuzosin as an expulsive therapy of ureteral stones. Tamsulosin, another alpha blocker, has also been used as an agent for the expulsive therapy for ureteral stones. It is unclear whether alfuzosin has similar efficacy as Tamsulosin in the management of ureteral stones. Objective To perform a systematic review and analysis of literatures comparing Alfuzosin with Tamsulosin or standard conservative therapy for the treatment of ureteral stones less than 10 mm in diameter. Methods A systematic literature review was performed in December 2014 using Pubmed, Embase, and the Cochrane library databases to identify relevant studies. All randomized and controlled trials were included. A subgroup analysis was performed comparing Alfuzosin with control therapy on the management of distal ureteral stones. Results Alfuzosin provided a significantly higher stone-free rate than the control treatments (RR: 1.85; 95% confidence interval [CI], 1.35–2.55; p<0.001), and a shorter stone expulsion time (Weighted mean difference [WMD]: -4.20 d, 95%CI, -6.19 to -2.21; p<0.001), but it has a higher complication rate (RR: 2.02; 95% CI, 1.30–3.15; p<0.01). When Alfuzosin was compared to Tamsulosin, there was no significant difference in terms of stone-free rate (RR: 0.90; 95% CI, 0.79–1.02; p = 0.09) as well as the stone expulsion time (WMD: 0.52 d, 95%CI, -1.61 to 2.64; p = 0.63). The adverse effects of Alfuzosin were similar to those of Tamsulosin (RR: 0.88; 95% CI, 0.61–1.26; p = 0.47). Conclusions Alfuzosin is a safe and effective agent for the expulsive therapy of ureteral stones smaller than 10 mm in size. It is more effective than therapeutic regiment without alpha blocker. It is equivalent to Tamsulosin in its effectiveness and safety profile. Adverse effects should always be kept in mind when use this class of drugs. PMID:26244843

  1. Transjugular intrahepatic portosystemic stent shunt for medically refractory hepatic hydrothorax: A systematic review and cumulative meta-analysis

    PubMed Central

    Ditah, Ivo C; Al Bawardy, Badr F; Saberi, Behnam; Ditah, Chobufo; Kamath, Patrick S

    2015-01-01

    AIM: To assess the effectiveness of transjugular intrahepatic portosystemic stent shunt (TIPSS) in refractory hepatic hydrothorax (RHH) in a systematic review and cumulative meta-analysis. METHODS: A comprehensive literature search was conducted on MEDLINE, EMBASE, and PubMed covering the period from January 1970 to August 2014. Two authors independently selected and abstracted data from eligible studies. Data were summarized using a random-effects model. Heterogeneity was assessed using the I2 test. RESULTS: Six studies involving a total of 198 patients were included in the analysis. The mean (SD) age of patients was 56 (1.8) years. Most patients (56.9%) had Child-Turcott-Pugh class C disease. The mean duration of follow-up was 10 mo (range, 5.7-16 mo). Response to TIPSS was complete in 55.8% (95%CI: 44.7%-66.9%), partial in 17.6% (95%CI: 10.9%-24.2%), and absent in 21.2% (95%CI: 14.2%-28.3%). The mean change in hepatic venous pressure gradient post-TIPSS was 12.7 mmHg. The incidence of TIPSS-related encephalopathy was 11.7% (95%CI: 6.3%-17.2%), and the 45-d mortality was 17.7% (95%CI: 11.34%-24.13%). CONCLUSION: TIPSS is associated with a clinically relevant response in RHH. TIPSS should be considered early in these patients, given its poor prognosis. PMID:26167253

  2. Informing web-based communication curricula in veterinary education: a systematic review of web-based methods used for teaching and assessing clinical communication in medical education.

    PubMed

    Artemiou, Elpida; Adams, Cindy L; Toews, Lorraine; Violato, Claudio; Coe, Jason B

    2014-01-01

    We determined the Web-based configurations that are applied to teach medical and veterinary communication skills, evaluated their effectiveness, and suggested future educational directions for Web-based communication teaching in veterinary education. We performed a systematic search of CAB Abstracts, MEDLINE, Scopus, and ERIC limited to articles published in English between 2000 and 2012. The review focused on medical or veterinary undergraduate to clinical- or residency-level students. We selected studies for which the study population was randomized to the Web-based learning (WBL) intervention with a post-test comparison with another WBL or non-WBL method and that reported at least one empirical outcome. Two independent reviewers completed relevancy screening, data extraction, and synthesis of results using Kirkpatrick and Kirkpatrick's framework. The search retrieved 1,583 articles, and 10 met the final inclusion criteria. We identified no published articles on Web based communication platforms in veterinary medicine; however, publications summarized from human medicine demonstrated that WBL provides a potentially reliable and valid approach for teaching and assessing communication skills. Student feedback on the use of virtual patients for teaching clinical communication skills has been positive,though evidence has suggested that practice with virtual patients prompted lower relation-building responses.Empirical outcomes indicate that WBL is a viable method for expanding the approach to teaching history taking and possibly to additional tasks of the veterinary medical interview. PMID:24418922

  3. Housing Status, Medical Care, and Health Outcomes Among People Living With HIV/AIDS: A Systematic Review

    PubMed Central

    Wilson, Michael G.; Shubert, Virginia; Gogolishvili, David; Globerman, Jason; Rueda, Sergio; Bozack, Anne K.; Caban, Maria; Rourke, Sean B.

    2016-01-01

    Background. Accumulating evidence suggests responses to HIV that combine individual-level interventions with those that address structural or contextual factors that influence risks and health outcomes of infection. Housing is such a factor. Housing occupies a strategic position as an intermediate structural factor, linking “upstream” economic, social, and cultural determinants to the more immediate physical and social environments in which everyday life is lived. The importance of housing status for HIV prevention and care has been recognized, but much of this attention has focused on homeless individuals as a special risk group. Analyses have less often addressed community housing availability and conditions as factors influencing population health or unstable, inadequate, or unaffordable housing as a situation or temporary state. A focus on individual-level characteristics associated with literal homelessness glosses over social, economic, and policy drivers operating largely outside any specific individual’s control that affect housing and residential environments and the health resources or risk exposures such contexts provide. Objectives. We examined the available empirical evidence on the association between housing status (broadly defined), medical care, and health outcomes among people with HIV and analyzed results to inform future research, program development, and policy implementation. Search methods. We searched 8 electronic health and social science databases from January 1, 1996, through March 31, 2014, using search terms related to housing, dwelling, and living arrangements and HIV and AIDS. We contacted experts for additional literature. Selection criteria. We selected articles if they were quantitative analyses published in English, French, or Spanish that included at least 1 measure of housing status as an independent variable and at least 1 health status, health care, treatment adherence, or risk behavior outcome among people with HIV in high-income countries. We defined housing status to include consideration of material or social dimensions of housing adequacy, stability, and security of tenure. Data collection and analysis. Two independent reviewers performed data extraction and quality appraisal. We used the Cochrane Risk of Bias Tool for randomized controlled trials and a modified version of the Newcastle Ottawa Quality Appraisal Tool for nonintervention studies. In our quality appraisal, we focused on issues of quality for observational studies: appropriate methods for determining exposure and measuring outcomes and methods to control confounding. Results. Searches yielded 5528 references from which we included 152 studies, representing 139 757 HIV-positive participants. Most studies were conducted in the United States and Canada. Studies examined access and utilization of HIV medical care, adherence to antiretroviral medications, HIV clinical outcomes, other health outcomes, emergency department and inpatient utilization, and sex and drug risk behaviors. With rare exceptions, across studies in all domains, worse housing status was independently associated with worse outcomes, controlling for a range of individual patient and care system characteristics. Conclusions. Lack of stable, secure, adequate housing is a significant barrier to consistent and appropriate HIV medical care, access and adherence to antiretroviral medications, sustained viral suppression, and risk of forward transmission. Studies that examined the history of homelessness or problematic housing years before outcome assessment were least likely to find negative outcomes, homelessness being a potentially modifiable contextual factor. Randomized controlled trials and observational studies indicate an independent effect of housing assistance on improved outcomes for formerly homeless or inadequately housed people with HIV. Housing challenges result from complex interactions between individual vulnerabilities and broader economic, political, and legal structural determinants of health. The broad structural processes sustaining social exclusion and inequality seem beyond the immediate reach of HIV interventions, but changing housing and residential environments is both possible and promising. PMID:26562123

  4. Plant-borne ovicides in the fight against mosquito vectors of medical and veterinary importance: a systematic review.

    PubMed

    Benelli, Giovanni

    2015-09-01

    Mosquitoes (Diptera: Culicidae) are a huge threat for millions of people worldwide, since they act as vectors for devastating parasites and pathogens. Culicidae control is of crucial importance. Mosquito eggs, larvae, and pupae are usually targeted using organophosphates, insect growth regulators, and microbial agents. Indoor residual spraying and insecticide-treated bed nets are also employed. However, these chemicals have negative effects on human health and the environment, and induce resistance in a number of species. Eco-friendly tools have been recently implemented against mosquito vectors, including botanical insecticides. The majority of researches focused on larvicides (745 SCOPUS results, July 2015) and adult repellents (434 SCOPUS results), while limited efforts were conducted to identify effective ovicides of botanical origin (59 SCOPUS results). Here, I review current knowledge on the effectiveness of plant-borne ovicides against major mosquito vectors of medical and veterinary importance. The majority of researches focused on the toxicity of crude extracts, their fractions, or essential oils against three important mosquito vectors, Anopheles stephensi, Aedes aegypti, and Culex quinquefasciatus. As a general trend, C. quinquefasciatus eggs were the most resistant to botanical ovicides. Five studies proposed selected compounds from plant extracts and essential oils as ovicides effective at few parts per million. However, no efforts were conducted to shed light on possible mechanisms underlying the toxicity of plant-borne ovicides. In the final section, a number of hot issues needing further research and cooperation among parasitologists, entomologists, and researchers working in natural product chemistry are outlined. PMID:26239801

  5. Childhood depression: a systematic review

    PubMed Central

    Lima, Nádia Nara Rolim; do Nascimento, Vânia Barbosa; de Carvalho, Sionara Melo Figueiredo; de Abreu, Luiz Carlos; Neto, Modesto Leite Rolim; Brasil, Aline Quental; Junior, Francisco Telésforo Celestino; de Oliveira, Gislene Farias; Reis, Alberto Olavo Advíncula

    2013-01-01

    As an important public health issue, childhood depression deserves special attention, considering the serious and lasting consequences of the disease to child development. Taking this into consideration, the present study was based on the following question: what practical contributions to clinicians and researchers does the current literature on childhood depression have to offer? The objective of the present study was to conduct a systematic review of articles regarding childhood depression. To accomplish this purpose, a systematic review of articles on childhood depression, published from January 1, 2010 to November 24, 2012, on MEDLINE and SciELO databases was carried out. Search terms were “depression” (medical subject headings [MeSH]), “child” (MeSH), and “childhood depression” (keyword). Of the 180 retrieved studies, 25 met the eligibility criteria. Retrieved studies covered a wide range of aspects regarding childhood depression, such as diagnosis, treatment, prevention and prognosis. Recent scientific literature regarding childhood depression converge to, directly or indirectly, highlight the negative impacts of depressive disorders to the children’s quality of life. Unfortunately, the retrieved studies show that childhood depression commonly grows in a background of vulnerability and poverty, where individual and familiar needs concerning childhood depression are not always taken into consideration. In this context, this review demonstrated that childhood-onset depression commonly leads to other psychiatric disorders and co-morbidities. Many of the retrieved studies also confirmed the hypothesis that human resources (eg, health care team in general) are not yet adequately trained to address childhood depression. Thus, further research on the development of programs to prepare health care professionals to deal with childhood depression is needed, as well as complementary studies, with larger and more homogeneous samples, centered on prevention and treatment of childhood depression. PMID:24092979

  6. Adolescent Sexual and Reproductive Health Services and Implications for the Provision of Voluntary Medical Male Circumcision: Results of a Systematic Literature Review

    PubMed Central

    Van Lith, Lynn M.; Mallalieu, Elizabeth C.; Waxman, Aliza; Hatzhold, Karin; Marcell, Arik V.; Kasedde, Susan; Lija, Gissenge; Hasen, Nina; Ncube, Gertrude; Samuelson, Julia L.; Bonnecwe, Collen; Seifert-Ahanda, Kim; Njeuhmeli, Emmanuel; Tobian, Aaron A. R.

    2016-01-01

    Background Voluntary medical male circumcision (VMMC) is a critical HIV prevention tool. Since 2007, sub-Saharan African countries with the highest prevalence of HIV have been mobilizing resources to make VMMC available. While implementers initially targeted adult men, demand has been highest for boys under age 18. It is important to understand how male adolescents can best be served by quality VMMC services. Methods and Findings A systematic literature review was performed to synthesize the evidence on best practices in adolescent health service delivery specific to males in sub-Saharan Africa. PubMed, Scopus, and JSTOR databases were searched for literature published between January 1990 and March 2014. The review revealed a general absence of health services addressing the specific needs of male adolescents, resulting in knowledge gaps that could diminish the benefits of VMMC programming for this population. Articles focused specifically on VMMC contained little information on the adolescent subgroup. The review revealed barriers to and gaps in sexual and reproductive health and VMMC service provision to adolescents, including structural factors, imposed feelings of shame, endorsement of traditional gender roles, negative interactions with providers, violations of privacy, fear of pain associated with the VMMC procedure, and a desire for elements of traditional non-medical circumcision methods to be integrated into medical procedures. Factors linked to effective adolescent-focused services included the engagement of parents and the community, an adolescent-friendly service environment, and VMMC counseling messages sufficiently understood by young males. Conclusions VMMC presents an opportune time for early involvement of male adolescents in HIV prevention and sexual and reproductive health programming. However, more research is needed to determine how to align VMMC services with the unique needs of this population. PMID:26938639

  7. A Systematic Review of Interventions Addressing Adherence to Anti-Diabetic Medications in Patients with Type 2 Diabetes—Components of Interventions

    PubMed Central

    Sapkota, Sujata; Brien, Jo-anne E.; Greenfield, Jerry R.; Aslani, Parisa

    2015-01-01

    Background Poor adherence to anti-diabetic medications contributes to suboptimal glycaemic control in patients with type 2 diabetes (T2D). A range of interventions have been developed to promote anti-diabetic medication adherence. However, there has been very little focus on the characteristics of these interventions and how effectively they address factors that predict non-adherence. In this systematic review we assessed the characteristics of interventions that aimed to promote adherence to anti-diabetic medications. Method Using appropriate search terms in Medline, Embase, CINAHL, International Pharmaceutical Abstracts (IPA), PUBmed, and PsychINFO (years 2000–2013), we identified 52 studies which met the inclusion criteria. Results Forty-nine studies consisted of patient-level interventions, two provider-level interventions, and one consisted of both. Interventions were classified as educational (n = 7), behavioural (n = 3), affective, economic (n = 3) or multifaceted (a combination of the above; n = 40). One study consisted of two interventions. The review found that multifaceted interventions, addressing several non-adherence factors, were comparatively more effective in improving medication adherence and glycaemic target in patients with T2D than single strategies. However, interventions with similar components and those addressing similar non-adherence factors demonstrated mixed results, making it difficult to conclude on effective intervention strategies to promote adherence. Educational strategies have remained the most popular intervention strategy, followed by behavioural, with affective components becoming more common in recent years. Most of the interventions addressed patient-related (n = 35), condition-related (n = 31), and therapy-related (n = 20) factors as defined by the World Health Organization, while fewer addressed health care system (n = 5) and socio-economic-related factors (n = 13). Conclusion There is a noticeable shift in the literature from using single to multifaceted intervention strategies addressing a range of factors impacting adherence to medications. However, research limitations, such as limited use of standardized methods and tools to measure adherence, lack of individually tailored adherence promoting strategies and variability in the interventions developed, reduce the ability to generalize the findings of the studies reviewed. Furthermore, this review highlights the need to develop multifaceted interventions which can be tailored to the individual patient’s needs over the duration of their diabetes management. PMID:26053004

  8. The impact of the electronic medical record on structure, process, and outcomes within primary care: a systematic review of the evidence

    PubMed Central

    Lorenzetti, Diane; Straus, Sharon E; Sykes, Lindsay; Quan, Hude

    2011-01-01

    Background The electronic medical record (EMR)/electronic health record (EHR) is becoming an integral component of many primary-care outpatient practices. Before implementing an EMR/EHR system, primary-care practices should have an understanding of the potential benefits and limitations. Objective The objective of this study was to systematically review the recent literature around the impact of the EMR/EHR within primary-care outpatient practices. Materials and methods Searches of Medline, EMBASE, CINAHL, ABI Inform, and Cochrane Library were conducted to identify articles published between January 1998 and January 2010. The gray literature and reference lists of included articles were also searched. 30 studies met inclusion criteria. Results and discussion The EMR/EHR appears to have structural and process benefits, but the impact on clinical outcomes is less clear. Using Donabedian's framework, five articles focused on the impact on healthcare structure, 21 explored healthcare process issues, and four focused on health-related outcomes. PMID:21659445

  9. Determinants of Medical and Health Care Expenditure Growth for Urban Residents in China: A Systematic Review Article

    PubMed Central

    ZHU, Xiaolong; CAI, Qiong; WANG, Jin; LIU, Yun

    2014-01-01

    In recent years, medical and health care consumption has risen, making health risk an important determinant of household spending and welfare. We aimed to examine the determinants of medical and health care expenditure to help policy-makers in the improvement of China’s health care system, benefiting the country, society and every household. This paper employs panel data from China’s provinces from 2001 to 2011 with all possible economic variations and studies the determinants of medical and healthcare expenditure for urban residents. CPI (consumer price index) of medical services and the resident consumption level of urban residents have positive influence on medical and health care expenditures for urban residents, while the local medical budget, the number of health institutions, the incidence of infectious diseases, the year-end population and the savings of urban residents will not have effect on medical and health care expenditure for urban residents. This paper proposed three relevant policy suggestions for Chinese governments based on the findings of the research. PMID:26171351

  10. Efficacy and safety of treating patients with refractory schizophrenia with antipsychotic medication and adjunctive electroconvulsive therapy: a systematic review and meta-analysis

    PubMed Central

    WANG, Wenzheng; PU, Chengcheng; JIANG, Jiangling; CAO, Xinyi; WANG, Jijun; ZHAO, Min; LI, Chunbo

    2015-01-01

    Background The efficacy and safety of the combined treatment of refractory schizophrenia with antipsychotic medications and electroconvulsive therapy (ECT) remain uncertain. Aims Conduct systematic review and meta-analysis of available literature in English and Chinese about ECT in the treatment of refractory schizophrenia. Methods English and Chinese databases were searched for studies published prior to May 20, 2015 regarding the efficacy and safety of the combined treatment of refractory schizophrenia with antipsychotic medications and ECT. Two researchers selected and evaluated studies independently using pre-defined criteria. Review Manager 5.3 software was used for data analysis. Results A total of 22 randomized control studies, 18 of which were conducted in mainland China, were included in the analysis. Meta-analysis of data from 18 of the 22 studies with a pooled sample of 1394 individuals found that compared to treatment with antipsychotic medications alone, combined treatment with antipsychotic medications and ECT had significantly higher rates of achieving study-specific criteria of ‘clinical improvement’ (RR=1.25, 95%CI=1.14-1.37). Based on the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria, the quality of evidence for this assessment of efficacy was ‘moderate’. However, the proportion of participants who experienced headache during the treatment was significantly higher in the combined treatment group (RR=9.10, 95%CI=3.97-20.86, based on a pooled sample of 517 from 8 studies) and the proportion who experienced memory impairment was also higher in the combined treatment group (RR=6.48, 95%CI=3.54-11.87, based on a pooled sample of 577 from 7 studies). The quality of evidence about these adverse events was rated as ‘very low’. Conclusions There are very few high quality randomized controlled clinical trials about the combination of antipsychotic medications and ECT in the treatment of refractory schizophrenia. This meta-analysis found that the combination of antipsychotic medications and ECT could improve psychiatric symptoms in patients with refractory schizophrenia, but the incomplete methodological information provided for most of the studies, publication bias (favoring studies with better outcomes in the combined treatment group), and the low quality of evidence about adverse outcomes, cognitive impairment, and overall functioning raise questions about the validity of the results. PMID:26549957

  11. A systematic review of the efficacy of prophylactic control measures for naturally occurring canine leishmaniosis. Part II: topically applied insecticide treatments and prophylactic medications.

    PubMed

    Wylie, C E; Carbonell-Antoñanzas, M; Aiassa, E; Dhollander, S; Zagmutt, F J; Brodbelt, D C; Solano-Gallego, L

    2014-11-01

    The objective of this study was to systematically review the efficacy of topically applied insecticide treatments of dogs (impregnated collars, spot-ons), and prophylactic medications to prevent natural Leishmania infantum (L. infantum) infection in dogs. Randomised controlled trials (RCT), non-randomised clinical trials, cohort studies and case-control studies that investigated preventive efficacy for natural L. infantum infection in dogs were eligible for inclusion. Two review authors independently assessed each study against the inclusion criteria, independently extracted relevant data from all included studies and assessed the risk of methodological shortcomings in each individual study. The odds ratio (OR) and absolute risk reduction (ARR) for dichotomous outcomes and mean difference for continuous outcomes were calculated. Meta-analysis was not performed due to heterogeneity of the studies identified. The search yielded 937 articles, from which 84 full text articles were selected for second stage screening. Eleven eligible studies were included; four on collars (two RCTs), three on spot-ons (two RCTs - one looking at two different dosing regimens), three on prophylactic medications (all RCTs) and one on both collars and spot-ons summarised in this paper. All of the studies were considered to be at a high risk of methodological shortcomings, with the exception of one spot-on study which was considered to be at an unclear risk of methodological shortcomings. Deltamethrin collars, 65% permethrin, 10% imidacloprid with 50% permethrin spot-ons and domperidone prophylactic medication tended to significantly reduce the proportion of dogs infected with L. infantum based on either parasitological or serological evidence. PMID:25062787

  12. A systematic review of patient self-reported barriers of adherence to antihypertensive medications using the world health organization multidimensional adherence model.

    PubMed

    AlGhurair, Suliman A; Hughes, Christine A; Simpson, Scot H; Guirguis, Lisa M

    2012-12-01

    Multiple barriers can influence adherence to antihypertensive medications. The aim of this systematic review was to determine what adherence barriers were included in each instrument and to describe the psychometric properties of the identified surveys. Barriers were characterized using the World Health Organization (WHO) Multidimensional Adherence Model with patient, condition, therapy, socioeconomic, and health care system/team-related barriers. Five databases (Medline, Embase, Health and Psychological Instruments, CINHAL, and International Pharmaceutical Abstracts [IPA]) were searched from 1980 to September 2011. Our search identified 1712 citations; 74 articles met inclusion criteria and 51 unique surveys were identified. The Morisky Medication Adherence Scale was the most commonly used survey. Only 20 surveys (39%) have established reliability and validity evidence. According to the WHO Adherence Model domains, patient-related barriers were most commonly addressed, while condition, therapy, and socioeconomic barriers were underrepresented. The complexity of adherence behavior requires robust self-report measurements and the inclusion of barriers relevant to each unique patient population and intervention. PMID:23205755

  13. Mobile text messaging for health: a systematic review of reviews.

    PubMed

    Hall, Amanda K; Cole-Lewis, Heather; Bernhardt, Jay M

    2015-03-18

    The aim of this systematic review of reviews is to identify mobile text-messaging interventions designed for health improvement and behavior change and to derive recommendations for practice. We have compiled and reviewed existing systematic research reviews and meta-analyses to organize and summarize the text-messaging intervention evidence base, identify best-practice recommendations based on findings from multiple reviews, and explore implications for future research. Our review found that the majority of published text-messaging interventions were effective when addressing diabetes self-management, weight loss, physical activity, smoking cessation, and medication adherence for antiretroviral therapy. However, we found limited evidence across the population of studies and reviews to inform recommended intervention characteristics. Although strong evidence supports the value of integrating text-messaging interventions into public health practice, additional research is needed to establish longer-term intervention effects, identify recommended intervention characteristics, and explore issues of cost-effectiveness. PMID:25785892

  14. Mobile Text Messaging for Health: A Systematic Review of Reviews

    PubMed Central

    Hall, Amanda K.; Cole-Lewis, Heather; Bernhardt, Jay M.

    2015-01-01

    The aim of this systematic review of reviews is to identify mobile text-messaging interventions designed for health improvement and behavior change and to derive recommendations for practice. We have compiled and reviewed existing systematic research reviews and meta-analyses to organize and summarize the text-messaging intervention evidence base, identify best-practice recommendations based on findings from multiple reviews, and explore implications for future research. Our review found that the majority of published text-messaging interventions were effective when addressing diabetes self-management, weight loss, physical activity, smoking cessation, and medication adherence for antiretroviral therapy. However, we found limited evidence across the population of studies and reviews to inform recommended intervention characteristics. Although strong evidence supports the value of integrating text-messaging interventions into public health practice, additional research is needed to establish longer-term intervention effects, identify recommended intervention characteristics, and explore issues of cost-effectiveness. PMID:25785892

  15. Medical Therapies for Uterine Fibroids – A Systematic Review and Network Meta-Analysis of Randomised Controlled Trials

    PubMed Central

    Gurusamy, Kurinchi S.; Vaughan, Jessica; Fraser, Ian S.; Best, Lawrence M. J.; Richards, Toby

    2016-01-01

    Background Uterine fibroids are common, often symptomatic and a third of women need repeated time off work. Consequently 25% to 50% of women with fibroids receive surgical treatment, namely myomectomy or hysterectomy. Hysterectomy is the definitive treatment as fibroids are hormone dependent and frequently recurrent. Medical treatment aims to control symptoms in order to replace or delay surgery. This may improve the outcome of surgery and prevent recurrence. Purpose To determine whether any medical treatment can be recommended in the treatment of women with fibroids about to undergo surgery and in those for whom surgery is not planned based on currently available evidence. Study Selection Two authors independently identified randomised controlled trials (RCT) of all pharmacological treatments aimed at the treatment of fibroids from a list of references obtained by formal search of MEDLINE, EMBASE, Cochrane library, Science Citation Index, and ClinicalTrials.gov until December 2013. Data Extraction Two authors independently extracted data from identified studies. Data Synthesis A Bayesian network meta-analysis was performed following the National Institute for Health and Care Excellence—Decision Support Unit guidelines. Odds ratios, rate ratios, or mean differences with 95% credible intervals (CrI) were calculated. Results and Limitations A total of 75 RCT met the inclusion criteria, 47 of which were included in the network meta-analysis. The overall quality of evidence was very low. The network meta-analysis showed differing results for different outcomes. Conclusions There is currently insufficient evidence to recommend any medical treatment in the management of fibroids. Certain treatments have future promise however further, well designed RCTs are needed. PMID:26919185

  16. Heterotopic ossification: a systematic review.

    PubMed

    Edwards, Dafydd S; Clasper, J C

    2015-12-01

    Heterotopic ossification (HO) is the formation of mature lamellar bone in extraskeletal soft tissues. It was first described 1000 years ago in the healing of fractures, and in relation to military wounds, texts from the American Civil War and World War I refer to HO specifically. It continues to cause problems to injured service personnel; the consequences of wound and soft tissue complications in traumatic amputations pose particular problems to rehabilitation and prosthetic use. While HO is seen in rare genetic conditions, it is most prevalent after joint replacement surgery and trauma. In the civilian setting HO has been commonly described in patients after traumatic brain injuries, spinal cord injuries and burns. Militarily, as a consequence of recent operations, and the characteristic injury of blast-related amputations, a renewed interest in HO has emerged due to an increased incidence seen in casualties. The heterogeneous nature of a blast related amputation makes it difficult for a single aetiological event to be identified, although it is now accepted that blast, amputation through the zone of injury, increased injury severity and associated brain injuries are significant risk factors in HO formation. The exact cellular event leading to HO has yet to be identified, and as a consequence its prevention is restricted to the use of anti-inflammatory medication and radiation, which is often contraindicated in the acute complex military casualty. A systematic review in PubMed and the Cochrane Database identified research articles related to HO to illustrate the military problem of HO and its management, current research concepts and experimental theories regarding HO. This also served as a gap analysis providing the researchers detail of any knowledge deficit in this field, in particular to the military aspects of HO; 637 out of 7891 articles initially identified that referenced HO were relevant to this review. PMID:25015927

  17. Antiepileptic drug withdrawal in medically and surgically treated patients: a meta-analysis of seizure recurrence and systematic review of its predictors.

    PubMed

    Lamberink, Herm J; Otte, Willem M; Geleijns, Karin; Braun, Kees P J

    2015-09-01

    Many seizure-free patients consider withdrawal of antiepileptic drugs, both when seizure control is achieved by medication alone, or once they became seizure-free following epilepsy surgery. The risk of recurrence is consequently of very important prognostic value. However, estimations of recurrence risks are outdated for both populations. In addition, although many publications have reported predictors of seizure relapse, no comprehensive overview of prognostic factors is available. A systematic review of the databases of PubMed and EMBASE was conducted, identifying articles on antiepileptic drug withdrawal in patient cohorts. Recurrence risk meta-analyses were performed for both populations at one, two, three to four, and five or more years of follow-up. Within the selected articles, studies presenting multivariable analysis of predictors were identified; all studied predictors were listed, as well as all significant independent predictors. The quality of separate analyses of predictors was assessed. There was no significant difference of long-term cumulative recurrence risk between surgical and medication-only populations, with respectively 29% and 34% recurrences. In medication-only treated patients, 25 factors have been reported as significant independent predictors; 12 have been reported in surgical cohorts. The quality of most analyses of predictors was low to moderate. No predictor was consistently found among all analyses, and for most predictors, study results were contradictory. No consistent set of predictors could be identified because a large number of variables have been identified in the literature, many studies reported contradicting results, study populations varied considerably, and the quality of the original studies was often low. Meta-analysis of individual participant data is necessary, because it allows for (1) correction for differences in follow-up duration between subjects and studies, (2) a study of interaction effects, (3) calculation of more accurate estimates valid across several populations, and (4) the assessment of each predictor's effect size. PMID:26292909

  18. Reaching the hard-to-reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups

    PubMed Central

    2014-01-01

    Background This study aims to review the literature regarding the barriers to sampling, recruitment, participation, and retention of members of socioeconomically disadvantaged groups in health research and strategies for increasing the amount of health research conducted with socially disadvantaged groups. Methods A systematic review with narrative synthesis was conducted. Searches of electronic databases Medline, PsychInfo, EMBASE, Social Science Index via Web of Knowledge and CINHAL were conducted for English language articles published up to May 2013. Qualitative and quantitative studies as well as literature reviews were included. Articles were included if they reported attempts to increase disadvantaged group participation in research, or the barriers to research with disadvantaged groups. Groups of interest were those described as socially, culturally or financially disadvantaged compared to the majority of society. Eligible articles were categorised according to five phases of research: 1) sampling, 2) recruitment and gaining consent, 3) data collection and measurement, 4) intervention delivery and uptake, and 5) retention and attrition. Results In total, 116 papers from 115 studies met inclusion criteria and 31 previous literature reviews were included. A comprehensive summation of the major barriers to working with various disadvantaged groups is provided, along with proposed strategies for addressing each of the identified types of barriers. Most studies of strategies to address the barriers were of a descriptive nature and only nine studies reported the results of randomised trials. Conclusions To tackle the challenges of research with socially disadvantaged groups, and increase their representation in health and medical research, researchers and research institutions need to acknowledge extended timeframes, plan for higher resourcing costs and operate via community partnerships. PMID:24669751

  19. Medical therapy of stricturing Crohn’s disease: what the gut can learn from other organs - a systematic review

    PubMed Central

    2014-01-01

    Crohn’s disease (CD) is a chronic remitting and relapsing disease. Fibrostenosing complications such as intestinal strictures, stenosis and ultimately obstruction are some of its most common long-term complications. Despite recent advances in the pathophysiological understanding of CD and a significant improvement of anti-inflammatory therapeutics, medical therapy for stricturing CD is still inadequate. No specific anti-fibrotic therapy exists and the incidence rate of strictures has essentially remained unchanged. Therefore, the current therapy of established fibrotic strictures comprises mainly endoscopic dilation as well as surgical approaches. However, these treatment options are associated with major complications as well as high recurrence rates. Thus, a specific anti-fibrotic therapy for CD is urgently needed. Importantly, there is now a growing body of evidence for prevention as well as effective medical treatment of fibrotic diseases of other organs such as the skin, lung, kidney and liver. In face of the similarity of molecular mechanisms of fibrogenesis across these organs, translation of therapeutic approaches from other fibrotic diseases to the intestine appears to be a promising treatment strategy. In particular transforming growth factor beta (TGF-β) neutralization, selective tyrosine kinase inhibitors, blockade of components of the renin-angiotensin system, IL-13 inhibitors and mammalian target of rapamycin (mTOR) inhibitors have emerged as potential drug candidates for anti-fibrotic therapy and may retard progression or even reverse established intestinal fibrosis. However, major challenges have to be overcome in the translation of novel anti-fibrotics into intestinal fibrosis therapy, such as the development of appropriate biomarkers that predict the development and accurately monitor therapeutic responses. Future clinical studies are a prerequisite to evaluate the optimal timing for anti-fibrotic treatment approaches, to elucidate the best routes of application, and to evaluate the potential of drug candidates to reach the ultimate goal: the prevention or reversal of established fibrosis and strictures in CD patients. PMID:24678903

  20. Medical Imaging: A Review

    NASA Astrophysics Data System (ADS)

    Ganguly, Debashis; Chakraborty, Srabonti; Balitanas, Maricel; Kim, Tai-Hoon

    The rapid progress of medical science and the invention of various medicines have benefited mankind and the whole civilization. Modern science also has been doing wonders in the surgical field. But, the proper and correct diagnosis of diseases is the primary necessity before the treatment. The more sophisticate the bio-instruments are, better diagnosis will be possible. The medical images plays an important role in clinical diagnosis and therapy of doctor and teaching and researching etc. Medical imaging is often thought of as a way to represent anatomical structures of the body with the help of X-ray computed tomography and magnetic resonance imaging. But often it is more useful for physiologic function rather than anatomy. With the growth of computer and image technology medical imaging has greatly influenced medical field. As the quality of medical imaging affects diagnosis the medical image processing has become a hotspot and the clinical applications wanting to store and retrieve images for future purpose needs some convenient process to store those images in details. This paper is a tutorial review of the medical image processing and repository techniques appeared in the literature.

  1. Information resources to aid parental decision-making on when to seek medical care for their acutely sick child: a narrative systematic review

    PubMed Central

    Neill, Sarah; Roland, Damian; Jones, Caroline HD; Thompson, Matthew; Lakhanpaul, Monica

    2015-01-01

    Objective To identify the effectiveness of information resources to help parents decide when to seek medical care for an acutely sick child under 5 years of age, including the identification of factors influencing effectiveness, by systematically reviewing the literature. Methods 5 databases and 5 websites were systematically searched using a combination of terms on children, parents, education, acute childhood illness. A narrative approach, assessing quality via the Mixed Methods Appraisal Tool, was used due to non-comparable research designs. Results 22 studies met the inclusion criteria: 9 randomised control trials, 8 non-randomised intervention studies, 2 qualitative descriptive studies, 2 qualitative studies and 1 mixed method study. Consultation frequency (15 studies), knowledge (9 studies), anxiety/reassurance (7 studies), confidence (4 studies) satisfaction (4 studies) and antibiotic prescription (4 studies) were used as measures of effectiveness. Quality of the studies was variable but themes supported information needing to be relevant and comprehensive to enable parents to manage an episode of minor illness Interventions addressing a range of symptoms along with assessment and management of childhood illness, appeared to have the greatest impact on the reported measures. The majority of interventions had limited impact on consultation frequencies, No conclusive evidence can be drawn from studies measuring other outcomes. Conclusions Findings confirm that information needs to be relevant and comprehensive to enable parents to manage an episode of minor illness. Incomplete information leaves parents still needing to seek help and irrelevant information appears to reduce parents’ trust in the intervention. Interventions are more likely to be effective if they are also delivered in non-stressful environments such as the home and are coproduced with parents. PMID:26674495

  2. Determinants of patient adherence: a review of systematic reviews

    PubMed Central

    Kardas, Przemyslaw; Lewek, Pawel; Matyjaszczyk, Michal

    2013-01-01

    Purpose: A number of potential determinants of medication non-adherence have been described so far. However, the heterogenic quality of existing publications poses the need for the use of a rigorous methodology in building a list of such determinants. The purpose of this study was a systematic review of current research on determinants of patient adherence on the basis of a recently agreed European consensus taxonomy and terminology. Methods: MEDLINE, EMBASE, CINAHL, Cochrane Library, IPA, and PsycINFO were systematically searched for systematic reviews published between 2000/01/01 and 2009/12/31 that provided determinants on non-adherence to medication. The searches were limited to reviews having adherence to medication prescribed by health professionals for outpatient as a major topic. Results: Fifty-one reviews were included in this review, covering 19 different disease categories. In these reviews, exclusively assessing non-adherence to chronic therapies, 771 individual factor items were identified, of which most were determinants of implementation, and only 47—determinants of persistence with medication. Factors with an unambiguous effect on adherence were further grouped into 8 clusters of socio-economic-related factors, 6 of healthcare team- and system-related factors, 6 of condition-related factors, 6 of therapy-related factors, and 14 of patient-related factors. The lack of standardized definitions and use of poor measurement methods resulted in many inconsistencies. Conclusions: This study provides clear evidence that medication non-adherence is affected by multiple determinants. Therefore, the prediction of non-adherence of individual patients is difficult, and suitable measurement and multifaceted interventions may be the most effective answer toward unsatisfactory adherence. The limited number of publications assessing determinants of persistence with medication, and lack of those providing determinants of adherence to short-term treatment identify areas for future research. PMID:23898295

  3. Application of systematic review methodology to the field of nutrition

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Systematic reviews represent a rigorous and transparent approach of synthesizing scientific evidence that minimizes bias. They evolved within the medical community to support development of clinical and public health practice guidelines, set research agendas and formulate scientific consensus state...

  4. A systematic review on comparing 2 common models for management of warfarin therapy; pharmacist-led service versus usual medical care.

    PubMed

    Entezari-Maleki, Taher; Dousti, Samaneh; Hamishehkar, Hadi; Gholami, Kheirollah

    2016-01-01

    Despite a growing body of literature supporting the potential benefit of pharmacist-managed warfarin therapy (PMWT), comprehensive reviews regarding this topic are still lacking. A systematic search of literature was done in Pubmed/Medline, Scopus, Google Scholar, and Cochrane Library from database inception to January 2014. Studies comparing PMWT with usual medical care (UMC) regarding the control of anticoagulation, bleeding and thromboembolic events, mortality, hospitalization, emergency department visit, cost, patients' satisfaction, and quality of life were included. Of 758 potential articles identified, 24 studies (4 randomized controlled trials [RCT] and 20 non-RCT studies) with a population of 11,607 were included. Among non-RCT studies, the percentage of time in the therapeutic range (72.1% vs 56.7%; P = .013), major bleeding events (0.6% vs 1.7%, P < .001), thromboembolic events (0.6% vs 2.9%; P < .001), hospitalization (3% vs 10%; P < .001), emergency department visits (7.9% vs 23.9%; P < .0001) significantly favored PMWT. The study supported PMWT regarding cost saving and patient satisfaction. The results showed that the PMWT model is superior to UMC in managing warfarin therapy based on observational studies. As well, it is comparable to UMC based on RCT studies. PMID:26100092

  5. Vertebroplasty and kyphoplasty--a systematic review of cement augmentation techniques for osteoporotic vertebral compression fractures compared to standard medical therapy.

    PubMed

    Robinson, Yohan; Olerud, Claes

    2012-05-01

    After more than two decades the treatment effect of cement augmentation of osteoporotic vertebral compression fractures (VCF) has now been questioned by two blinded randomised placebo-controlled trials. Thus many practitioners are uncertain on the recommendation for cement augmentation techniques in elderly patients with osteoporotic VCF. This systematic review analyses randomised controlled trials on vertebroplasty and kyphoplasty to provide an overview on the current evidence. From an electronic database research 8 studies could be identified meeting our inclusion criteria of osteoporotic VCF in elderly (age>60 years), treatment with vertebroplasty or kyphoplasty, controlled with placebo or standard medical therapy, quality of life, function, or pain as primary parameter, and randomisation. Only two studies were properly blinded using a sham-operation as control. The other studies were using a non-surgical treatment control group. Further possible bias may be caused by manufacturer involvement in financing of three published RCT. There is level Ib evidence that vertebroplasty is no better than placebo, which is conflicting with the available level IIb evidence that there is a positive short-term effect of cement augmentation compared to standard medical therapy with regard to QoL, function and pain. Kyphoplasty is not superior to vertebroplasty with regard to pain, but with regard to VCF reduction (evidence level IIb). Kyphoplasty is probably not cost-effective (evidence level IIb), and vertebroplasty has not more than short-term cost-effectiveness (evidence level IV). Vertebroplasty and kyphoplasty cannot be recommended as standard treatment for osteoporotic VCF. Ongoing sham-controlled trials may provide further evidence in this regard. PMID:22425141

  6. Efficacy of Atypical Antipsychotic Medication in the Management of Behaviour Problems in Children with Intellectual Disabilities and Borderline Intelligence: A Systematic Review

    ERIC Educational Resources Information Center

    Unwin, Gemma L.; Deb, Shoumitro

    2011-01-01

    The use of medications to manage problem behaviours is widespread. However, robust evidence to support their use seems to be lacking. The aim was to review research evidence into the efficacy of atypical antipsychotic medication in managing problem behaviour in children with intellectual disabilities and borderline intelligence. A systematic…

  7. A systematic review of systematic reviews of homeopathy

    PubMed Central

    Ernst, E

    2002-01-01

    Homeopathy remains one of the most controversial subjects in therapeutics. This article is an attempt to clarify its effectiveness based on recent systematic reviews. Electronic databases were searched for systematic reviews/meta-analysis on the subject. Seventeen articles fulfilled the inclusion/exclusion criteria. Six of them related to re-analyses of one landmark meta-analysis. Collectively they implied that the overall positive result of this meta-analysis is not supported by a critical analysis of the data. Eleven independent systematic reviews were located. Collectively they failed to provide strong evidence in favour of homeopathy. In particular, there was no condition which responds convincingly better to homeopathic treatment than to placebo or other control interventions. Similarly, there was no homeopathic remedy that was demonstrated to yield clinical effects that are convincingly different from placebo. It is concluded that the best clinical evidence for homeopathy available to date does not warrant positive recommendations for its use in clinical practice. PMID:12492603

  8. Mal de debarquement syndrome: a systematic review.

    PubMed

    Van Ombergen, Angelique; Van Rompaey, Vincent; Maes, Leen K; Van de Heyning, Paul H; Wuyts, Floris L

    2016-05-01

    Mal de debarquement (MdD) is a subjective perception of self-motion after exposure to passive motion, in most cases sea travel, hence the name. Mal de debarquement occurs quite frequently in otherwise healthy individuals for a short period of time (several hours). However, in some people symptoms remain for a longer period of time or even persist and this is then called mal de debarquement syndrome (MdDS). The underlying pathogenesis is poorly understood and therefore, treatment options are limited. In general, limited studies have focused on the topic, but the past few years more and more interest has been attributed to MdDS and its facets, which is reflected by an increasing number of papers. Till date, some interesting reviews on the topic have been published, but a systematic review of the literature is lacking and could help to address the shortcomings and flaws of the current literature. We here present a systematic review of MdD(S) based on a systematic search of medical databases employing predefined criteria, using the terms "mal de debarquement" and "sea legs". Based on this, we suggest a list of criteria that could aid healthcare professionals in the diagnosis of MdDS. Further research needs to address the blank gaps by addressing how prevalent MdD(S) really is, by digging deeper into the underlying pathophysiology and setting up prospective, randomized placebo-controlled studies to evaluate the effectiveness of possible treatment strategies. PMID:26559820

  9. Improving the uptake of systematic reviews: a systematic review of intervention effectiveness and relevance

    PubMed Central

    Wallace, John; Byrne, Charles; Clarke, Mike

    2014-01-01

    Objective Little is known about the barriers, facilitators and interventions that impact on systematic review uptake. The objective of this study was to identify how uptake of systematic reviews can be improved. Selection criteria Studies were included if they addressed interventions enhancing the uptake of systematic reviews. Reports in any language were included. All decisionmakers were eligible. Studies could be randomised trials, cluster-randomised trials, controlled-clinical trials and before-and-after studies. Data sources We searched 19 databases including PubMed, EMBASE and The Cochrane Library, covering the full range of publication years from inception to December 2010. Two reviewers independently extracted data and assessed quality according to the Effective Practice and Organisation of Care criteria. Results 10 studies from 11 countries, containing 12 interventions met our criteria. Settings included a hospital, a government department and a medical school. Doctors, nurses, mid-wives, patients and programme managers were targeted. Six of the studies were geared to improving knowledge and attitudes while four targeted clinical practice. Synthesis of results Three studies of low-to-moderate risk of bias, identified interventions that showed a statistically significant improvement: educational visits, short summaries of systematic reviews and targeted messaging. Promising interventions include e-learning, computer-based learning, inactive workshops, use of knowledge brokers and an e-registry of reviews. Juxtaposing barriers and facilitators alongside the identified interventions, it was clear that the three effective approaches addressed a wide range of barriers and facilitators. Discussion A limited number of studies were found for inclusion. However, the extensive literature search is one of the strengths of this review. Conclusions Targeted messaging, educational visits and summaries are recommended to enhance systematic review uptake. Identified promising approaches need to be developed further. New strategies are required to encompass neglected barriers and facilitators. This review addressed effectiveness and also appropriateness of knowledge uptake strategies. PMID:25324321

  10. Local production of medical technologies and its effect on access in low and middle income countries: a systematic review of the literature

    PubMed Central

    Kaplan, Warren Allan; Ritz, Lindsay Sarah; Vitello, Marie

    2011-01-01

    Objectives: The objective of this study was to assess the existing theoretical and empirical literature examining the link between "local production" of pharmaceuticals and medical devices and increased local access to these products. Our preliminary hypothesis is that studies showing a robust relationship between local production and access to medical products are sparse, at best. Methods: An extensive literature search was conducted using a wide variety of databases and search terms intending to capture as many different aspects of this issue as possible. The results of the search were reviewed and categorized according to their relevance to the research question. The literature was also reviewed to determine the rigor used to examine the effects of local production and what implications these experiences hold for other developing countries. Results: Literature addressing the benefits of local production and the link between it and access to medical products is sparse, mainly descriptive and lacking empirical evidence. Of the literature we reviewed that addressed comparative economics and strategic planning of multinational and domestic firms, there are few dealing with emerging markets and lower-middle income countries and even fewer that compare local biomedical producers with multinational corporations in terms of a reasonable metric. What comparisons exist mainly relate to prices of local versus foreign/multinational produced medicines. Conclusions: An assessment of the existing theoretical and empirical literature examining the link between "local production" of pharmaceuticals and medical devices and increased local access to these products reveals a paucity of literature explicitly dealing with this issue. Of the literature that does exist, methods used to date are insufficient to prove a robust relationship between local production of medical products and access to these products. There are mixed messages from various studies, and although the studies may correctly depict specific situations in specific countries with reference to specific products, such evidence cannot be generalized. Our review strongly supports the need for further research in understanding the dynamic link between local production and access to medical products PMID:23093883

  11. A Systematic Review of Interventions Addressing Adherence to Anti-Diabetic Medications in Patients with Type 2 Diabetes—Impact on Adherence

    PubMed Central

    Sapkota, Sujata; Brien, Jo-anne; Greenfield, Jerry; Aslani, Parisa

    2015-01-01

    Background The global prevalence of diabetes is increasing. Medications are a recommended strategy to control hyperglycaemia. However, patient adherence can be variable, impacting health outcomes. A range of interventions for patients with type 2 diabetes have focused on improving treatment adherence. This review evaluates the impact of these interventions on adherence to anti-diabetic medications and focuses on the methods and tools used to measure adherence. Method Medline, Embase, CINAHL, IPA, PUBmed, and PsychINFO were searched for relevant articles published in 2000–2013, using appropriate search terms. Results Fifty two studies addressing adherence to anti-diabetic medications in patients with type 2 diabetes met the inclusion criteria and were reviewed. Each study was assessed for research design, method(s) used for measuring medication adherence, and impact of intervention on medication adherence and glycaemic control. Fourteen studies were published in 2000–2009 and 38 in 2010–2013. Twenty two interventions led to improvements in adherence to anti-diabetic medications, while only nine improved both medication adherence and glycaemic control. A single strategy could not be identified which would be guaranteed to improve anti-diabetic medication adherence consistently. Nonetheless, most interventions were successful in influencing one or more of the outcomes assessed, indicating the usefulness of these interventions under certain circumstances. Self-report, particularly the Summary of Diabetes Self-Care Activities questionnaire was the most commonly used tool to assess medication adherence, although other self-report tools were used in more recent studies. Overall, there was a slight increase in the number of studies that employed multiple methods to assess medication adherence in studies conducted after 2008. Conclusion The diversity of interventions and adherence measurements prevented a meta-analysis of the impact of interventions on adherence to therapy, highlighting the need for more consistency in methods in the area of adherence research. Whilst effective interventions were identified, it is not possible to conclude on an effective intervention that can be generalised to all patients with type 2 diabetes. PMID:25710465

  12. Systematic Review of Clozapine Cardiotoxicity.

    PubMed

    Curto, Martina; Girardi, Nicoletta; Lionetto, Luana; Ciavarella, Giuseppino M; Ferracuti, Stefano; Baldessarini, Ross J

    2016-07-01

    Clozapine is exceptionally effective in psychotic disorders and can reduce suicidal risk. Nevertheless, its use is limited due to potentially life-threatening adverse effects, including myocarditis and cardiomyopathy. Given their clinical importance, we systematically reviewed research on adverse cardiac effects of clozapine, aiming to improve estimates of their incidence, summarize features supporting their diagnosis, and evaluate proposed monitoring procedures. Incidence of early (≤2 months) myocarditis ranges from <0.1 to 1.0 % and later (3-12 months) cardiomyopathy about 10 times less. Diagnosis rests on relatively nonspecific symptoms, ECG changes, elevated indices of myocardial damage, cardiac MRI findings, and importantly, echocardiographic evidence of developing ventricular failure. Treatment involves stopping clozapine and empirical applications of steroids, diuretics, beta-blockers, and antiangiotensin agents. Mortality averages approximately 25 %. Safety of clozapine reuse remains uncertain. Systematic studies are needed to improve knowledge of the epidemiology, avoidance, early identification, and treatment of these adverse effects, with effective and practicable monitoring protocols. PMID:27222142

  13. Systematic Review Methodology in Higher Education

    ERIC Educational Resources Information Center

    Bearman, Margaret; Smith, Calvin D.; Carbone, Angela; Slade, Susan; Baik, Chi; Hughes-Warrington, Marnie; Neumann, David L.

    2012-01-01

    Systematic review methodology can be distinguished from narrative reviews of the literature through its emphasis on transparent, structured and comprehensive approaches to searching the literature and its requirement for formal synthesis of research findings. There appears to be relatively little use of the systematic review methodology within the…

  14. Views of Ethical Best Practices in Sharing Individual-Level Data From Medical and Public Health Research: A Systematic Scoping Review.

    PubMed

    Bull, Susan; Roberts, Nia; Parker, Michael

    2015-07-01

    There is increasing support for sharing individual-level data generated by medical and public health research. This scoping review of empirical research and conceptual literature examined stakeholders' perspectives of ethical best practices in data sharing, particularly in low- and middle-income settings. Sixty-nine empirical and conceptual articles were reviewed, of which, only five were empirical studies and eight were conceptual articles focusing on low- and middle-income settings. We conclude that support for sharing individual-level data is contingent on the development and implementation of international and local policies and processes to support ethical best practices. Further conceptual and empirical research is needed to ensure data sharing policies and processes in low- and middle-income settings are appropriately informed by stakeholders' perspectives. PMID:26297745

  15. Education 2.0 - How has social media and Web 2.0 been integrated into medical education? A systematical literature review

    PubMed Central

    Hollinderbäumer, Anke; Hartz, Tobias; Ückert, Frank

    2013-01-01

    Objective: Present-day students have grown up with considerable knowledge concerning multi-media. The communication modes they use are faster, more spontaneous, and independent of place and time. These new web-based forms of information and communication are used by students, educators, and patients in various ways. Universities which have already used these tools report many positive effects on the learning behaviour of the students. In a systematic literature review, we summarized the manner in which the integration of Social Media and Web 2.0 into education has taken place. Method: A systematic literature search covering the last 5 years using MeSH terms was carried out via PubMed. Result: Among the 20 chosen publications, there was only one German publication. Most of the publications are from the US and Great Britain. The latest publications report on the concrete usage of the tools in education, including social networking, podcasts, blogs, wikis, YouTube, Twitter and Skype. Conclusion: The integration of Web 2.0 and Social Media is the modern form of self-determined learning. It stimulates reflection and actively integrates the students in the construction of their knowledge. With these new tools, the students acquire skills which they need in both their social and professional lives. PMID:23467509

  16. Protocol for a systematic review of telephone delivered psychosocial interventions on relapse prevention, adherence to psychiatric medication and health risk behaviours in adults with a psychotic disorder

    PubMed Central

    Beck, Alison K; Baker, Amanda; Turner, Alyna; Haddock, Gillian; Kelly, Peter J; Berry, Katherine; Bucci, Sandra

    2015-01-01

    Introduction The mental and physical health of individuals with a psychotic illness are typically poor. When adhered to, medication can reduce relapse. However, despite adherence, relapse remains common and functional outcomes often remain compromised. Compliance is also typically low. Cardiovascular-related morbidity and mortality is also elevated, along with several important modifiable health risk behaviours. Access to psychosocial interventions is therefore important, but currently limited. Telephone delivered interventions represent a promising solution, although further clarity is needed. Accordingly, we aim to provide an overview and critical analysis of the current state of evidence for telephone delivered psychosocial interventions targeting key health priorities in adults with a psychotic disorder, including (1) relapse, (2) adherence to psychiatric medication and/or (3) modifiable cardiovascular health risk behaviours. Methods and analysis Our methods are informed by published guidelines. The review is registered and any protocol amendments will be tracked. Ten electronic peer-reviewed and four grey literature databases have been identified. Preliminary searches have been conducted for literature on psychosocial telephone interventions targeting relapse, medication adherence and/or health risk behaviours in adults with a psychotic disorder. Articles classified as ‘evaluation’ will be assessed against standardised criteria and checked by an independent assessor. The searches will be re-run just before final analyses and further studies retrieved for inclusion. A narrative synthesis will be reported, structured around intervention type and content, population characteristics and outcomes. Where possible, ‘summary of findings’ tables will be generated for each comparison. For the primary outcome of each trial, when data are available, we will calculate a risk ratio and its 95% CI (dichotomous outcomes) and/or effect size according to Cohen's formula (continuous outcomes). Ethics and dissemination No ethical issues are foreseen. Findings will be disseminated widely to clinicians and researchers via journal publication and conference presentation(s). Trial registration number PROSPERO CRD42015025402. PMID:26700289

  17. Glandular odontogenic cyst: systematic review

    PubMed Central

    MacDonald-Jankowski, D S

    2010-01-01

    Objectives The aim of this study was to evaluate the principal features of “glandular odontogenic cyst” (GOC), by systematic review (SR), and to compare their frequencies among four global groups. Methods The databases searched were the PubMed interface of MEDLINE and LILACS. Only those reports of GOCs that occurred in a series in the reporting authors' caseload were considered. All cases were confirmed histopathologically. Results 18 reports on 17 series of consecutive cases were included in the SR. GOC affected males twice as frequently and the mandible almost three times as frequently. The mean age at first presentation was 44 years, coincident with that of the Western global group, in which the largest proportion of reports and cases first presented in the second half of the fifth decade. However, age at presentation of GOCs in the East Asian and sub-Saharan African global groups was nearly a decade younger, this was significant. Six reports included details of at least one clinical presentation. Eight reports included at least one conventional radiological feature. There were some significant differences between global groups. The Western global group had a particular predilection for the anterior sextants of both jaws. The sub-Saharan African group displayed buccolingual expansion (as did the Latin American group) and tooth displacement in every case. 18% of GOCs recurred overall, except in the sub-Saharan African global group. Conclusions GOCs have a marked propensity to recur in most global groups. GOCs presented in older patients and with swellings, affected the anterior sextants of both jaws, and radiologically were more likely to present as a well-defined unilocular radiolucency with buccolingual expansion. Tooth displacement, root resorption and an association with unerupted teeth occurred in 50%, 30% and 11% of cases, respectively. PMID:20203274

  18. Identifying Best Practices for Increasing Linkage to, Retention, and Re-engagement in HIV Medical Care: Findings from a Systematic Review, 1996-2014.

    PubMed

    Higa, Darrel H; Crepaz, Nicole; Mullins, Mary M

    2016-05-01

    A systematic review was conducted to identify best practices for increasing linkage, retention and re-engagement in HIV care (LRC) for persons living with HIV (PLWH). Our search strategy consisted of automated searches of electronic databases and hand searches of journals, reference lists and listservs. We developed two sets of criteria: evidence-based to identify evidence-based interventions (EBIs) tested with a comparison group and evidence-informed to identify evidence-informed interventions (EIs) tested with a one-group design. Eligible interventions included being published between 1996 and 2014, U.S.-based studies with a comparison or one-group designs with pre-post data, international randomized controlled trials, and having objective measures of LRC-relevant outcomes. We identified 10 best practices: 5 EBIs and 5 EIs. None focused on re-engagement. Providers and prevention planners can use the review findings to identify best practices suitable for their clinics, agencies, or communities to increase engagement in care for PLWH, ultimately leading to viral suppression. PMID:26404014

  19. Systematic reviews and meta-analysis.

    PubMed

    Askie, Lisa; Offringa, Martin

    2015-12-01

    Systematic reviews and meta-analyses are at the top of the 'evidence hierarchy' when assessing the effectiveness of health interventions. As such, they are important sources of synthesized information for decision-makers including consumers, clinicians, funders, payers, regulators, and researchers. The main reasons for undertaking systematic reviews and meta-analyses are to minimize bias and to maximize data by collating all the relevant, available evidence on a particular topic. In order to correctly inform decision-makers, but not mislead them, a number of key methodological conditions need to be met when undertaking these types of analysis. In this article we first review the history of systematic reviews and meta-analyses and then outline those conditions that may lead to the correct, or incorrect, use of these types of study. Also, new variations on standard systematic review methods are explored, with the pros and cons of each outlined. PMID:26515266

  20. Database choices in endocrine systematic reviews

    PubMed Central

    Vassar, Matt; Carr, Branden; Kash-Holley, Melissa; DeWitt, Elizabeth; Koller, Chelsea; Day, Joshua; Day, Kimberly; Herrmann, David; Holzmann, Matt

    2015-01-01

    Objective The choice of bibliographic database during the systematic review search process has been an ongoing conversation among information specialists. With newer information sources, such as Google Scholar and clinical trials registries, we were interested in which databases were utilized by information specialists and systematic review researchers. Method We retrieved 144 systematic reviews and meta-analyses from 4 clinical endocrinology journals and extracted all information sources used during the search processes. Results Findings indicate that traditional bibliographic databases are most often used, followed by regional databases, clinical trials registries, and gray literature databases. Conclusions This study informs information specialists about additional resources that may be considered during the search process. PMID:26512217

  1. Medical waste management - A review.

    PubMed

    Windfeld, Elliott Steen; Brooks, Marianne Su-Ling

    2015-11-01

    This paper examines medical waste management, including the common sources, governing legislation and handling and disposal methods. Many developed nations have medical waste legislation, however there is generally little guidance as to which objects can be defined as infectious. This lack of clarity has made sorting medical waste inefficient, thereby increasing the volume of waste treated for pathogens, which is commonly done by incineration. This review highlights that the unnecessary classification of waste as infectious results in higher disposal costs and an increase in undesirable environmental impacts. The review concludes that better education of healthcare workers and standardized sorting of medical waste streams are key avenues for efficient waste management at healthcare facilities, and that further research is required given the trend in increased medical waste production with increasing global GDP. PMID:26301686

  2. A critical review of the core medical training curriculum in the UK: A medical education perspective

    PubMed Central

    Gkotsi, Despoina; Panteliou, Eleftheria

    2014-01-01

    Summary This paper represents a systematic evaluation of the Core Medical Training Curriculum in the UK. The authors critically review the curriculum from a medical education perspective based mainly on the medical education literature as well as their personal experience of this curriculum. They conclude in practical recommendations and suggestions which, if adopted, could improve the design and implementation of this postgraduate curriculum. The systematic evaluation approach described in this paper is transferable to the evaluation of other undergraduate or postgraduate curricula, and could be a helpful guide for medical teachers involved in the delivery and evaluation of any medical curriculum PMID:25057366

  3. Systematic reviews in the field of nutrition

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Systematic reviews are valuable tools for staying abreast of evolving nutrition and aging -related topics, formulating dietary guidelines, establishing nutrient reference intakes, formulating clinical practice guidance, evaluating health claims, and setting research agendas. Basic steps of conductin...

  4. Antidepressants in pregnancy: a systematic review.

    PubMed

    Udechuku, Adaobi; Nguyen, Tram; Hill, Rebecca; Szego, Klara

    2010-11-01

    Part of three systematic reviews on the effects of psychotropic medication exposure in pregnancy, this paper critically reviews the literature on adverse effects of antidepressant use during pregnancy, and derives recommendations for clinical practice. Electronic databases were searched for original research studies examining the effects of gestational exposure to antidepressants on pregnancy, neonatal and longer-term developmental outcomes. Most results were derived from cohort (prospective and retrospective) and casecontrol studies. There were no randomized controlled trials. Congenital malformations: 35 studies identified, 12 demonstrated a significant association between antidepressant use in early pregnancy and congenital malformations. Pregnancy outcomes: 35 articles identified, outcomes measured rates of spontaneous abortion (4 out of 7 studies reporting elevated risk), preterm birth (15 out of 19 reporting elevated risk) and abnormal birth weight (8 out of 23 reporting elevated risk). Neonatal outcomes: 17 controlled studies including one meta-analysis were identified concerning neonatal adaptation. 15 studies showed an association between gestational exposure to antidepressants and neonatal adaptation difficulties. Three studies examined an association between selective serotonin reuptake inhibitor (SSRI) exposure and persistent pulmonary hypertension in the neonate with conflicting results. Longer-term developmental outcomes: 6 of 7 studies comparing developmental outcomes of children exposed to antidepressants in utero with non- exposed children reported no significant differences. Most of these medications remain relatively safe in pregnancy, but some significant areas of concern exist, particularly some evidence of higher risk of preterm birth, neonatal adaptation difficulties and congenital cardiac malformations (with paroxetine). The impact of these findings on the risk-benefit analysis when treating pregnant women with antidepressants is discussed. PMID:21034181

  5. A systematic method for search term selection in systematic reviews.

    PubMed

    Thompson, Jenna; Davis, Jacqueline; Mazerolle, Lorraine

    2014-06-01

    The wide variety of readily available electronic media grants anyone the freedom to retrieve published references from almost any area of research around the world. Despite this privilege, keeping up with primary research evidence is almost impossible because of the increase in professional publishing across disciplines. Systematic reviews are a solution to this problem as they aim to synthesize all current information on a particular topic and present a balanced and unbiased summary of the findings. They are fast becoming an important method of research across a number of fields, yet only a small number of guidelines exist on how to define and select terms for a systematic search. This article presents a replicable method for selecting terms in a systematic search using the semantic concept recognition software called leximancer (Leximancer, University of Queensland, Brisbane, Australia). We use this software to construct a set of terms from a corpus of literature pertaining to transborder interventions for drug control and discuss the applicability of this method to systematic reviews in general. This method aims to contribute a more 'systematic' approach for selecting terms in a manner that is entirely replicable for any user. PMID:26052649

  6. Worldwide inequality in production of systematic reviews

    PubMed Central

    Jamali, Arsia; Nedjat, Saharnaz; Heidari, Kazem; Jamali, Raika; Hassanpour, Kiana; Nedjat, Sima; Anvari, Pasha; Majdzadeh, Reza

    2015-01-01

    Background: Investment in science is vital for the development and well-being of societies. This study aims to assess the scientific productivity of countries by quantifying their publication of systematic reviews taking the gross national income per capita (GNIPC) into account. Methods: Medline and ISI Web of Science were searched for systematic reviews published between 1st January 2006 and 31st December 2010. The productivity of each country was quantified by exploring the authors’ affiliation. The GNIPC was used according to the World Bank Report. Concentration index (CI) was calculated as the index of inequality. Results: CI of percentage of systematic reviews as a function of percentage of countries ranked by GNIPC was 0.82 which indicates inequality in production of systematic reviews in pro rich countries. Countries with high income produced 206.23 times more systematic reviews than low income countries, while this ratio for lower middle and upper middle countries was 9.67 and 12.97, respectively. The highest concentration index was observed in clinical sciences (0.76) and the lowest in public health (0.61). Conclusion: This study demonstrates a significant gap between industrialized and nonindustrialized countries in the production of systematic reviews. Addressing this gap needs tremendous national and international efforts. PMID:26913272

  7. Systematic Reviews of Animal Models: Methodology versus Epistemology

    PubMed Central

    Greek, Ray; Menache, Andre

    2013-01-01

    Systematic reviews are currently favored methods of evaluating research in order to reach conclusions regarding medical practice. The need for such reviews is necessitated by the fact that no research is perfect and experts are prone to bias. By combining many studies that fulfill specific criteria, one hopes that the strengths can be multiplied and thus reliable conclusions attained. Potential flaws in this process include the assumptions that underlie the research under examination. If the assumptions, or axioms, upon which the research studies are based, are untenable either scientifically or logically, then the results must be highly suspect regardless of the otherwise high quality of the studies or the systematic reviews. We outline recent criticisms of animal-based research, namely that animal models are failing to predict human responses. It is this failure that is purportedly being corrected via systematic reviews. We then examine the assumption that animal models can predict human outcomes to perturbations such as disease or drugs, even under the best of circumstances. We examine the use of animal models in light of empirical evidence comparing human outcomes to those from animal models, complexity theory, and evolutionary biology. We conclude that even if legitimate criticisms of animal models were addressed, through standardization of protocols and systematic reviews, the animal model would still fail as a predictive modality for human response to drugs and disease. Therefore, systematic reviews and meta-analyses of animal-based research are poor tools for attempting to reach conclusions regarding human interventions. PMID:23372426

  8. What is orthopaedic triage? A systematic review

    PubMed Central

    Morris, Joanne H; James, Rebecca E; Davey, Rachel; Waddington, Gordon

    2015-01-01

    Rationale, aims and objectives Complex and chronic disease is placing significant pressure on hospital outpatient departments. Novel ways of delivering care have been developed recently and are often described as ‘triage’ services. This paper reviews the literature pertaining to definitions and descriptions of orthopaedic/musculoskeletal triage processes, in order to provide information on ‘best practice’ to assist health care facilities. Method A comprehensive open-ended search was conducted using electronic databases to identify studies describing models of triage clinics for patients with a musculoskeletal/orthopaedic complaint, who have been referred to hospital outpatient clinics for a surgical consultation. Studies were critically appraised using the McMaster quality appraisal tool and ranked using the National Health and Medical Research Council hierarchy of evidence. A thematic analysis of the definitions, processes and procedures of triage described within the literature was undertaken. Results 1930 studies were identified and 45 were included in the review (including diagnostic and evaluative research). The hierarchy of evidence ranged from I to IV; however, the majority were at low levels of evidence and scored poorly on the critical appraisal tool. Three broad themes of triage were identified: presence of a referral, configuration of the triage (who, how and where) and the aim of triage. However, there were significant inconsistencies across these themes. Conclusions This systematic review highlighted the need for standardization of the definition of triage, the procedures of assessment and management and measures of outcome used in orthopaedic/musculoskeletal triage to ensure best-practice processes, procedures and outcomes for triage clinics. PMID:25410703

  9. Contribution of systematic reviews to management decisions.

    PubMed

    Cook, Carly N; Possingham, Hugh P; Fuller, Richard A

    2013-10-01

    Systematic reviews comprehensively summarize evidence about the effectiveness of conservation interventions. We investigated the contribution to management decisions made by this growing body of literature. We identified 43 systematic reviews of conservation evidence, 23 of which drew some concrete conclusions relevant to management. Most reviews addressed conservation interventions relevant to policy decisions; only 35% considered practical on-the-ground management interventions. The majority of reviews covered only a small fraction of the geographic and taxonomic breadth they aimed to address (median = 13% of relevant countries and 16% of relevant taxa). The likelihood that reviews contained at least some implications for management tended to increase as geographic coverage increased and to decline as taxonomic breadth increased. These results suggest the breadth of a systematic review requires careful consideration. Reviews identified a mean of 312 relevant primary studies but excluded 88% of these because of deficiencies in design or a failure to meet other inclusion criteria. Reviews summarized on average 284 data sets and 112 years of research activity, yet the likelihood that their results had at least some implications for management did not increase as the amount of primary research summarized increased. In some cases, conclusions were elusive despite the inclusion of hundreds of data sets and years of cumulative research activity. Systematic reviews are an important part of the conservation decision making tool kit, although we believe the benefits of systematic reviews could be significantly enhanced by increasing the number of reviews focused on questions of direct relevance to on-the-ground managers; defining a more focused geographic and taxonomic breadth that better reflects available data; including a broader range of evidence types; and appraising the cost-effectiveness of interventions. PMID:24001025

  10. Borderline Intellectual Functioning: A Systematic Literature Review

    ERIC Educational Resources Information Center

    Peltopuro, Minna; Ahonen, Timo; Kaartinen, Jukka; Seppl, Heikki; Nrhi, Vesa

    2014-01-01

    The literature related to people with borderline intellectual functioning (BIF) was systematically reviewed in order to summarize the present knowledge. Database searches yielded 1,726 citations, and 49 studies were included in the review. People with BIF face a variety of hardships in life, including neurocognitive, social, and mental health

  11. Borderline Intellectual Functioning: A Systematic Literature Review

    ERIC Educational Resources Information Center

    Peltopuro, Minna; Ahonen, Timo; Kaartinen, Jukka; Seppälä, Heikki; Närhi, Vesa

    2014-01-01

    The literature related to people with borderline intellectual functioning (BIF) was systematically reviewed in order to summarize the present knowledge. Database searches yielded 1,726 citations, and 49 studies were included in the review. People with BIF face a variety of hardships in life, including neurocognitive, social, and mental health…

  12. Complementary therapies for reducing body weight: a systematic review.

    PubMed

    Pittler, M H; Ernst, E

    2005-09-01

    The prevalence of obesity is increasing at an alarming rate and a plethora of complementary therapies are on offer claiming effectiveness for reducing body weight. The aim of this systematic review is to critically assess the evidence from randomized controlled trials (RCTs) and systematic reviews of complementary therapies for reducing body weight. Literature searches were conducted on Medline, Embase, Amed, and the Cochrane Library until January 2004. Hand-searches of relevant medical journals and bibliographies of identified articles were conducted. There were no restrictions regarding the language of publication. Trial selection, quality assessment and data abstraction were performed systematically and independently by two authors. Data from RCTs and systematic reviews, which based their findings on the results of RCTs, were included. Six systematic reviews and 25 additional RCTs met our inclusion criteria and were reviewed. The evidence related to acupuncture, acupressure, dietary supplements, homeopathy and hypnotherapy. Except for hypnotherapy, Ephedra sinica and other ephedrine-containing dietary supplements the weight of the evidence is not convincing enough to suggest effectiveness. For these interventions, small effects compared with placebo were identified. In conclusion, our findings suggest that for most complementary therapies, the weight of the evidence for reducing body is not convincing. Hypnotherapy, E. sinica and other ephedrine-containing dietary supplements may lead to small reductions in body weight. However, the intake of E. sinica and ephedrine is associated with an increased risk of adverse events. Interventions suggesting positive effects in single RCTs require independent replication. PMID:15925954

  13. [Medical image compression: a review].

    PubMed

    Noreña, Tatiana; Romero, Eduardo

    2013-01-01

    Modern medicine is an increasingly complex activity , based on the evidence ; it consists of information from multiple sources : medical record text , sound recordings , images and videos generated by a large number of devices . Medical imaging is one of the most important sources of information since they offer comprehensive support of medical procedures for diagnosis and follow-up . However , the amount of information generated by image capturing gadgets quickly exceeds storage availability in radiology services , generating additional costs in devices with greater storage capacity . Besides , the current trend of developing applications in cloud computing has limitations, even though virtual storage is available from anywhere, connections are made through internet . In these scenarios the optimal use of information necessarily requires powerful compression algorithms adapted to medical activity needs . In this paper we present a review of compression techniques used for image storage , and a critical analysis of them from the point of view of their use in clinical settings. PMID:23715317

  14. Dental insurance: A systematic review

    PubMed Central

    Garla, Bharath Kumar; Satish, G.; Divya, K. T.

    2014-01-01

    To review uses of finance in dentistry. A search of 25 electronic databases and World Wide Web was conducted. Relevant journals were hand searched and further information was requested from authors. Inclusion criteria were a predefined hierarchy of evidence and objectives. Study validity was assessed with checklists. Two reviewers independently screened sources, extracted data, and assessed validity. Insurance has come of ages and has become the mainstay of payment in many developed countries. So much so that all the alternative forms of payment which originated as an alternative to fee for service now depend on insurance at one point or the other. Fee for service is still the major form of payment in many developing countries including India. It is preferred in many instances since the payment is made immediately. PMID:25558454

  15. Dental insurance: A systematic review.

    PubMed

    Garla, Bharath Kumar; Satish, G; Divya, K T

    2014-12-01

    To review uses of finance in dentistry. A search of 25 electronic databases and World Wide Web was conducted. Relevant journals were hand searched and further information was requested from authors. Inclusion criteria were a predefined hierarchy of evidence and objectives. Study validity was assessed with checklists. Two reviewers independently screened sources, extracted data, and assessed validity. Insurance has come of ages and has become the mainstay of payment in many developed countries. So much so that all the alternative forms of payment which originated as an alternative to fee for service now depend on insurance at one point or the other. Fee for service is still the major form of payment in many developing countries including India. It is preferred in many instances since the payment is made immediately. PMID:25558454

  16. Haematospermia – A Systematic Review

    PubMed Central

    Kumar, Priya; Kapoor, Sona; Nargund, Vinod

    2006-01-01

    Haematospermia (or haemospermia) is a distressing symptom in sexually active men. In most cases, it is caused by non-specific inflammation of the prostate and seminal vesicles. In a small percentage of men, however, it may be a manifestation of genito-urinary or systemic malignancy, in particular prostate cancer. The purpose of this review is to explain the causes and management of patients with haematospermia. PMID:16834849

  17. Systematic reviews and knowledge translation.

    PubMed Central

    Tugwell, Peter; Robinson, Vivian; Grimshaw, Jeremy; Santesso, Nancy

    2006-01-01

    Proven effective interventions exist that would enable all countries to meet the Millennium Development Goals. However, uptake and use of these interventions in the poorest populations is at least 50% less than in the richest populations within each country. Also, we have recently shown that community effectiveness of interventions is lower for the poorest populations due to a "staircase" effect of lower coverage/access, worse diagnostic accuracy, less provider compliance and less consumer adherence. We propose an evidence-based framework for equity-oriented knowledge translation to enhance community effectiveness and health equity. This framework is represented as a cascade of steps to assess and prioritize barriers and thus choose effective knowledge translation interventions that are tailored for relevant audiences (public, patient, practitioner, policy-maker, press and private sector), as well as the evaluation, monitoring and sharing of these strategies. We have used two examples of effective interventions (insecticide-treated bednets to prevent malaria and childhood immunization) to illustrate how this framework can provide a systematic method for decision-makers to ensure the application of evidence-based knowledge in disadvantaged populations. Future work to empirically validate and evaluate the usefulness of this framework is needed. We invite researchers and implementers to use the cascade for equity-oriented knowledge translation as a guide when planning implementation strategies for proven effective interventions. We also encourage policy-makers and health-care managers to use this framework when deciding how effective interventions can be implemented in their own settings. PMID:16917652

  18. Medical hyperspectral imaging: a review

    PubMed Central

    Lu, Guolan; Fei, Baowei

    2014-01-01

    Abstract. Hyperspectral imaging (HSI) is an emerging imaging modality for medical applications, especially in disease diagnosis and image-guided surgery. HSI acquires a three-dimensional dataset called hypercube, with two spatial dimensions and one spectral dimension. Spatially resolved spectral imaging obtained by HSI provides diagnostic information about the tissue physiology, morphology, and composition. This review paper presents an overview of the literature on medical hyperspectral imaging technology and its applications. The aim of the survey is threefold: an introduction for those new to the field, an overview for those working in the field, and a reference for those searching for literature on a specific application. PMID:24441941

  19. Medical hyperspectral imaging: a review.

    PubMed

    Lu, Guolan; Fei, Baowei

    2014-01-01

    Hyperspectral imaging (HSI) is an emerging imaging modality for medical applications, especially in disease diagnosis and image-guided surgery. HSI acquires a three-dimensional dataset called hypercube, with two spatial dimensions and one spectral dimension. Spatially resolved spectral imaging obtained by HSI provides diagnostic information about the tissue physiology, morphology, and composition. This review paper presents an overview of the literature on medical hyperspectral imaging technology and its applications. The aim of the survey is threefold: an introduction for those new to the field, an overview for those working in the field, and a reference for those searching for literature on a specific application. PMID:24441941

  20. Medical hyperspectral imaging: a review

    NASA Astrophysics Data System (ADS)

    Lu, Guolan; Fei, Baowei

    2014-01-01

    Hyperspectral imaging (HSI) is an emerging imaging modality for medical applications, especially in disease diagnosis and image-guided surgery. HSI acquires a three-dimensional dataset called hypercube, with two spatial dimensions and one spectral dimension. Spatially resolved spectral imaging obtained by HSI provides diagnostic information about the tissue physiology, morphology, and composition. This review paper presents an overview of the literature on medical hyperspectral imaging technology and its applications. The aim of the survey is threefold: an introduction for those new to the field, an overview for those working in the field, and a reference for those searching for literature on a specific application.

  1. Systematic imaging review: Multiple Sclerosis

    PubMed Central

    Katdare, Aparna; Ursekar, Meher

    2015-01-01

    Multiple sclerosis (MS) is a chronic, inflammatory disease of the central nervous system characterised by immune-mediated demyelination, and is a leading cause of neurological disability worldwide. It has a wide spectrum of clinical presentations which overlap with other neurological conditions many times. Further, the radiological array of findings in MS can also be confused for multiple other conditions, leading to the need to look for the more typical findings, and interpret these in close conjunction with the clinical picture including temporal evolution. This review aims to revisit the MRI findings in MS, including recent innovations in imaging, and to help distinguish MS from its mimics. PMID:26538845

  2. Annual review of ecology and systematics

    SciTech Connect

    Fautin, D.G. ); Futuyma, D.J. ); James, F.C. )

    1992-01-01

    This book contains proceedings of the Annual Review of Ecology and Systematics. Topics covered include: global change, world environment, ecology, ecosystems, interactions, pollutants and climatic change. with Volume 23 the succession from the pioneers to the next seral stage has been completed. This seems an appropriate opportunity to renew the invitation to members of the ecology and systematics communities last issued in Volume 14 (1983) for suggestions for reviews that we might not think of soliciting ourselves. The names of the spine and title have changed, bust the objectives have not.

  3. Medication Reconciliation and Therapy Management in Dialysis-Dependent Patients: Need for a Systematic Approach

    PubMed Central

    Cardone, Katie E.; Manley, Harold J.; St. Peter, Wendy L.; Shaffer, Rachel; Somers, Michael; Mehrotra, Rajnish

    2013-01-01

    Summary Patients with ESRD undergoing dialysis have highly complex medication regimens and disproportionately higher total cost of care compared with the general Medicare population. As shown by several studies, dialysis-dependent patients are at especially high risk for medication-related problems. Providing medication reconciliation and therapy management services is critically important to avoid costs associated with medication-related problems, such as adverse drug events and hospitalizations in the ESRD population. The Medicare Modernization Act of 2003 included an unfunded mandate stipulating that medication therapy management be offered to high-risk patients enrolled in Medicare Part D. Medication management services are distinct from the dispensing of medications and involve a complete medication review for all disease states. The dialysis facility is a logical coordination center for medication management services, like medication therapy management, and it is likely the first health care facility that a patient will present to after a care transition. A dedicated and adequately trained clinician, such as a pharmacist, is needed to provide consistent, high-quality medication management services. Medication reconciliation and medication management services that could consistently and systematically identify and resolve medication-related problems would be likely to improve ESRD patient outcomes and reduce total cost of care. Herein, this work provides a review of available evidence and recommendations for optimal delivery of medication management services to ESRD patients in a dialysis facility-centered model. PMID:23990162

  4. VISCOSUPPLEMENTATION IN ANKLE OSTEOARTHRITIS: A SYSTEMATIC REVIEW

    PubMed Central

    Faleiro, Thiago Batista; Schulz, Renata da Silva; Jambeiro, Jorge Eduardo de Schoucair; Tavares, Antero; Delmonte, Fernando Moreira; Daltro, Gildásio de Cerqueira

    2016-01-01

    ABSTRACT To evaluate the efficacy of viscosupplementation in patients with osteoarthritis of the ankle. A systematic review to evaluate the evidence in the literature on the use of viscosupplementation for osteoarthritis of the ankle. For this review, we considered blind randomized prospective studies involving the use of viscosupplementation for osteoarthritis of the ankle. A total of 1,961 articles were identified in various databases. After examining each of the articles, five articles were included in this review. Treatment with intraarticular hyaluronic acid is a safe treatment modality that significantly improves functional scores of patients, with no evidence of superiority in relation to other conservative treatments. Further clinical trials with larger numbers of patients are needed so that we can recommend its use and address unanswered questions. Systematic Review of Randomized Clinical Trials. PMID:26997916

  5. Application of systematic review methodology to the field of nutrition.

    PubMed

    Lichtenstein, Alice H; Yetley, Elizabeth A; Lau, Joseph

    2008-12-01

    Systematic reviews represent a rigorous and transparent approach to synthesizing scientific evidence that minimizes bias. They evolved within the medical community to support development of clinical and public health practice guidelines, set research agendas, and formulate scientific consensus statements. The use of systematic reviews for nutrition-related topics is more recent. Systematic reviews provide independently conducted comprehensive and objective assessments of available information addressing precise questions. This approach to summarizing available data is a useful tool for identifying the state of science including knowledge gaps and associated research needs, supporting development of science-based recommendations and guidelines, and serving as the foundation for updates as new data emerge. Our objective is to describe the steps for performing systematic reviews and highlight areas unique to the discipline of nutrition that are important to consider in data assessment. The steps involved in generating systematic reviews include identifying staffing and planning for outside expert input, forming a research team, developing an analytic framework, developing and refining research questions, defining eligibility criteria, identifying search terms, screening abstracts according to eligibility criteria, retrieving articles for evaluation, constructing evidence and summary tables, assessing methodological quality and applicability, and synthesizing results including performing meta-analysis, if appropriate. Unique and at times challenging, nutrition-related considerations include baseline nutrient exposure, nutrient status, bioequivalence of bioactive compounds, bioavailability, multiple and interrelated biological functions, undefined nature of some interventions, and uncertainties in intake assessment. Systematic reviews are a valuable and independent component of decision-making processes by groups responsible for developing science-based recommendations and policies. PMID:19022948

  6. Latent Tuberculosis in Pregnancy: A Systematic Review

    PubMed Central

    Malhamé, Isabelle; Cormier, Maxime; Sugarman, Jordan; Schwartzman, Kevin

    2016-01-01

    Background In countries with low tuberculosis (TB) incidence, immigrants from higher incidence countries represent the major pool of individuals with latent TB infection (LTBI). The antenatal period represents an opportunity for immigrant women to access the medical system, and hence for potential screening and treatment of LTBI. However, such screening and treatment during pregnancy remains controversial. Objectives In order to further understand the prevalence, natural history, screening and management of LTBI in pregnancy, we conducted a systematic literature review addressing the screening and treatment of LTBI, in pregnant women without known HIV infection. Methods A systematic review of 4 databases (Embase, Embase Classic, Medline, Cochrane Library) covering articles published from January 1st 1980 to April 30th 2014. Articles in English, French or Spanish with relevant information on prevalence, natural history, screening tools, screening strategies and treatment of LTBI during pregnancy were eligible for inclusion. Articles were excluded if (1) Full text was not available (2) they were case series or case studies (3) they focused exclusively on prevalence, diagnosis and treatment of active TB (4) the study population was exclusively HIV-infected. Results Of 4,193 titles initially identified, 208 abstracts were eligible for review. Of these, 30 articles qualified for full text review and 22 were retained: 3 cohort studies, 2 case-control studies, and 17 cross-sectional studies. In the USA, the estimated prevalence of LTBI ranged from 14 to 48% in women tested, and tuberculin skin test (TST) positivity was associated with ethnicity. One study suggested that incidence of active TB was significantly increased during the 180 days postpartum (Incidence rate ratio, 1.95 (95% CI 1.24–3.07). There was a high level of adherence with both skin testing (between 90–100%) and chest radiography (93–100%.). In three studies from low incidence settings, concordance between TST and an interferon-gamma release assay was 77, 88 and 91% with kappa values ranging from 0.26 to 0.45. In low incidence settings, an IGRA may be more specific and less sensitive than TST, and results do not appear to be altered by pregnancy. The proportion of women who attended follow-up visits after positive tuberculin tests varied from 14 to 69%, while 5 to 42% of those who attended follow-up visits completed a minimum of 6 months of isoniazid treatment. One study raised the possibility of an association of pregnancy/post-partum state with INH hepatitis (risk ratio 2,5, 95% CI 0.8–8.2) and fatal hepatotoxicity (rate ratio 4.0, 95% CI 0.2–258). One study deemed INH safe during breastfeeding based on peak concentrations in plasma and breast milk after INH administration. Conclusion Pregnancy is an opportunity to screen for LTBI. Interferon-gamma release assays are likely comparable to tuberculin skin tests and may be used during pregnancy. Efforts should be made to improve adherence with follow-up and treatment post-partum. Further data are needed with respect to safety and feasibility of antepartum INH therapy, and with respect to alternative treatment regimens. PMID:27149116

  7. Treatment of Childhood Obesity: A Systematic Review

    ERIC Educational Resources Information Center

    Staniford, Leanne J.; Breckon, Jeff D.; Copeland, Robert J.

    2012-01-01

    Childhood obesity trends have increased dramatically over the past three decade's. The purpose of this quantitative systematic review is to provide an update of the evidence, illustrating the efficacy of childhood obesity treatment, considering whether treatment fidelity has been measured and/or reported and whether this related to the treatment…

  8. "Philosophy for Children": A Systematic Review

    ERIC Educational Resources Information Center

    Trickey, S.; Topping, K. J.

    2004-01-01

    This paper offers a systematic critical review of controlled outcome studies of the "Philosophy for Children" (P4C) method in primary (elementary) and secondary (high) schools. Ten studies met the stringent criteria for inclusion, measuring outcomes by norm-referenced tests of reading, reasoning, cognitive ability, and other curriculum-related…

  9. Educational interventions to improve prescribing competency: a systematic review

    PubMed Central

    Kamarudin, Gritta; Penm, Jonathan; Chaar, Betty; Moles, Rebekah

    2013-01-01

    Objective To review the literature on educational interventions to improve prescribing and identify educational methods that improve prescribing competency in both medical and non-medical prescribers. Design A systematic review was conducted. The databases Medline, International Pharmaceutical Abstracts (IPA), EMBASE and CINAHL were searched for articles in English published between January 1990 and July 2013. Setting Primary and secondary care. Participants Medical and non-medical prescribers. Intervention Education-based interventions to aid improvement in prescribing competency. Primary outcome Improvements in prescribing competency (knows how) or performance (shows how) as defined by Miller's competency model. This was primarily demonstrated through prescribing examinations, changes in prescribing habits or adherence to guidelines. Results A total of 47 studies met the inclusion criteria and were included in the systematic review. Studies were categorised by their method of assessment, with 20 studies assessing prescribing competence and 27 assessing prescribing performance. A wide variety of educational interventions were employed, with different outcome measures and methods of assessments. In particular, six studies demonstrated that specific prescribing training using the WHO Guide to Good Prescribing increased prescribing competency in a wide variety of settings. Continuing medical education in the form of academic detailing and personalised prescriber feedback also yielded positive results. Only four studies evaluated educational interventions targeted at non-medical prescribers, highlighting that further research is needed in this area. Conclusions A broad range of educational interventions have been conducted to improve prescribing competency. The WHO Guide to Good Prescribing has the largest body of evidence to support its use and is a promising model for the design of targeted prescribing courses. There is a need for further development and evaluation of educational methods for non-medical prescribers. PMID:23996821

  10. The Effectiveness of the Problem-Based Learning Teaching Model for Use in Introductory Chinese Undergraduate Medical Courses: A Systematic Review and Meta-Analysis

    PubMed Central

    Zhang, Yanqi; Zhou, Liang; Liu, Xiaoyu; Liu, Ling; Wu, Yazhou; Zhao, Zengwei; Yi, Dali; Yi, Dong

    2015-01-01

    Background Although the problem-based learning (PBL) emerged in 1969 and was soon widely applied internationally, the rapid development in China only occurred in the last 10 years. This study aims to compare the effect of PBL and lecture-based learning (LBL) on student course examination results for introductory Chinese undergraduate medical courses. Methods Randomized and nonrandomized controlled trial studies on PBL use in Chinese undergraduate medical education were retrieved through PubMed, the Excerpta Medica Database (EMBASE), Chinese National Knowledge Infrastructure (CNKI) and VIP China Science and Technology Journal Database (VIP-CSTJ) with publication dates from 1st January 1966 till 31 August 2014. The pass rate, excellence rate and examination scores of course examination were collected. Methodological quality was evaluated based on the modified Jadad scale. The I-square statistic and Chi-square test of heterogeneity were used to assess the statistical heterogeneity. Overall RRs or SMDs with their 95% CIs were calculated in meta-analysis. Meta-regression and subgroup meta-analyses were also performed based on comparators and other confounding factors. Funnel plots and Egger’s tests were performed to assess degrees of publication bias. Results The meta-analysis included 31studies and 4,699 subjects. Fourteen studies were of high quality with modified Jadad scores of 4 to 6, and 17 studies were of low quality with scores of 1 to 3. Relative to the LBL model, the PBL model yielded higher course examination pass rates [RR = 1.09, 95%CI (1.03, 1.17)], excellence rates [RR = 1.66, 95%CI (1.33, 2.06)] and examination scores [SMD = 0.82, 95%CI (0.63, 1.01)]. The meta-regression results show that course type was the significant confounding factor that caused heterogeneity in the examination-score meta-analysis (t = 0.410, P<0.001). The examination score SMD in “laboratory course” subgroup [SMD = 2.01, 95% CI: (1.50, 2.52)] was higher than that in “theory course” subgroup [SMD = 0.72, 95% CI: (0.56, 0.89)]. Conclusions PBL teaching model application in introductory undergraduate medical courses can increase course examination excellence rates and scores in Chinese medical education system. It is more effective when applied to laboratory courses than to theory-based courses. PMID:25822653

  11. Understanding systematic conceptual structures in polysemous medical terms.

    PubMed

    Gangemi, A; Pisanelli, D M; Steve, G

    2000-01-01

    Polysemy is a bottleneck for the demanding needs of semantic data management. We suggest the importance of a well-founded conceptual analysis for understanding some systematic structures underlying polysemy in the medical lexicon. We present some cases studies, which exploit the methods (ontological integration and general theories) and tools (description logics and ontology libraries) of the ONIONS methodology defined elsewhere by the authors. This paper addresses an aspect (systematic metomymies) of the project we are involved in, which investigates the feasibility of building a large-scale ontology library of medicine that integrates the most important medical terminology banks. PMID:11079890

  12. Surgical treatment in spine Paget's disease: a systematic review.

    PubMed

    Jorge-Mora, Alberto; Amhaz-Escanlar, Samer; Lois-Iglesias, Ana; Leborans-Eiris, Susana; Pino-Minguez, Jesús

    2016-01-01

    Paget's disease of bone (PDB) is a disease characterized by a disorder in the bone metabolism. The spine is the second region affected after the pelvis. Surgical treatment is reserved for cases refractory to medical treatment. We performed a systematic review of patients with Paget disease of bone affecting the spine, treated surgically in the last 30 years. The main objective of the review is to find out indications for surgery, outcomes of these patients and also the standard perioperative management. PMID:26126588

  13. Effectiveness of brief interventions as part of the screening, brief intervention and referral to treatment (SBIRT) model for reducing the non-medical use of psychoactive substances: a systematic review protocol

    PubMed Central

    2012-01-01

    Background There is a significant public health burden associated with substance use in Canada. The early detection and/or treatment of risky substance use has the potential to dramatically improve outcomes for those who experience harms from the non-medical use of psychoactive substances, particularly adolescents whose brains are still undergoing development. The Screening, Brief Intervention, and Referral to Treatment model is a comprehensive, integrated approach for the delivery of early intervention and treatment services for individuals experiencing substance use-related harms, as well as those who are at risk of experiencing such harm. Methods This article describes the protocol for a systematic review of the effectiveness of brief interventions as part of the Screening, Brief Intervention, and Referral to Treatment model for reducing the non-medical use of psychoactive substances. Studies will be selected in which brief interventions target non-medical psychoactive substance use (excluding alcohol, nicotine, or caffeine) among those 12 years and older who are opportunistically screened and deemed at risk of harms related to psychoactive substance use. We will include one-on-one verbal interventions and exclude non-verbal brief interventions (for example, the provision of information such as a pamphlet or online interventions) and group interventions. Primary, secondary and adverse outcomes of interest are prespecified. Randomized controlled trials will be included; non-randomized controlled trials, controlled before-after studies and interrupted time series designs will be considered in the absence of randomized controlled trials. We will search several bibliographic databases (for example, MEDLINE, EMBASE, CINAHL, PsycINFO, CORK) and search sources for grey literature. We will meta-analyze studies where possible. We will conduct subgroup analyses, if possible, according to drug class and intervention setting. Discussion This review will provide evidence on the effectiveness of brief interventions as part of the Screening, Brief Intervention, and Referral to Treatment protocol aimed at the non-medical use of psychoactive substances and may provide guidance as to where future research might be most beneficial. PMID:22587894

  14. Open-source point-of-care electronic medical records for use in resource-limited settings: systematic review and questionnaire surveys

    PubMed Central

    Bru, Juan; Berger, Christopher A

    2012-01-01

    Background Point-of-care electronic medical records (EMRs) are a key tool to manage chronic illness. Several EMRs have been developed for use in treating HIV and tuberculosis, but their applicability to primary care, technical requirements and clinical functionalities are largely unknown. Objectives This study aimed to address the needs of clinicians from resource-limited settings without reliable internet access who are considering adopting an open-source EMR. Study eligibility criteria Open-source point-of-care EMRs suitable for use in areas without reliable internet access. Study appraisal and synthesis methods The authors conducted a comprehensive search of all open-source EMRs suitable for sites without reliable internet access. The authors surveyed clinician users and technical implementers from a single site and technical developers of each software product. The authors evaluated availability, cost and technical requirements. Results The hardware and software for all six systems is easily available, but they vary considerably in proprietary components, installation requirements and customisability. Limitations This study relied solely on self-report from informants who developed and who actively use the included products. Conclusions and implications of key findings Clinical functionalities vary greatly among the systems, and none of the systems yet meet minimum requirements for effective implementation in a primary care resource-limited setting. The safe prescribing of medications is a particular concern with current tools. The dearth of fully functional EMR systems indicates a need for a greater emphasis by global funding agencies to move beyond disease-specific EMR systems and develop a universal open-source health informatics platform. PMID:22763661

  15. Does Cancer Literature Reflect Multidisciplinary Practice? A Systematic Review of Oncology Studies in the Medical Literature Over a 20-Year Period

    SciTech Connect

    Holliday, Emma B.; Ahmed, Awad A.; Yoo, Stella K.; Jagsi, Reshma; Hoffman, Karen E.

    2015-07-15

    Purpose: Quality cancer care is best delivered through a multidisciplinary approach requiring awareness of current evidence for all oncologic specialties. The highest impact journals often disseminate such information, so the distribution and characteristics of oncology studies by primary intervention (local therapies, systemic therapies, and targeted agents) were evaluated in 10 high-impact journals over a 20-year period. Methods and Materials: Articles published in 1994, 2004, and 2014 in New England Journal of Medicine, Lancet, Journal of the American Medical Association, Lancet Oncology, Journal of Clinical Oncology, Annals of Oncology, Radiotherapy and Oncology, International Journal of Radiation Oncology, Biology, Physics, Annals of Surgical Oncology, and European Journal of Surgical Oncology were identified. Included studies were prospectively conducted and evaluated a therapeutic intervention. Results: A total of 960 studies were included: 240 (25%) investigated local therapies, 551 (57.4%) investigated systemic therapies, and 169 (17.6%) investigated targeted therapies. More local therapy trials (n=185 [77.1%]) evaluated definitive, primary treatment than systemic (n=178 [32.3%]) or targeted therapy trials (n=38 [22.5%]; P<.001). Local therapy trials (n=16 [6.7%]) also had significantly lower rates of industry funding than systemic (n=207 [37.6%]) and targeted therapy trials (n=129 [76.3%]; P<.001). Targeted therapy trials represented 5 (2%), 38 (10.2%), and 126 (38%) of those published in 1994, 2004, and 2014, respectively (P<.001), and industry-funded 48 (18.9%), 122 (32.6%), and 182 (54.8%) trials, respectively (P<.001). Compared to publication of systemic therapy trial articles, articles investigating local therapy (odds ratio: 0.025 [95% confidence interval: 0.012-0.048]; P<.001) were less likely to be found in high-impact general medical journals. Conclusions: Fewer studies evaluating local therapies, such as surgery and radiation, are published in high-impact oncology and medicine literature. Further research and attention are necessary to guide efforts promoting appropriate representation of all oncology studies in high-impact, broad-readership journals.

  16. Psychological Profile of Sasang Typology: A Systematic Review

    PubMed Central

    Park, Soo Hyun; Lee, Soo Jin; Kim, Myoung-geun; Wedding, Danny; Kwon, Young-Kyu

    2009-01-01

    A systematic review of studies related to the psychological characteristics of Sasang types was conducted with the goal of delineating generalizable psychological profiles based on Sasang typology, a traditional Korean medical typology with medical herbs and acupuncture that is characterized as personalized medicine. Journal articles pertaining to Sasang typology were collected using five electronic database systems in Korea and in the USA. As a result, 64 potentially relevant studies were identified and 21 peer-reviewed research articles that employed psychometric inventories were included. Beginning with the use of the Minnesota Multiphasic Personality Inventory in 1992, Myers-Briggs Type Indicator, NEO-Personality Inventory, Temperament and Character Inventory and other personality assessment tools were employed in the identified studies. Because data synthesis could not be carried out due to the heterogeneity of the studies, the present review article sought to delineate the mutual relevance of the studies based on research results pertaining to the correlation between the aforementioned psychological assessment instruments. Results of the review indicate that two super-factors, Extraversion and Neuroticism, serve as the foundation in regards to delineating personality constructs, such that the So-Yang type scored high on the Extraversion dimension and low on the Neuroticism dimension, while the So-Eum type scored low on the Extraversion dimension and high on the Neuroticism dimension. The present systematic review indicates that Sasang typology shares similarities with the Western psychological tradition. PMID:19745008

  17. Acupuncture for erectile dysfunction: a systematic review protocol

    PubMed Central

    Cui, Xiaoming; Li, Xiaoli; Peng, Weina; Zhou, Jing; Yu, Jinna; Ye, Yongming; Liu, Zhishun

    2015-01-01

    Introduction This systematic review protocol aims to provide a protocol for assessing the safety and effectiveness of acupuncture for the treatment of erectile dysfunction(ED). Previous systematic reviews did not draw convincing conclusions owing to high heterogeneity and few included randomised controlled trials, so it is necessary to reassess the efficacy and safety of acupuncture for ED. Methods and analysis Eight electronic databases will be searched: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PubMed, EMBASE, PsycInfo, the Chinese Biomedical Literature Database (CBM), the Chinese Medical Current Content (CMCC) and the China National Knowledge Infrastructure (CNKI). Related Chinese literature will be searched in other Chinese databases. All relevant randomised controlled trials in English or Chinese without any restrictions of publication type will be included. The main outcome measure will be improvements in sexual activity assessed by validated questionnaires. Assessment of risk of bias, data synthesis and subgroup analysis will be carried out using Review Manager 5.3. Ethics and dissemination The results of the systematic review will be disseminated via publication in a peer-reviewed journal and presented at a relevant conference. The data we will use do not include individual patient data, so ethical approval is not required. Trial registration number PROSPERO CRD42014013575. PMID:25805531

  18. Public health interventions in midwifery: a systematic review of systematic reviews

    PubMed Central

    2012-01-01

    Background Maternity care providers, particularly midwives, have a window of opportunity to influence pregnant women about positive health choices. This aim of this paper is to identify evidence of effective public health interventions from good quality systematic reviews that could be conducted by midwives. Methods Relevant databases including MEDLINE, Pubmed, EBSCO, CRD, MIDIRS, Web of Science, The Cochrane Library and Econlit were searched to identify systematic reviews in October 2010. Quality assessment of all reviews was conducted. Results Thirty-six good quality systematic reviews were identified which reported on effective interventions. The reviews were conducted on a diverse range of interventions across the reproductive continuum and were categorised under: screening; supplementation; support; education; mental health; birthing environment; clinical care in labour and breast feeding. The scope and strength of the review findings are discussed in relation to current practice. A logic model was developed to provide an overarching framework of midwifery public health roles to inform research policy and practice. Conclusions This review provides a broad scope of high quality systematic review evidence and definitively highlights the challenge of knowledge transfer from research into practice. The review also identified gaps in knowledge around the impact of core midwifery practice on public health outcomes and the value of this contribution. This review provides evidence for researchers and funders as to the gaps in current knowledge and should be used to inform the strategic direction of the role of midwifery in public health in policy and practice. PMID:23134701

  19. Prevalence of Axis-1 psychiatric (with focus on depression and anxiety) disorder and symptomatology among non-medical prescription opioid users in substance use treatment: systematic review and meta-analyses.

    PubMed

    Goldner, Elliot M; Lusted, Anna; Roerecke, Michael; Rehm, Jrgen; Fischer, Benedikt

    2014-03-01

    Non-medical prescription opioid use (NMPOU) constitutes a substantial clinical and public health concern in North America. Although there is evidence of elevated rates of mental health problems among people with NMPOU, the extent of these correlations specifically in treatment samples has not been systematically assessed. A systematic review and meta-analysis were conducted for Axis-1 psychiatric diagnoses and symptoms with a principal focus on depression and anxiety disorders in substance use treatment samples reporting NMPOU at admission to treatment (both criteria within past 30days). 11 unique studies (all from either the United States or Canada) met inclusion criteria and were included in the meta-analysis. The pooled prevalence of 'any' mental health problems (both diagnosis and symptoms) among substance abuse treatment patients reporting NMPOU was 43% (95% CI: 32%-54%; I(2) for inter-study heterogeneity: 99.5%). The pooled prevalence of depression diagnosis among substance abuse treatment patients reporting NMPOU was 27% (95% CI: 9%-45%; I(2): 99.2%); the pooled prevalence of anxiety diagnosis in the sample was 29% (95% CI: 14%-44%; I(2): 98.7%). The prevalence rates of psychiatric problems (both diagnosis and symptoms), depression diagnosis and anxiety diagnosis are disproportionately high in substance use treatment samples reporting NMPOU relative to general population rates. Adequate and effective clinical strategies are needed to address co-occurring NMPOU and mental health in substance use treatment systems, especially given rising treatment demand for NMPOU. Efforts are needed to better understand the temporal and causal relationships among NMPOU, mental health problems, and treatment seeking in order to improve interventions. PMID:24333033

  20. Fungal Periprosthetic Joint Infection of the Hip: A Systematic Review

    PubMed Central

    Schoof, Benjamin; Jakobs, Oliver; Schmidl, Stefan; Klatte, Till Orla; Frommelt, Lars; Gehrke, Thorsten; Gebauer, Matthias

    2015-01-01

    Periprosthetic joint infection (PJI) is a severe complication of total joint arthroplasty with an incidence of approximately 1%. Due to the high risk of persisting infection, successful treatment of fungal PJI is challenging. The purpose of this study was to gain insight into the current management of fungal PJI of the hip and, by systematically reviewing the cases published so far, to further improve the medical treatment of this serious complication of total hip arthroplasty. Thus, we conducted a systematic review of the available literature concerning fungal PJI in total hip arthroplasty, including 45 cases of fungal PJI. At the moment a two-stage revision procedure is favorable and there is an ongoing discussion on the therapeutic effect of antifungal drug loaded cement spacers on fungal periprosthetic infections of the hip. Due to the fact that there is rare experience with it, there is urgent need to establish guidelines for the treatment of fungal infections of total hip arthroplasty. PMID:25874063

  1. Body image during the menopausal transition: a systematic scoping review.

    PubMed

    Pearce, Gemma; Thgersen-Ntoumani, Cecilie; Duda, Joan

    2014-01-01

    This scoping review aimed to examine women's body image during the menopausal transition systematically. A systematic search strategy and exclusion criteria were applied to ensure that only relevant research was included in the review. A total of 15 studies in 17 papers were included highlighting an equivocal relationship between body image and the menopausal transition. The menopausal transition is complex and individual, and should not be examined as a simple positive or negative transition. There is a sense of confusion for women experiencing the menopausal transition due to contradicting medical advice and societal expectations of body image. Currently, the research consists of exploratory-based studies that highlight the importance of researching this field further to aid adaptive coping and self-management across this transition. PMID:25211211

  2. Universal screening for intimate partner violence: a systematic review.

    PubMed

    Todahl, Jeff; Walters, Elaine

    2011-07-01

    Intimate partner violence (IPV) is known to be prevalent among therapy-seeking populations. Yet, despite a growing understanding of the dynamics of IPV and of the acceptability of screening, universal screening practices have not been systematically adopted in family therapy settings. A rapidly growing body of research data-almost entirely conducted in medical settings-has investigated attitudes and practices regarding universal screening for IPV. This article is a systematic review of the IPV universal screening research literature. The review summarizes literature related to IPV screening rates and practices, factors associated with provider screening practice, the role of training and institutional support on screening practice, impact of screening on disclosure rates, client beliefs and preferences for screening, and key safety considerations and screening competencies. Implications for family therapy and recommendations for further inquiry and screening model development are provided. PMID:21745237

  3. Systematic review building a preceptor support system.

    PubMed

    Goss, Carol R

    2015-01-01

    This systematic review identifies the significance of the preceptor role in affecting new graduate nurse retention. Findings from 20 research studies provide support that nurse preceptors receiving continuing education and perceiving reward and recognition from the preceptor position positively affect new graduate nurse retention. Hospital administration, nurse managers, nurse educators, preceptors, and new graduate nurses each play a role in the successful implementation of a preceptor support system. PMID:25325297

  4. Evidence supporting the need for considering the effects of smoking on drug disposition and effectiveness in medication practices: a systematic narrative review.

    PubMed

    Sohn, Hyun Soon; Kim, Hyunah; Song, Im-Sook; Lim, Eunjeong; Kwon, Mihwa; Ha, Ji-Hye; Kwon, Jin-Won

    2015-08-01

    This study was conducted to provide a narrative overview of interactions between smoking and drug effectiveness/ pharmacokinetics. Database searches were performed to identify review articles published prior to March 10, 2013. Eligible articles reporting altered pharmacokinetic profiles, drug response, or adverse drug effects due to drug-smoking interactions were selected. Information on mechanism of action and clinical effects from the selected articles (n = 83) were summarized by therapeutic drug class. For cardiovascular drugs, smoking effects were variable. Smoking reduced aspirin response but increased clopidogrel response by increasing active metabolites. Warfarin, which has a narrow therapeutic range, required dosage adjustment in smokers due to its rapid clearance. Smoking is a risk factor for respiratory disease, leading to a lower response to corticosteroid and requiring increased doses or additional drugs. Higher doses of theophylline and some antipsychotics, which are mainly metabolized by CYP1A2, are required to reach an optimal plasma concentration in smokers. Smoking is also a risk factor for cancer, especially for lung cancer. Erlotinib or gefitinib are epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) for lung cancer and showed lower anticancer effects in smokers. This summary of the interactions between smoking and drug pharmacological properties will aid healthcare professionals in providing patients with appropriate drug therapies, and emphasizes the need for considering smoking status as a patient factor in the clinical setting. PMID:26104035

  5. Using Multiple Types of Studies in Systematic Reviews of Health Care Interventions – A Systematic Review

    PubMed Central

    Peinemann, Frank; Tushabe, Doreen Allen; Kleijnen, Jos

    2013-01-01

    Background A systematic review may evaluate different aspects of a health care intervention. To accommodate the evaluation of various research questions, the inclusion of more than one study design may be necessary. One aim of this study is to find and describe articles on methodological issues concerning the incorporation of multiple types of study designs in systematic reviews on health care interventions. Another aim is to evaluate methods studies that have assessed whether reported effects differ by study types. Methods and Findings We searched PubMed, the Cochrane Database of Systematic Reviews, and the Cochrane Methodology Register on 31 March 2012 and identified 42 articles that reported on the integration of single or multiple study designs in systematic reviews. We summarized the contents of the articles qualitatively and assessed theoretical and empirical evidence. We found that many examples of reviews incorporating multiple types of studies exist and that every study design can serve a specific purpose. The clinical questions of a systematic review determine the types of design that are necessary or sufficient to provide the best possible answers. In a second independent search, we identified 49 studies, 31 systematic reviews and 18 trials that compared the effect sizes between randomized and nonrandomized controlled trials, which were statistically different in 35%, and not different in 53%. Twelve percent of studies reported both, different and non-different effect sizes. Conclusions Different study designs addressing the same question yielded varying results, with differences in about half of all examples. The risk of presenting uncertain results without knowing for sure the direction and magnitude of the effect holds true for both nonrandomized and randomized controlled trials. The integration of multiple study designs in systematic reviews is required if patients should be informed on the many facets of patient relevant issues of health care interventions. PMID:24416098

  6. Adipokines and Migraine: A Systematic Review

    PubMed Central

    Peterlin, B. Lee; Sacco, Simona; Bernecker, Claudia; Scher, Ann I.

    2016-01-01

    Background Migraine is comorbid with obesity. Recent research suggests an association between migraine and adipocytokines, proteins that are predominantly secreted from adipose tissue and which participate in energy homeostasis and inflammatory processes. Objectives In this review, we first briefly discuss the association between migraine and obesity and the importance of adipose tissue as a neuroendocrine organ. We then present a systematic review of the extant literature evaluating circulating levels of adiponectin and leptin in those with migraine. Methods A search of the PubMed database was conducted using the keywords “migraine,” “adiponectin,” and “leptin.” In addition reference lists of relevant articles were reviewed for possible inclusion. English language studies published between 2005 and 2015 evaluating circulating blood concentration of adiponectin or leptin in those with migraine were included. Conclusions While the existing data are suggestive that adipokines may be associated with migraine, substantial study design differences and conflicting results limit definitive conclusions. Future research utilizing carefully considered designs and methodology is warranted. In particular careful and systematic characterization of pain states at the time of samples, as well as systematic consideration of demographic (eg, age, sex) and other vital covariates (eg, obesity status, lipids) are needed to determine if adipokines play a role in migraine pathophysiology and if any adipokine represents a viable, novel migraine biomarker, or drug target. PMID:27012149

  7. Intermittent pneumatic compression therapy: a systematic review.

    PubMed

    Feldman, J L; Stout, N L; Wanchai, A; Stewart, B R; Cormier, J N; Armer, J M

    2012-03-01

    Intermittent pneumatic compression (IPC) therapy is an effective modality to reduce the volume of the lymphedematous limbs alone or in conjunction with other modalities of therapy such as decongestive therapy. However, there is no consensus on the frequency or treatment parameters for IPC devices. We undertook a systematic review of contemporary peer-reviewed literature (2004-2011) to evaluate the evidence for use of IPC in the treatment of lymphedema. In select patients, IPC use may provide an acceptable home-based treatment modality in addition to wearing compression garments. PMID:22768469

  8. Metabolomics in bladder cancer: a systematic review

    PubMed Central

    Cheng, Yidong; Yang, Xiao; Deng, Xiaheng; Zhang, Xiaolei; Li, Pengchao; Tao, Jun; Qin, Chao; Wei, Jifu; Lu, Qiang

    2015-01-01

    Bladder cancer (BC) is the most common urological malignancy. Early diagnosis of BC is crucial to improve patient outcomes. Currently, metabolomics is a potential technique that can be used to detect BC. We reviewed current publications and synthesised the findings on BC and metabolomics, i.e. metabolite upregulation and downregulation. Fourteen metabolites (lactic acid, leucine, valine, phenylalanine, glutamate, histidine, aspartic acid, tyrosine, serine, uracil, hypoxanthine, carnitine, pyruvic acid and citric acid) were identified as potential biomarkers for BC. In conclusion, this systematic review presents new opportunities for the diagnosis of BC. PMID:26379905

  9. Contrast therapy--a systematic review.

    PubMed

    Hing, Wayne A; White, Steven G; Bouaaphone, Anousith; Lee, Peter

    2008-08-01

    Contrast therapy is a strategy that is widely utilised in a number of sporting codes to aid recovery. This wide use might suggest that contrast therapy is an effective recovery modality however support for this assumption appears to be mainly anecdotal. The purpose of this paper is to review the efficacy of contrast therapy. To achieve this objective, a systematic review of randomised controlled trials (RCTs) that have specifically evaluated the therapeutic efficacy of contrast therapy was performed. A search to identify appropriate literature was conducted across a number of electronic databases. The titles and abstracts of the papers identified were reviewed to select papers specifically relating to contrast therapy. Twelve RCTs met the inclusion and exclusion criteria. The PEDro Scale, a systematic tool used to critique RCTs, was employed to critique the methodological quality of these studies. This review highlights both the lack in quantity and quality of research regarding the efficacy of contrast therapy for sports recovery. There appears to be insufficient evidence that contrast therapy aids in recovery and the limited methodological quality of the reviewed studies makes it difficult to draw clear conclusions about this form of therapy. Future research needs to re-examine the use of contrast therapy and in particular whole body immersion recovery strategies within the appropriate sports setting. This research will need to be of sufficient quality to enable appropriate conclusions to be made with regards to its use as a recovery strategy. PMID:19083715

  10. Educational attainment and obesity: A systematic review

    PubMed Central

    Cohen, Alison K.; Rai, Manisha; Rehkopf, David H.; Abrams, Barbara

    2013-01-01

    Background Although previous systematic reviews considered the relationship between socioeconomic status and obesity, almost 200 peer-reviewed articles have been published since the last review on that topic, and this paper focuses specifically on education, which has different implications. Methods The authors systematically review the peer-reviewed literature from around the world considering the association between educational attainment and obesity. Databases from public health and medicine, education, psychology, economics, and other social sciences were searched, and articles published in English, French, Portuguese, and Spanish were included. Results This paper includes 289 articles that report on 410 populations in 91 countries. The relationship between educational attainment and obesity was modified by both gender and the country's economic development level: an inverse association was more common in studies of higher-income countries and a positive association was more common in lower-income countries, with stronger social patterning among women. Relatively few studies reported on lower-income countries, controlled for a comprehensive set of potential confounding variables, and/or attempted to assess causality through the use of quasi-experimental designs. Conclusions Future research should address these gaps to understand if the relationship between educational attainment and obesity may be causal, thus supporting education policy as a tool for obesity prevention. PMID:23889851

  11. The effectiveness of massage therapy for the treatment of nonspecific low back pain: a systematic review of systematic reviews

    PubMed Central

    Kumar, Saravana; Beaton, Kate; Hughes, Tricia

    2013-01-01

    Introduction The last decade has seen a growth in the utilization of complementary and alternative medicine therapies, and one of the most popular and sought-after complementary and alternative medicine therapies for nonspecific low back pain is massage. Massage may often be perceived as a safe therapeutic modality without any significant risks or side effects. However, despite its popularity, there continues to be ongoing debate on the effectiveness of massage in treating nonspecific low back pain. With a rapidly evolving research evidence base and access to innovative means of synthesizing evidence, it is time to reinvestigate this issue. Methods A systematic, step-by-step approach, underpinned by best practice in reviewing the literature, was utilized as part of the methodology of this umbrella review. A systematic search was conducted in the following databases: Embase, MEDLINE, AMED, ICONDA, Academic Search Premier, Australia/New Zealand Reference Centre, CINAHL, HealthSource, SPORTDiscus, PubMed, The Cochrane Library, Scopus, Web of Knowledge/Web of Science, PsycINFO, and ProQuest Nursing and Allied Health Source, investigating systematic reviews and meta-analyses from January 2000 to December 2012, and restricted to English-language documents. Methodological quality of included reviews was undertaken using the Centre for Evidence Based Medicine critical appraisal tool. Results Nine systematic reviews were found. The methodological quality of the systematic reviews varied (from poor to excellent) although, overall, the primary research informing these systematic reviews was generally considered to be weak quality. The findings indicate that massage may be an effective treatment option when compared to placebo and some active treatment options (such as relaxation), especially in the short term. There is conflicting and contradictory findings for the effectiveness of massage therapy for the treatment of nonspecific low back pain when compared against other manual therapies (such as mobilization), standard medical care, and acupuncture. Conclusion There is an emerging body of evidence, albeit small, that supports the effectiveness of massage therapy for the treatment of non-specific low back pain in the short term. Due to common methodological flaws in the primary research, which informed the systematic reviews, recommendations arising from this evidence base should be interpreted with caution. PMID:24043951

  12. Quality of reviews on sugar-sweetened beverages and health outcomes: a systematic review123

    PubMed Central

    Weed, Douglas L; Mink, Pamela J

    2011-01-01

    Background: Medical and public health decisions are informed by reviews, which makes the quality of reviews an important scientific concern. Objective: We systematically assessed the quality of published reviews on sugar-sweetened beverages (SSBs) and health, which is a controversial topic that is important to public health. Design: We performed a search of PubMed and Cochrane databases and a hand search of reference lists. Studies that were selected were published reviews and meta-analyses (June 2001 to June 2011) of epidemiologic studies of the relation between SSBs and obesity, type 2 diabetes, metabolic syndrome, and coronary heart disease. A standardized data-abstraction form was used. Review quality was assessed by using the validated instrument AMSTAR (assessment of multiple systematic reviews), which is a one-page tool with 11 questions. Results: Seventeen reviews met our inclusion and exclusion criteria: obesity or weight (16 reviews), diabetes (3 reviews), metabolic syndrome (3 reviews), and coronary heart disease (2 reviews). Authors frequently used a strictly narrative review (7 of 17 reviews). Only 6 of 17 reviews reported quantitative data in a table format. Overall, reviews of SSBs and health outcomes received moderately low–quality scores by the AMSTAR [mean: 4.4 points; median: 4 points; range: 1–8.5 points (out of a possible score of 11 points)]. AMSTAR scores were not related to the conclusions of authors (8 reviews reported an association with a mean AMSTAR score of 4.1 points; 9 reviews with equivocal conclusions scored 4.7 points; P value = 0.84). Less than one-third of published reviews reported a comprehensive literature search, listed included and excluded studies, or used duplicate study selection and data abstraction. Conclusion: The comprehensive reporting of epidemiologic evidence and use of systematic methodologies to interpret evidence were underused in published reviews on SSBs and health. PMID:21918218

  13. Psychosexual care in prostate cancer survivorship: a systematic review

    PubMed Central

    Persad, Raj

    2015-01-01

    Background Prostate cancer (PC) is the most common cancer in men. Due to improvements in medical care, the number of PC survivors is increasing. Current literature demonstrates survivors have significant unmet needs including psychosexual care. We assess patients psychosexual needs by systematic review of literature over the past 20 years up to May 2015 in order to see what issues need to be addressed within psychosexual care. Methods A systematic review was conducted on PC survivorship and psychosexual care. The search strategy aimed to identify all references related to PC survivorship programme components (parts of survivorship programmes) AND survivorship AND psychosexual concerns. Search terms used were as follows: (PC OR prostate neoplasms) AND (survivorship OR survivor*) OR [psychosexual impairment or sexual dysfunction or erectile dysfunction (ED)] AND [comorbidity or quality of life (QoL)]. Results The systematic review identified 17 papers, examining unmet needs in psychosexual care post PC therapy. Conclusions These findings of this review may change psychosexual care of PC survivors, as national and international guidance is needed. PMID:26816840

  14. A systematic review of economic evaluations of therapy in asthma

    PubMed Central

    Bahadori, Katayoun; Quon, Bradley S; Doyle-Waters, Mary M; Marra, Carlo; FitzGerald, J Mark

    2010-01-01

    Background: Asthma’s cost-effectiveness is a major consideration in the evaluation of its treatment options. Our objective was to perform a systematic review of the cost-effectiveness of asthma medications. Methods: We performed a systematic search of MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, OHE-HEED, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Health Technology Assessments Database, NHS Economic Evaluation Database, and Web of Science and reviewed references from key articles between 1990 and Jan 2008. Results: A total of 49 RCTs met the inclusion criteria. Maintenance therapy with inhaled corticosteroids was found to be very cost-effective and in uncontrolled asthmatics patients currently being treated with ICS, the combination of an ICS/LABA represents a safe, cost-effective treatment. The simplified strategy using budesonide and formoterol for maintenance and reliever therapy was also found to be as cost-effective as salmeterol/fluticasone plus salbutamol. Omalizumab was found to be cost-effective. An important caveat with regard to the published literature is the relatively high proportion of economic evaluations which are funded by the manufacturers of specific drug treatments. Conclusion: Future studies should be completed independent of industry support and ensure that the comparator arms within studies should include dosages of drugs that are equivalent. PMID:21437038

  15. Chronic Traumatic Encephalopathy and Suicide: A Systematic Review

    PubMed Central

    Wortzel, Hal S.; Shura, Robert D.; Brenner, Lisa A.

    2013-01-01

    Traumatic brain injury (TBI) is a global health concern, and the recent literature reports that a single mild TBI can result in chronic traumatic encephalopathy (CTE). It has been suggested that CTE may lead to death by suicide, raising important prevention, treatment, and policy implications. Thus, we conducted a systematic review of the medical literature to answer the key question: What is the existing evidence in support of a relationship between CTE and suicide? Systematic searches of CTE and suicide yielded 85 unique abstracts. Seven articles were identified for full text review. Only two case series met inclusion criteria and included autopsies from 17 unique cases, 5 of whom died by suicide. Neither studies used blinding, control cases, or systematic data collection regarding TBI exposure and/or medical/neuropsychiatric history. The identified CTE literature revealed divergent opinions regarding neuropathological elements of CTE and heterogeneity regarding clinical manifestations. Overall quality of evidence regarding a relationship between CTE and suicide was rated as very low using Grading of Recommendations Assessment, Development and Evaluation Working Group (GRADE) criteria. Further studies of higher quality and methodological rigor are needed to determine the existence and nature of any relationship between CTE and suicide. PMID:24328030

  16. [Systematic review of diagnostic tests accuracy: a narrative review].

    PubMed

    de Oliveira, Glória Maria; Camargo, Fábio Trinca; Gonçalves, Eduardo Costa; Duarte, Carlos Vinicius Nascimento; Guimarães, Carlos Alberto

    2010-04-01

    The aim of this study is to perform a narrative review of systematic reviews of diagnostic tests accuracy. We undertook a search using The Cochrane Methodology Reviews (Cochrane Reviews of Diagnostic Test Accuracy), Medline and LILACS up to October 2009. Reference lists of included studies were also hand searched. The following search strategy was constructed by using a combination of subject headings and text words: 1. Cochrane Methodology Reviews: accuracy study "Methodology" 2. In Pubmed "Meta-Analysis" [Publication Type] AND "Evidence-Based Medicine" [Mesh]) AND "Sensitivity and Specificity" [Mesh] 3. LILACS (revisao sistematica) or "literatura de REVISAO como assunto" [Descritor de assunto] and (sistematica) or "SISTEMATICA" [Descritor de assunto] and (acuracia) or "SENSIBILIDADE e especificidade" [Descritor de assunto]. In summary, the methodological planning and preparation of systematic reviews of therapeutic interventions are prior to that used in systematic reviews of diagnostic tests accuracy. There are more sources of heterogeneity in design of diagnostic test studies, which impair the synthesis - meta-analysis - of the results. To work around this problem, there are currently uniform requirements for diagnostic test manuscripts submitted to leading biomedical journals. PMID:20549106

  17. Surgical interventions for gastric cancer: a review of systematic reviews

    PubMed Central

    He, Weiling; Tu, Jian; Huo, Zijun; Li, Yuhuang; Peng, Jintao; Qiu, Zhenwen; Luo, Dandong; Ke, Zunfu; Chen, Xinlin

    2015-01-01

    Aim: To evaluate methodological quality and the extent of concordance among meta-analysis and/or systematic reviews on surgical interventions for gastric cancer (GC). Methods: A comprehensive search of PubMed, Medline, EMBASE, the Cochrane library and the DARE database was conducted to identify the reviews comparing different surgical interventions for GC prior to April 2014. After applying included criteria, available data were summarized and appraised by the Oxman and Guyatt scale. Results: Fifty six reviews were included. Forty five reviews (80.4%) were well conducted, with scores of adapted Oxman and Guyatt scale ≥ 14. The reviews differed in criteria for avoiding bias and assessing the validity of the primary studies. Many primary studies displayed major methodological flaws, such as randomization, allocation concealment, and dropouts and withdrawals. According to the concordance assessment, laparoscopy-assisted gastrectomy (LAG) was superior to open gastrectomy, and laparoscopy-assisted distal gastrectomy was superior to open distal gastrectomy in short-term outcomes. However, the concordance regarding other surgical interventions, such as D1 vs. D2 lymphadenectomy, and robotic gastrectomy vs. LAG were absent. Conclusion: Systematic reviews on surgical interventions for GC displayed relatively high methodological quality. The improvement of methodological quality and reporting was necessary for primary studies. The superiority of laparoscopic over open surgery was demonstrated. But concordance on other surgical interventions was rare, which needed more well-designed RCTs and systematic reviews. PMID:26550311

  18. Health effects of indebtedness: a systematic review

    PubMed Central

    2014-01-01

    Background In the aftermath of the global financial crisis, millions of households have been left with debts that they are unable to manage. Indebtedness may impair the wellbeing of those affected by it for years to come. This systematic review focuses on the long-term consequences of indebtedness on health. Methods The method used in the paper is a systematic review. First, bibliographic databases were searched for peer-reviewed articles. Second, the references and citations of the included articles were searched for additional articles. Results The results from our sample of 33 peer-reviewed studies demonstrate serious health effects related to indebtedness. Individuals with unmet loan payments had suicidal ideation and suffered from depression more often than those without such financial problems. Unpaid financial obligations were also related to poorer subjective health and health-related behaviour. Debt counselling and other programmes to mitigate debt-related stress are needed to alleviate the adverse effects of indebtedness on health. Conclusions The results demonstrate that indebtedness has serious effects on health. PMID:24885280

  19. Latino Veterans with PTSD: A Systematic Review

    PubMed Central

    Pittman, James O. E.

    2014-01-01

    Latinos have a long history of military service with recent service including combat conditions and multiple deployments, which are highly associated with posttraumatic stress disorder (PTSD). Clinical acumen underscores the importance of culture in assessment and treatment, but there has been little scientific literature that investigates the unique needs of veteran Latinos with PTSD. The primary goal of this systematic review was to analyze the existing literature on Latino veterans with PTSD and to critically evaluate attention to cultural issues. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used to guide this review. Peer-reviewed, research reports written in English on Latino Veterans with PTSD since 1980 were included; 20 were assessment related, and nine were treatment related. All studies were quantitative. Only 13 studies mentioned culture as part of the context for Latino veterans, and only seven included cultural factors as part of the study design. Present findings highlight a lack of research focused on understanding cultural factors related to the assessment and treatment of Latino veterans with PTSD. Culturally-informed research on Latino veterans from current wars, Latina veterans and Latino veteran treatment outcomes are necessary to provide culturally-appropriate care to this growing veteran subgroup. PMID:25379284

  20. Latino Veterans with PTSD: A Systematic Review.

    PubMed

    Pittman, James O E

    2014-09-01

    Latinos have a long history of military service with recent service including combat conditions and multiple deployments, which are highly associated with posttraumatic stress disorder (PTSD). Clinical acumen underscores the importance of culture in assessment and treatment, but there has been little scientific literature that investigates the unique needs of veteran Latinos with PTSD. The primary goal of this systematic review was to analyze the existing literature on Latino veterans with PTSD and to critically evaluate attention to cultural issues. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used to guide this review. Peer-reviewed, research reports written in English on Latino Veterans with PTSD since 1980 were included; 20 were assessment related, and nine were treatment related. All studies were quantitative. Only 13 studies mentioned culture as part of the context for Latino veterans, and only seven included cultural factors as part of the study design. Present findings highlight a lack of research focused on understanding cultural factors related to the assessment and treatment of Latino veterans with PTSD. Culturally-informed research on Latino veterans from current wars, Latina veterans and Latino veteran treatment outcomes are necessary to provide culturally-appropriate care to this growing veteran subgroup. PMID:25379284

  1. Elder Abuse Research: A Systematic Review

    PubMed Central

    Daly, Jeanette M.; Merchant, Mary L.; Jogerst, Gerald J.

    2016-01-01

    A systematic review of elder abuse research has not been conducted across disciplines. The purpose of this research was to provide a systematic review of and assign an evidence grade to the research articles on elder abuse. Sixteen healthcare and criminal justice literature databases were searched. The literature review was of English-language publications reporting research on abuse of people aged 55 years and older, from any country. Titles, abstracts, and publications were retrieved from 16 databases and were reviewed by at least 2 independent readers who graded each from A (evidence of well-designed meta-analysis) to D (evidence from expert opinion or multiple case reports) on the quality of the evidence gained from the research. Of 6,676 titles identified in the search, 1,700 publications met inclusion criteria. Omitting duplicates from the 1,700 publications, 590 publications were annotated and graded. No elder abuse research publication was given an A grade. Fourteen publications were given a B grade (controlled trials), 483 were given a C grade (observational studies), and 93 were given a D grade (opinion or multiple case reports). Of the 590 publications, 492 were quantitative studies, 78 were qualitative studies, and 20 were case studies. Little evidence is available that supports any intervention to prevent elder abuse. Financial support for elder abuse research is needed along with more rigorous research trials. PMID:21978292

  2. Disasters and Perinatal Health: A Systematic Review

    PubMed Central

    Harville, EW; Xiong, X; Buekens, P

    2012-01-01

    Background The empirical literature on the effects of disaster on pregnancy and the postpartum period is limited. The objective of this review was to examine the existing evidence on the effect of disasters on perinatal health. Methods A systematic review was conducted by searching electronic databases (MEDLINE, EMBASE, Cinahl, PsycInfo), including literature on disasters and pregnancy outcomes (e.g., preterm birth, low birthweight, congenital anomalies), mental health, and child development. 110 articles were identified, but many published reports were anecdotes or recommendations rather than systematic studies. The final review included 49 peer-reviewed studies that met inclusion criteria. Results Studies addressing the World Trade Center disaster of September 11th and other terrorist attacks, environmental/chemical disasters, and natural disasters such as hurricanes and earthquakes were identified. Disasters of various types may reduce fetal growth in some women, though there does not appear to be an effect on gestational age at birth. Severity of exposure is the major predictor of mental health issues among pregnant and postpartum women. The mother's mental health after a disaster may more strongly influence on child development than any direct effect of disaster-related prenatal stress. Conclusions There is evidence that disaster impacts maternal mental health and some perinatal health outcomes, particular among highly-exposed women. Future research should focus on under-studied outcomes such as spontaneous abortion. Relief workers and clinicians should concentrate on the most exposed women, particularly with respect to mental health. PMID:21375788

  3. Infliximab-Related Infusion Reactions: Systematic Review

    PubMed Central

    Ron, Yulia; Kivity, Shmuel; Ben-Horin, Shomron; Israeli, Eran; Fraser, Gerald M.; Dotan, Iris; Chowers, Yehuda; Confino-Cohen, Ronit; Weiss, Batia

    2015-01-01

    Objective: Administration of infliximab is associated with a well-recognised risk of infusion reactions. Lack of a mechanism-based rationale for their prevention, and absence of adequate and well-controlled studies, has led to the use of diverse empirical administration protocols. The aim of this study is to perform a systematic review of the evidence behind the strategies for preventing infusion reactions to infliximab, and for controlling the reactions once they occur. Methods: We conducted extensive search of electronic databases of MEDLINE [PubMed] for reports that communicate various aspects of infusion reactions to infliximab in IBD patients. Results: We examined full texts of 105 potentially eligible articles. No randomised controlled trials that pre-defined infusion reaction as a primary outcome were found. Three RCTs evaluated infusion reactions as a secondary outcome; another four RCTs included infusion reactions in the safety evaluation analysis; and 62 additional studies focused on various aspects of mechanism/s, risk, primary and secondary preventive measures, and management algorithms. Seven studies were added by a manual search of reference lists of the relevant articles. A total of 76 original studies were included in quantitative analysis of the existing strategies. Conclusions: There is still paucity of systematic and controlled data on the risk, prevention, and management of infusion reactions to infliximab. We present working algorithms based on systematic and extensive review of the available data. More randomised controlled trials are needed in order to investigate the efficacy of the proposed preventive and management algorithms. PMID:26092578

  4. Vending machine assessment methodology. A systematic review.

    PubMed

    Matthews, Melissa A; Horacek, Tanya M

    2015-07-01

    The nutritional quality of food and beverage products sold in vending machines has been implicated as a contributing factor to the development of an obesogenic food environment. How comprehensive, reliable, and valid are the current assessment tools for vending machines to support or refute these claims? A systematic review was conducted to summarize, compare, and evaluate the current methodologies and available tools for vending machine assessment. A total of 24 relevant research studies published between 1981 and 2013 met inclusion criteria for this review. The methodological variables reviewed in this study include assessment tool type, study location, machine accessibility, product availability, healthfulness criteria, portion size, price, product promotion, and quality of scientific practice. There were wide variations in the depth of the assessment methodologies and product healthfulness criteria utilized among the reviewed studies. Of the reviewed studies, 39% evaluated machine accessibility, 91% evaluated product availability, 96% established healthfulness criteria, 70% evaluated portion size, 48% evaluated price, 52% evaluated product promotion, and 22% evaluated the quality of scientific practice. Of all reviewed articles, 87% reached conclusions that provided insight into the healthfulness of vended products and/or vending environment. Product healthfulness criteria and complexity for snack and beverage products was also found to be variable between the reviewed studies. These findings make it difficult to compare results between studies. A universal, valid, and reliable vending machine assessment tool that is comprehensive yet user-friendly is recommended. PMID:25772195

  5. The prevalence of stillbirths: a systematic review

    PubMed Central

    Say, Lale; Donner, Allan; Gülmezoglu, A Metin; Taljaard, Monica; Piaggio, Gilda

    2006-01-01

    Background Stillbirth rate is an important indicator of access to and quality of antenatal and delivery care. Obtaining overall estimates across various regions of the world is not straightforward due to variation in definitions, data collection methods and reporting. Methods We conducted a systematic review of a range of pregnancy-related conditions including stillbirths and performed meta-analysis of the subset of studies reporting stillbirth rates. We examined variation across rates and used meta-regression techniques to explain observed variation. Results We identified 389 articles on stillbirth prevalence among the 2580 included in the systematic review. We included 70 providing 80 data sets from 50 countries in the meta-analysis. Pooled prevalence rates show variation across various subgroup categories. Rates per 100 births are higher in studies conducted in less developed country settings as compared to more developed (1.17 versus 0.50), of inadequate quality as compared to adequate (1.12 versus 0.66), using sub-national sample as compared to national (1.38 versus 0.68), reporting all stillbirths as compared to late stillbirths (0.95 versus 0.63), published in non-English as compared to English (0.91 versus 0.59) and as journal articles as compared to non-journal (1.37 versus 0.67). The results of the meta-regression show the significance of two predictor variables – development status of the setting and study quality – on stillbirth prevalence. Conclusion Stillbirth prevalence at the community level is typically less than 1% in more developed parts of the world and could exceed 3% in less developed regions. Regular reviews of stillbirth rates in appropriately designed and reported studies are useful in monitoring the adequacy of care. Systematic reviews of prevalence studies are helpful in explaining sources of variation across rates. Exploring these methodological issues will lead to improved standards for assessing the burden of reproductive ill-health. PMID:16401351

  6. Child maltreatment prevention: a systematic review of reviews

    PubMed Central

    Butchart, Alexander

    2009-01-01

    Abstract Objective To synthesize recent evidence from systematic and comprehensive reviews on the effectiveness of universal and selective child maltreatment prevention interventions, evaluate the methodological quality of the reviews and outcome evaluation studies they are based on, and map the geographical distribution of the evidence. Methods A systematic review of reviews was conducted. The quality of the systematic reviews was evaluated with a tool for the assessment of multiple systematic reviews (AMSTAR), and the quality of the outcome evaluations was assessed using indicators of internal validity and of the construct validity of outcome measures. Findings The review focused on seven main types of interventions: home visiting, parent education, child sex abuse prevention, abusive head trauma prevention, multi-component interventions, media-based interventions, and support and mutual aid groups. Four of the seven – home-visiting, parent education, abusive head trauma prevention and multi-component interventions – show promise in preventing actual child maltreatment. Three of them – home visiting, parent education and child sexual abuse prevention – appear effective in reducing risk factors for child maltreatment, although these conclusions are tentative due to the methodological shortcomings of the reviews and outcome evaluation studies they draw on. An analysis of the geographical distribution of the evidence shows that outcome evaluations of child maltreatment prevention interventions are exceedingly rare in low- and middle-income countries and make up only 0.6% of the total evidence base. Conclusion Evidence for the effectiveness of four of the seven main types of interventions for preventing child maltreatment is promising, although it is weakened by methodological problems and paucity of outcome evaluations from low- and middle-income countries. PMID:19551253

  7. Borderline intellectual functioning: a systematic literature review.

    PubMed

    Peltopuro, Minna; Ahonen, Timo; Kaartinen, Jukka; Seppälä, Heikki; Närhi, Vesa

    2014-12-01

    The literature related to people with borderline intellectual functioning (BIF) was systematically reviewed in order to summarize the present knowledge. Database searches yielded 1,726 citations, and 49 studies were included in the review. People with BIF face a variety of hardships in life, including neurocognitive, social, and mental health problems. When adults with BIF were compared with the general population, they held lower-skilled jobs and earned less money. Although some risk factors (e.g., low birth weight) and preventive factors (e.g., education) were reported, they were not specific to BIF. The review finds that, despite the obvious everyday problems, BIF is almost invisible in the field of research. More research, societal discussion, and flexible support systems are needed. PMID:25409130

  8. Errors in systematic reviews: an example of computed tomography screening for lung cancer.

    PubMed

    Yip, Rowena; Islami, Farhad; Zhao, Shijun; Tao, Menghua; Yankelevitz, David F; Boffetta, Paolo

    2014-01-01

    Systematic reviews are utilized in evidence-based medicine and are increasingly being used to help guide standards, guidelines, and clinical practice. The National Lung Screening Trial results prompted such a review of lung cancer screening literature. The review was endorsed by five major medical societies. We aimed at assessing its accuracy. Two independent groups of two reviewers reviewed the systematic review, including its source literature. Errors were placed into three major categories and tabulated: (i) selection of studies, (ii) misrepresentation of published reports, and (iii) errors in calculation and rounding. A total of 151 errors were found. There were 13 errors in selection of studies, 124 errors due to misrepresentation of published reports, and 14 errors in calculations and rounding. The extent of these errors raises concern about the credibility of the conclusions of the recent lung cancer screening systematic review. A process that allows for a thorough checking of data included in systematic reviews should be established. PMID:23715405

  9. Program for reviewing returned medications.

    PubMed

    Gilliand, B F; Stanislav, G H; Constantin, J J; Schwinghammer, T L

    1992-04-01

    A program for reviewing medication doses returned to the pharmacy department is described. Discrepancies concerning returned doses at a teaching hospital led to the creation of a returned-dose log sheet. A pharmacist enters the patient's name, medication, and administration schedule and forwards a copy to the charge nurse on the patient's unit, who records the reasons for the return. A pharmacist then uses the form to resolve any discrepancies in the pharmacy records and follows up if necessary. Monthly summaries of the forms are prepared. After a pilot phase and educational feedback, the rate of return of log sheets by nurses increased to 95%. It took nurses about 10 minutes per unit to complete a form, and pharmacists required 15 to 20 minutes for completion and follow-up. The percentage of dispensed doses that were returned decreased from 1.1% during the first month of the full program to 0.4% during the eighth month. The most common reason given by nurses for returned doses was that the dose had already been charted as having been given. The therapeutic classifications most frequently represented by the returns were gastrointestinal drugs, cardiovascular drugs, anti-infective agents, and electrolytic, caloric, and water balance drugs. The use of a log sheet to document and explain the return of scheduled doses to the pharmacy department improved communication, resolved discrepancies in the records, and reduced the rate of returns. PMID:1595723

  10. Advanced nursing roles: a systematic review.

    PubMed

    Jokiniemi, Krista; Pietilä, Anna-Maija; Kylmä, Jari; Haatainen, Kaisa

    2012-09-01

    In this systematic literature review, we analyzed and synthesized the literature on one specialized advance practice nursing role in three countries for the purpose of describing and comparing these roles, as well as discussing whether an international consensus of the advance practice nursing definition is possible. A systematic search on CINAHL and PubMed Medline was conducted in 2011 to search the literature on the nurse consultant in the UK, the clinical nurse specialist in the USA, and the clinical nurse consultant in Australia. The studies (n = 42) were analyzed and combined using qualitative content analysis method. The roles of the nurse consultant, clinical nurse specialist, and clinical nurse consultant were similar. The variation in the roles appears to derive from organizational or individual choices, not the country in question. The study process comprised a synthesized representation of one specialized advance practice nursing role. More work is needed to further define the concept of the advance practice nursing, as well as its implementation on other cultures beyond this review. Based on this review, an international consensus regarding the definition of advance practice nursing and its subroles is possible. PMID:22950621

  11. Match analysis in football: a systematic review.

    PubMed

    Sarmento, Hugo; Marcelino, Rui; Anguera, M Teresa; CampaniÇo, Jorge; Matos, Nuno; LeitÃo, José Carlos

    2014-12-01

    Abstract The main focus of this paper was to review the available literature on match analysis in adult male football. The most common research topics were identified, their methodologies described and the evolutionary tendencies of this research area systematised. A systematic review of Institute for Scientific Information (ISI) Web of Knowledge database was performed according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines. The following keywords were used: football and soccer, each one associated with the terms: match analysis, performance analysis, notational analysis, game analysis, tactical analysis and patterns of play. Of 2732 studies initially identified, only 53 were fully reviewed, and their outcome measures abstracted and analysed. Studies that fit all inclusion criteria were organised according to their research design as descriptive, comparative or predictive. Results showed that 10 studies focused predominantly on a description of technical, tactical and physical performance variables. From all comparative studies, the dependent variables more frequently used were "playing position" and "competitive level". Even though the literature stresses the importance of developing predictive models of sports performance, only few studies (n = 8) have focused on modelling football performance. Situational variables like game location, quality of opposing teams, match status and match half have been progressively included as object of research, since they seem to work as effective covariables of football performance. Taking into account the limitations of the reviewed studies, future research should provide comprehensive operational definitions for the studied variables, use standardised categories and description of activities and participants, and consider integrating the situational and interactional contexts into the analysis of football performance. PMID:24787442

  12. Inuit Elderly: A Systematic Review of Peer Reviewed Journal Articles.

    PubMed

    Somogyi, Balvinder K; Barker, Melanie; MacLean, Calvin; Grischkan, Pamela

    2015-01-01

    Over the last century, Inuit have experienced rapid social changes that have greatly impacted their way of life, health, and intergenerational traditions. Although there is a growing body of research concerning Inuit youth, relatively little is known about elderly Inuit. In an effort to bridge this knowledge gap, a systematic review of peer-reviewed journal articles was conducted. This review identified a dearth of research on older Inuit, and highlighted limitations in service provision to this primarily rural and isolated population. Implications for policy and practice and recommendations for future research are also discussed. PMID:25826418

  13. Tinnitus and arterial hypertension: a systematic review.

    PubMed

    Figueiredo, Ricardo Rodrigues; de Azevedo, Andréia Aparecida; Penido, Norma de Oliveira

    2015-11-01

    Tinnitus is considered a multi-factorial symptom. Arterial hypertension has been cited as a tinnitus etiological factor. To assess the scientific evidence on the associations between arterial hypertension and tinnitus. A systematic review was performed using PubMed, ISI Web, Lilacs and SciELO scientific databases. This review included articles published in Portuguese, Spanish, French and English correlating tinnitus with hypertension. Letters to editors and case reports were excluded. A total of 424 articles were identified, of which only 20 met the inclusion criteria. Studies that analyzed the incidence of hypertension in tinnitus patients tended to show an association, while those that evaluated the incidence of tinnitus in hypertensive patients did not. There is evidence of an association between tinnitus and hypertension, although a cause and effect relationship is uncertain. Changes in the cochlear microcirculation, resulting in hearing loss, may be an adjuvant factor in tinnitus pathophysiology. PMID:25190255

  14. Systematic review of human papillomavirus vaccine coadministration.

    PubMed

    Noronha, Alinea S; Markowitz, Lauri E; Dunne, Eileen F

    2014-05-13

    Human papillomavirus (HPV) vaccination is recommended in early adolescence, at an age when other vaccines are also recommended. Administration of multiple vaccines during one visit is an opportunity to improve uptake of adolescent vaccines. We conducted a systematic review of safety and immunogenicity of HPV vaccines coadministered with other vaccines. Our review included 9 studies, 4 of quadrivalent HPV vaccine and 5 of bivalent HPV vaccine; coadministered vaccines included: meningococcal conjugate, hepatitis A, hepatitis B, combined hepatitis A and B, tetanus, diphtheria, acellular pertussis, and inactivated poliovirus vaccines. Studies varied in methods of data collection and measurement of immunogenicity and safety. Noninferiority of immune response and an acceptable safety profile were demonstrated when HPV vaccine was coadministered with other vaccines. PMID:24412351

  15. Economic burden of asthma: a systematic review

    PubMed Central

    Bahadori, Katayoun; Doyle-Waters, Mary M; Marra, Carlo; Lynd, Larry; Alasaly, Kadria; Swiston, John; FitzGerald, J Mark

    2009-01-01

    Background Asthma is associated with enormous healthcare expenditures that include both direct and indirect costs. It is also associated with the loss of future potential earnings related to both morbidity and mortality. The objective of the study is to determine the burden of disease costs associated with asthma. Methods We performed a systematic search of MEDLINE, EMBASE, CINAHL, CDSR, OHE-HEED, and Web of Science Databases between 1966 and 2008. Results Sixty-eight studies met the inclusion criteria. Hospitalization and medications were found to be the most important cost driver of direct costs. Work and school loss accounted for the greatest percentage of indirect costs. The cost of asthma was correlated with comorbidities, age, and disease severity. Conclusion Despite the availability of effective preventive therapy, costs associated with asthma are increasing. Strategies including education of patients and physicians, and regular follow-up are required to reduce the economic burden of asthma. PMID:19454036

  16. A Systematic Review on the Efficacy of Amlodipine in the Treatment of Patients With Hypertension With Concomitant Diabetes Mellitus and/or Renal Dysfunction, When Compared With Other Classes of Antihypertensive Medication.

    PubMed

    Jeffers, Barrett W; Robbins, Jeffery; Bhambri, Rahul; Wajsbrot, Dalia

    2015-01-01

    The long-term cardiovascular (CV) effects of calcium channel blockers, with special focus on amlodipine, were compared with other classes of antihypertensive medications in high-risk hypertensive patient subgroups. A systematic literature review and meta-analysis was undertaken of 38 unique randomized, active-controlled, parallel-group trials comparing amlodipine/calcium channel blockers with diuretics, β-blockers, α-blockers, angiotensin-converting enzyme inhibitors, or angiotensin II receptor blockers, with ≥6-month follow-up, and which had included assessment of blood pressure (BP) and CV events [all-cause death, CV death, myocardial infarction (MI), stroke, congestive heart failure (CHF), or major CV events (MACE: MI, CHF, stroke, and CV death)], in hypertensive patients (baseline systolic/diastolic BP ≥140/≥90 mm Hg) with either concomitant diabetes and/or renal dysfunction. In hypertensive patients with diabetes, no difference was found for amlodipine versus comparators with respect to all-cause death, CV death, MACE, and MI; a decrease in stroke risk, and an increase in CHF risk, was seen. In hypertensive patients with renal dysfunction, no difference was found for amlodipine versus comparators with respect to all-cause death, CV death, MACE, MI, and CHF; a decrease in stroke risk was seen. Amlodipine was found to be at least as efficacious as all the other classes of antihypertensive agents in reducing systolic and diastolic BP. Long-term control of BP is critical for avoiding complications of hypertension in high-risk patients, particularly CV and cerebrovascular events such as stroke. This analysis has provided evidence that amlodipine is an appealing therapeutic option in the long-term management of hypertension in both diabetic and renal dysfunction patients. PMID:25738570

  17. Facilitated communication and authorship: a systematic review.

    PubMed

    Schlosser, Ralf W; Balandin, Susan; Hemsley, Bronwyn; Iacono, Teresa; Probst, Paul; von Tetzchner, Stephen

    2014-12-01

    Facilitated Communication (FC) is a technique whereby individuals with disabilities and communication impairments allegedly select letters by typing on a keyboard while receiving physical support, emotional encouragement, and other communication supports from facilitators. The validity of FC stands or falls on the question of who is authoring the typed messages--the individual with a disability or the facilitator. The International Society for Augmentative and Alternative Communication (ISAAC) formed an Ad Hoc Committee on FC and charged this committee to synthesize the evidence base related to this question in order to develop a position statement. The purpose of this paper is to report this synthesis of the extant peer-reviewed literature on the question of authorship in FC. A multi-faceted search was conducted including electronic database searches, ancestry searches, and contacting selected authors. The authors considered synopses of systematic reviews, and systematic reviews, which were supplemented with individual studies not included in any prior reviews. Additionally, documents submitted by the membership were screened for inclusion. The evidence was classified into articles that provided (a) quantitative experimental data related to the authorship of messages, (b) quantitative descriptive data on the output generated through FC without testing of authorship, (c) qualitative descriptive data on the output generated via FC without testing of authorship, and (d) anecdotal reports in which writers shared their perspectives on FC. Only documents with quantitative experimental data were analyzed for authorship. Results indicated unequivocal evidence for facilitator control: messages generated through FC are authored by the facilitators rather than the individuals with disabilities. Hence, FC is a technique that has no validity. PMID:25384895

  18. Automatic Evidence Retrieval for Systematic Reviews

    PubMed Central

    Choong, Miew Keen; Galgani, Filippo; Dunn, Adam G

    2014-01-01

    Background Snowballing involves recursively pursuing relevant references cited in the retrieved literature and adding them to the search results. Snowballing is an alternative approach to discover additional evidence that was not retrieved through conventional search. Snowballing’s effectiveness makes it best practice in systematic reviews despite being time-consuming and tedious. Objective Our goal was to evaluate an automatic method for citation snowballing’s capacity to identify and retrieve the full text and/or abstracts of cited articles. Methods Using 20 review articles that contained 949 citations to journal or conference articles, we manually searched Microsoft Academic Search (MAS) and identified 78.0% (740/949) of the cited articles that were present in the database. We compared the performance of the automatic citation snowballing method against the results of this manual search, measuring precision, recall, and F1 score. Results The automatic method was able to correctly identify 633 (as proportion of included citations: recall=66.7%, F1 score=79.3%; as proportion of citations in MAS: recall=85.5%, F1 score=91.2%) of citations with high precision (97.7%), and retrieved the full text or abstract for 490 (recall=82.9%, precision=92.1%, F1 score=87.3%) of the 633 correctly retrieved citations. Conclusions The proposed method for automatic citation snowballing is accurate and is capable of obtaining the full texts or abstracts for a substantial proportion of the scholarly citations in review articles. By automating the process of citation snowballing, it may be possible to reduce the time and effort of common evidence surveillance tasks such as keeping trial registries up to date and conducting systematic reviews. PMID:25274020

  19. Chronic Inflammatory Disease and Osteopathy: A Systematic Review

    PubMed Central

    Cicchitti, Luca; Martelli, Marta; Cerritelli, Francesco

    2015-01-01

    Background Chronic inflammatory diseases (CID) are globally highly prevalent and characterized by severe pathological medical conditions. Several trials were conducted aiming at measuring the effects of manipulative therapies on patients affected by CID. The purpose of this review was to explore the extent to which osteopathic manipulative treatment (OMT) can be benefi-cial in medical conditions also classified as CID. Methods This review included any type of experimental study which enrolled sub-jects with CID comparing OMT with any type of control procedure. The search was conducted on eight databases in January 2014 using a pragmatic literature search approach. Two independent re-viewers conducted study selection and data extraction for each study. The risk of bias was evaluated according to the Cochrane methods. Heterogeneity was assessed and meta-analysis performed where possible. Results 10 studies met the inclusion criteria for this review enrolling 386 subjects. The search identified six RCTs, one laboratory study, one cross-over pilot studies, one observation-al study and one case control pilot study. Results suggest a potential effect of osteopathic medicine on patients with medical pathologies associated with CID (in particular Chronic Obstructive Pul-monary Disease (COPD), Irritable Bowel Syndrome, Asthma and Peripheral Arterial Disease) com-pared to no treatment or sham therapy although data remain elusive. Moreover one study showed possible effects on arthritis rat model. Meta-analysis was performed for COPD studies only show-ing no effect of any type of OMT applied versus control. No major side effects were reported by those receiving OMT. Conclusion The present systematic review showed inconsistent data on the effect of OMT in the treatment of medical conditions potentially associated with CID, however the OMT appears to be a safe approach. Further more robust trials are needed to determine the direction and magnitude of the effect of OMT and to generalize favorable results. PMID:25781621

  20. Systematic Review of Breastfeeding and Herbs

    PubMed Central

    Budzynska, Katarzyna; Gardner, Zoë E.; Dugoua, Jean-Jacques; Low Dog, Tieraona

    2012-01-01

    Abstract Objectives Despite popular and historical use, there has been little modern research conducted to determine the safety and efficacy of herb use during breastfeeding. The purpose of this study was to systematically review the clinical literature on herbal medicine and lactation. Methods The databases PubMed, CAB Abstracts, Cochrane Central Register of Controlled Trials, HealthSTAR, Cumulative Index to Nursing and Allied Health Literature, and Reprotox were systematically searched for human trials from 1970 until 2010. Reference lists from relevant articles were hand-searched. Results Thirty-two studies met the inclusion criteria. Clinical studies were divided into three categories: survey studies (n=11), safety studies (n=8), and efficacy studies (n=13). Six studies were randomized controlled trials. The most common herbs studied were St. John's wort (Hypericum perforatum L.) (n=3), garlic (Allium sativum L.) extract (n=2), and senna (Cassia senna L.) (n=2). Studies were very heterogeneous with regard to study design, herbal intervention, and outcome measures. Overall, poor methodological quality predominated among the studies. Conclusions Our review concludes that further research is needed to assess the prevalence, efficacy, and safety of commonly used herbs during breastfeeding. PMID:22686865

  1. Enteral Nutrition in Dementia: A Systematic Review

    PubMed Central

    Brooke, Joanne; Ojo, Omorogieva

    2015-01-01

    The aim of this systematic review is to evaluate the role of enteral nutrition in dementia. The prevalence of dementia is predicted to rise worldwide partly due to an aging population. People with dementia may experience both cognitive and physical complications that impact on their nutritional intake. Malnutrition and weight loss in dementia correlates with cognitive decline and the progress of the disease. An intervention for long term eating difficulties is the provision of enteral nutrition through a Percutaneous Endoscopic Gastrostomy tube to improve both nutritional parameters and quality of life. Enteral nutrition in dementia has traditionally been discouraged, although further understanding of physical, nutritional and quality of life outcomes are required. The following electronic databases were searched: EBSCO Host, MEDLINE, PubMed, Cochrane Database of Systematic Reviews and Google Scholar for publications from 1st January 2008 and up to and including 1st January 2014. Inclusion criteria included the following outcomes: mortality, aspiration pneumonia, pressure sores, nutritional parameters and quality of life. Each study included separate analysis for patients with a diagnosis of dementia and/or neurological disease. Retrospective and prospective observational studies were included. No differences in mortality were found for patients with dementia, without dementia or other neurological disorders. Risk factors for poor survival included decreased or decreasing serum albumin levels, increasing age or over 80 years and male gender. Evidence regarding pneumonia was limited, although did not impact on mortality. No studies explored pressure sores or quality of life. PMID:25854831

  2. Enteral nutrition in dementia: a systematic review.

    PubMed

    Brooke, Joanne; Ojo, Omorogieva

    2015-04-01

    The aim of this systematic review is to evaluate the role of enteral nutrition in dementia. The prevalence of dementia is predicted to rise worldwide partly due to an aging population. People with dementia may experience both cognitive and physical complications that impact on their nutritional intake. Malnutrition and weight loss in dementia correlates with cognitive decline and the progress of the disease. An intervention for long term eating difficulties is the provision of enteral nutrition through a Percutaneous Endoscopic Gastrostomy tube to improve both nutritional parameters and quality of life. Enteral nutrition in dementia has traditionally been discouraged, although further understanding of physical, nutritional and quality of life outcomes are required. The following electronic databases were searched: EBSCO Host, MEDLINE, PubMed, Cochrane Database of Systematic Reviews and Google Scholar for publications from 1st January 2008 and up to and including 1st January 2014. Inclusion criteria included the following outcomes: mortality, aspiration pneumonia, pressure sores, nutritional parameters and quality of life. Each study included separate analysis for patients with a diagnosis of dementia and/or neurological disease. Retrospective and prospective observational studies were included. No differences in mortality were found for patients with dementia, without dementia or other neurological disorders. Risk factors for poor survival included decreased or decreasing serum albumin levels, increasing age or over 80 years and male gender. Evidence regarding pneumonia was limited, although did not impact on mortality. No studies explored pressure sores or quality of life. PMID:25854831

  3. Pharmaceutical supply chain risks: a systematic review

    PubMed Central

    2013-01-01

    Introduction Supply of medicine as a strategic product in any health system is a top priority. Pharmaceutical companies, a major player of the drug supply chain, are subject to many risks. These risks disrupt the supply of medicine in many ways such as their quantity and quality and their delivery to the right place and customers and at the right time. Therefore risk identification in the supply process of pharmaceutical companies and mitigate them is highly recommended. Objective In this study it is attempted to investigate pharmaceutical supply chain risks with perspective of manufacturing companies. Methods Scopus, PubMed, Web of Science bibliographic databases and Google scholar scientific search engines were searched for pharmaceutical supply chain risk management studies with 6 different groups of keywords. All results found by keywords were reviewed and none-relevant articles were excluded by outcome of interests and researcher boundaries of study within 4 steps and through a systematic method. Results Nine articles were included in the systematic review and totally 50 main risks based on study outcome of interest extracted which classified in 7 categories. Most of reported risks were related to supply and supplier issues. Organization and strategy issues, financial, logistic, political, market and regulatory issues were in next level of importance. Conclusion It was shown that the majority of risks in pharmaceutical supply chain were internal risks due to processes, people and functions mismanagement which could be managed by suitable mitigation strategies. PMID:24355166

  4. How to conduct systematic reviews more expeditiously?

    PubMed

    Tsertsvadze, Alexander; Chen, Yen-Fu; Moher, David; Sutcliffe, Paul; McCarthy, Noel

    2015-01-01

    Healthcare consumers, researchers, patients and policy makers increasingly use systematic reviews (SRs) to aid their decision-making process. However, the conduct of SRs can be a time-consuming and resource-intensive task. Often, clinical practice guideline developers or other decision-makers need to make informed decisions in a timely fashion (e.g. outbreaks of infection, hospital-based health technology assessments). Possible approaches to address the issue of timeliness in the production of SRs are to (a) implement process parallelisation, (b) adapt and apply innovative technologies, and/or (c) modify SR processes (e.g. study eligibility criteria, search sources, data extraction or quality assessment). Highly parallelised systematic reviewing requires substantial resources to support a team of experienced information specialists, reviewers and methodologists working alongside with clinical content experts to minimise the time for completing individual review steps while maximising the parallel progression of multiple steps. Effective coordination and management within the team and across external stakeholders are essential elements of this process. Emerging innovative technologies have a great potential for reducing workload and improving efficiency of SR production. The most promising areas of application would be to allow automation of specific SR tasks, in particular if these tasks are time consuming and resource intensive (e.g. language translation, study selection, data extraction). Modification of SR processes involves restricting, truncating and/or bypassing one or more SR steps, which may risk introducing bias to the review findings. Although the growing experiences in producing various types of rapid reviews (RR) and the accumulation of empirical studies exploring potential bias associated with specific SR tasks have contributed to the methodological development for expediting SR production, there is still a dearth of research examining the actual impact of methodological modifications and comparing the findings between RRs and SRs. This evidence would help to inform as to which SR tasks can be accelerated or truncated and to what degree, while maintaining the validity of review findings. Timely delivered SRs can be of value in informing healthcare decisions and recommendations, especially when there is practical urgency and there is no other relevant synthesised evidence. PMID:26563648

  5. Systematic Reviews and Meta-Analysis of Health IT.

    PubMed

    Urquhart, Christine; Currell, Rosemary

    2016-01-01

    This contribution examines how systematic reviews contribute to the evaluation of health IT planning and implementation. It defines and explains the systematic review process and how higher level overviews of health IT can be conducted. A reprise of some of the Cochrane reviews relating to health IT, particularly those conducted for the Cochrane Effective Practice and Organization of Care Group (EPOC), provides examples of the type of question that can be answered (at least in part) by a Cochrane-type systematic review. The contribution also discusses the benefits and limitations of the systematic review process using examples of reviews on telemedicine, nursing records, and home uterine monitoring in pregnancy. PMID:27198108

  6. Work-related leukemia: a systematic review

    PubMed Central

    2013-01-01

    Leukemia is a complex disease, which only became better understood during the last decades following the development of new laboratory techniques and diagnostic methods. Despite our improved understanding of the physiology of the disease, little is yet known about the causes of leukemia. A variety of potential risk factors have been suggested so far, including personal habits and lifestyle, and a wide range of occupational or environmental exposures. A causal association with leukemia has only been documented to date for ionizing radiation, benzene and treatment with cytostatic drugs, but there is an ongoing scientific debate on the possible association of leukemia with a number of other work-related hazards. In this article, we have reviewed scientific studies, published over the past 5 years, which investigated potential associations between leukemia and exposure to occupational risk factors. The systematic literature review took place via electronic databases, using specific search criteria, and independent reviewers have further filtered the search results to identify the number of articles, presented in our paper. A large number of studies included in the review referred to the effects of ionizing radiation, where new data suggest that the effects of exposure to small doses of ionizing radiation should probably be reevaluated. Some other works appear to substantiate a potential association of the disease with certain pesticides. Further research is also suggested regarding the role of infectious agents or exposure to certain chemicals like formaldehyde or butadiene in the pathogenesis of leukemia. PMID:23697536

  7. Outpatient treatment of uncomplicated diverticulitis: a systematic review.

    PubMed

    Sánchez-Velázquez, Patricia; Grande, Luis; Pera, Miguel

    2016-06-01

    Acute diverticulitis occurs in up to 25% of patients with diverticulosis. The majority of cases are mild or uncomplicated and it has become a frequent reason for consultation in the emergency department. On the basis of the National Inpatient Sample database from the USA, 86% of patients admitted with diverticulitis were treated with medical therapy. However, several recent studies have shown that outpatient treatment with antibiotics is safe and effective. The aim of this systematic review is to update the evidence published in the outpatient treatment of uncomplicated acute diverticulitis. We performed a systematic review according to the PRISMA guidelines and searched in MEDLINE and Cochrane databases all English-language articles on the management of acute diverticulitis using the following search terms: 'diverticulitis', 'outpatient', and 'uncomplicated'. Data were extracted independently by two investigators. A total of 11 articles for full review were yielded: one randomized controlled trial, eight prospective cohort studies, and two retrospective cohort studies. Treatment successful rate on an outpatient basis, which means that no further complications were reported, ranged from 91.5 to 100%. Fewer than 8% of patients were readmitted in the hospital. Intolerance to oral intake and lack of family or social support are common exclusion criteria used for this approach, whereas severe comorbidities are not definitive exclusion criteria in all the studies. Ambulatory treatment of uncomplicated acute diverticulitis is safe, effective, and economically efficient when applying an appropriate selection in most reviewed studies. PMID:26891198

  8. Measuring Intensity of End of Life Care: A Systematic Review

    PubMed Central

    Luta, Xhyljeta; Maessen, Maud; Egger, Matthias; Stuck, Andreas E.; Goodman, David; Clough-Gorr, Kerri M.

    2015-01-01

    Background Many studies have measured the intensity of end of life care. However, no summary of the measures used in the field is currently available. Objectives To summarise features, characteristics of use and reported validity of measures used for evaluating intensity of end of life care. Methods This was a systematic review according to PRISMA guidelines. We performed a comprehensive literature search in Ovid Medline, Embase, The Cochrane Library of Systematic Reviews and reference lists published between 1990-2014. Two reviewers independently screened titles, abstracts, full texts and extracted data. Studies were eligible if they used a measure of end of life care intensity, defined as all quantifiable measures describing the type and intensity of medical care administered during the last year of life. Results A total of 58 of 1590 potentially eligible studies met our inclusion criteria and were included. The most commonly reported measures were hospitalizations (n = 44), intensive care unit admissions (n = 39) and chemotherapy use (n = 27). Studies measured intensity of care in different timeframes ranging from 48 hours to 12 months. The majority of studies were conducted in cancer patients (n = 31). Only 4 studies included information on validation of the measures used. None evaluated construct validity, while 3 studies considered criterion and 1 study reported both content and criterion validity. Conclusions This review provides a synthesis to aid in choosing intensity of end of life care measures based on their previous use but simultaneously highlights the crucial need for more validation studies and consensus in the field. PMID:25875471

  9. Systematic Review of Inspiratory Muscle Training After Cerebrovascular Accident.

    PubMed

    Martín-Valero, Rocío; De La Casa Almeida, Maria; Casuso-Holgado, Maria Jesus; Heredia-Madrazo, Alfonso

    2015-11-01

    This systematic review examines levels of evidence and recommendation grades of various therapeutic interventions of inspiratory muscle training in people who have had a stroke. Benefits from different levels of force and resistance in respiratory muscles are shown in this population. This review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) directives and was completed in November 2014. The search limits were studies published in English between 2004 and 2014. Relevant studies were searched for in MEDLINE, PEDro, OAIster, Scopus, PsycINFO, Web of Knowledge, CINAHL, SPORTDiscus, DOAJ, Cochrane, Embase, Academic Search Complete, Fuente Académica, and MedicLatina. Initially, 20 articles were identified. After analyzing all primary documents, 14 studies were excluded. Only 6 studies were relevant to this review. Three different types of interventions were found (maximum inspiratory training, controlled training, and nonintervention) in 3 different groups. One specific study compared 3 inspiratory muscle training groups with a group of breathing exercises (diaphragmatic exercises with pursed lips) and a control group. Future long-term studies with larger sample sizes are needed. It is necessary to apply respiratory muscle training as a service of the national health system and to consider its inclusion in the conventional neurological program. PMID:26493591

  10. Educational games in geriatric medicine education: a systematic review

    PubMed Central

    2010-01-01

    Objective To systematically review the medical literature to assess the effect of geriatric educational games on the satisfaction, knowledge, beliefs, attitudes and behaviors of health care professionals. Methods We conducted a systematic review following the Cochrane Collaboration methodology including an electronic search of 10 electronic databases. We included randomized controlled trials (RCT) and controlled clinical trials (CCT) and excluded single arm studies. Population of interests included members (practitioners or students) of the health care professions. Outcomes of interests were participants' satisfaction, knowledge, beliefs, attitude, and behaviors. Results We included 8 studies evaluating 5 geriatric role playing games, all conducted in United States. All studies suffered from one or more methodological limitations but the overall quality of evidence was acceptable. None of the studies assessed the effects of the games on beliefs or behaviors. None of the 8 studies reported a statistically significant difference between the 2 groups in terms of change in attitude. One study assessed the impact on knowledge and found non-statistically significant difference between the 2 groups. Two studies found levels of satisfaction among participants to be high. We did not conduct a planned meta-analysis because the included studies either reported no statistical data or reported different summary statistics. Conclusion The available evidence does not support the use of role playing interventions in geriatric medical education with the aim of improving the attitudes towards the elderly. PMID:20416055

  11. Acupuncture for adults with overactive bladder: a systematic review protocol

    PubMed Central

    Mo, Qian; Wang, Yang; Ye, Yongming; Yu, Jinna; Liu, Zhishun

    2015-01-01

    Introduction Overactive bladder (OAB) is a symptom syndrome defined by the International Continence Society (ICS) as ‘the presence of urinary urgency (both daytime and nighttime), usually accompanied by increased frequency and nocturia with or without urge urinary incontinence in the absence of a urinary tract infection or other obvious pathology’. Clinical studies indicate that acupuncture could reduce micturition over 24 h, urgency episodes over 24 h, and improve quality of life among people with OAB. This systematic review protocol details the proposed methods for evaluating the effectiveness and safety of acupuncture for OAB. Methods and analysis The following databases will be searched for relevant studies: the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Incontinence Group Trials Register, MEDLINE, EMBASE, Chinese Biomedical Literature Database (CBM), Chinese Medical Current Content (CMCC), Chinese Scientific Journal Database (VIP database), Wan-Fang Data, and China National Knowledge Infrastructure (CNKI) and will hand search a list of medical journals as a supplement. Any randomised controlled trials in English or Chinese without restriction of publication status will be included with treatment of OAB. Outcomes will mainly include number of micturition episodes over 24 h, number of urgency episodes over 24 h and number of incontinence episodes over 24 h. Two reviewers will independently screen the titles, abstracts or even full texts, and extract data. Two other reviewers will assess study quality. Revman 5.1 software will be used to conduct meta-analysis and calculate the risk ratio for dichotomous data. Weighted mean difference or standard mean difference will be calculated for continuous data. The Cochrane collaboration's tool will be used to assess the risk of bias. Dissemination This systematic review protocol will provide information on acupuncture therapy for OAB. The results will be disseminated through peer-reviewed publication or conference presentations. Protocol registration PROSPERO CRD42014010181. PMID:25573525

  12. Interventions to delay functional decline in people with dementia: a systematic review of systematic reviews

    PubMed Central

    Laver, Kate; Dyer, Suzanne; Whitehead, Craig; Clemson, Lindy; Crotty, Maria

    2016-01-01

    Objective To summarise existing systematic reviews that assess the effects of non-pharmacological, pharmacological and alternative therapies on activities of daily living (ADL) function in people with dementia. Design Overview of systematic reviews. Methods A systematic search in the Cochrane Database of Systematic Reviews, DARE, Medline, EMBASE and PsycInfo in April 2015. Systematic reviews of randomised controlled trials conducted in people with Alzheimer's disease or dementia measuring the impact on ADL function were included. Methodological quality of the systematic reviews was independently assessed by two authors using the AMSTAR tool. The quality of evidence of the primary studies for each intervention was assessed using GRADE. Results A total of 23 systematic reviews were included in the overview. The quality of the reviews varied; however most (65%) scored 8/11 or more on the AMSTAR tool, indicating high quality. Interventions that were reported to be effective in minimising decline in ADL function were: exercise (6 studies, 289 participants, standardised mean difference (SMD) 0.68, 95% CI 0.08 to 1.27; GRADE: low), dyadic interventions (8 studies, 988 participants, SMD 0.37, 95% CI 0.05 to 0.69; GRADE: low) acetylcholinesterase inhibitors and memantine (12 studies, 4661 participants, donepezil 10 mg SMD 0.18, 95% CI 0.03 to 0.32; GRADE: moderate), selegiline (7 studies, 810 participants, SMD 0.27, 95% CI 0.13 to 0.41; GRADE: low), huperzine A (2 studies, 70 participants, SMD 1.48, 95% CI 0.95 to 2.02; GRADE: very low) and Ginkgo biloba (7 studies, 2530 participants, SMD 0.36, 95% CI 0.28 to 0.44; GRADE: very low). Conclusions Healthcare professionals should ensure that people with dementia are encouraged to exercise and that primary carers are trained and supported to provide safe and effective care for the person with dementia. Acetylcholinesterase inhibitors or memantine should be trialled unless contraindicated. Trial registration number CRD42015020179. PMID:27121704

  13. Emergency cricothyrotomy – a systematic review

    PubMed Central

    2013-01-01

    Background An emergency cricothyrotomy is the last-resort in most airway management protocols and is performed when it is not possible to intubate or ventilate a patient. This situation can rapidly prove fatal, making it important to identify the best method to establish a secure airway. We conducted a systematic review to identify whether there exists superiority between available commercial kits versus traditional surgical and needle techniques. Methods Medline, EMBASE and other databases were searched for pertinent studies. The inclusion criteria included manikin, animal and human studies and there were no restrictions regarding the professional background of the person performing the procedure. Results In total, 1,405 unique references were identified; 108 full text articles were retrieved; and 24 studies were included in the review. Studies comparing kits with one another or with various surgical and needle techniques were identified. The outcome measures included in this systematic review were success rate and time consumption. The investigators performing the studies had chosen unique combinations of starting and stopping points for time measurements, making comparisons between studies difficult and leading to many conflicting results. No single method was shown to be better than the others, but the size of the studies makes it impossible to draw firm conclusions. Conclusions The large majority of the studies were too small to demonstrate statistically significant differences, and the limited available evidence was of low or very low quality. That none of the techniques in these studies demonstrated better results than the others does not necessarily indicate that each is equally good, and these conclusions will likely change as new evidence becomes available. PMID:23725520

  14. Systematic review of character development and childhood chronic illness

    PubMed Central

    Maslow, Gary R; Hill, Sherika N

    2016-01-01

    AIM: To review empirical evidence on character development among youth with chronic illnesses. METHODS: A systematic literature review was conducted using PubMed and PSYCHINFO from inception until November 2013 to find quantitative studies that measured character strengths among youth with chronic illnesses. Inclusion criteria were limited to English language studies examining constructs of character development among adolescents or young adults aged 13-24 years with a childhood-onset chronic medical condition. A librarian at Duke University Medical Center Library assisted with the development of the mesh search term. Two researchers independently reviewed relevant titles (n = 549), then abstracts (n = 45), and finally manuscripts (n = 3). RESULTS: There is a lack of empirical research on character development and childhood-onset chronic medical conditions. Three studies were identified that used different measures of character based on moral themes. One study examined moral reasoning among deaf adolescents using Kohlberg’s Moral Judgement Instrument; another, investigated moral values of adolescent cancer survivors with the Values In Action Classification of Strengths. A third study evaluated moral behavior among young adult survivors of burn injury utilizing the Tennessee Self-Concept, 2nd edition. The studies observed that youth with chronic conditions reasoned at less advanced stages and had a lower moral self-concept compared to referent populations, but that they did differ on character virtues and strengths when matched with healthy peers for age, sex, and race/ethnicity. Yet, generalizations could not be drawn regarding character development of youth with chronic medical conditions because the studies were too divergent from each other and biased from study design limitations. CONCLUSION: Future empirical studies should learn from the strengths and weaknesses of the existing literature on character development among youth with chronic medical conditions. PMID:27170931

  15. Contribution of Systematic Reviews to Management Decisions

    PubMed Central

    COOK, CARLY N; POSSINGHAM, HUGH P; FULLER, RICHARD A

    2014-01-01

    Systematic reviews comprehensively summarize evidence about the effectiveness of conservation interventions. We investigated the contribution to management decisions made by this growing body of literature. We identified 43 systematic reviews of conservation evidence, 23 of which drew some concrete conclusions relevant to management. Most reviews addressed conservation interventions relevant to policy decisions; only 35% considered practical on-the-ground management interventions. The majority of reviews covered only a small fraction of the geographic and taxonomic breadth they aimed to address (median = 13% of relevant countries and 16% of relevant taxa). The likelihood that reviews contained at least some implications for management tended to increase as geographic coverage increased and to decline as taxonomic breadth increased. These results suggest the breadth of a systematic review requires careful consideration. Reviews identified a mean of 312 relevant primary studies but excluded 88% of these because of deficiencies in design or a failure to meet other inclusion criteria. Reviews summarized on average 284 data sets and 112 years of research activity, yet the likelihood that their results had at least some implications for management did not increase as the amount of primary research summarized increased. In some cases, conclusions were elusive despite the inclusion of hundreds of data sets and years of cumulative research activity. Systematic reviews are an important part of the conservation decision making tool kit, although we believe the benefits of systematic reviews could be significantly enhanced by increasing the number of reviews focused on questions of direct relevance to on-the-ground managers; defining a more focused geographic and taxonomic breadth that better reflects available data; including a broader range of evidence types; and appraising the cost-effectiveness of interventions. Contribuciones de las Revisiones Sistemáticas a las Decisiones de Manejo Resumen Las revisiones sistemáticas resumen integralmente la evidencia sobre la efectividad de las intervenciones de conservación. Investigamos la contribución de las decisiones de manejo hechas por este creciente cuerpo de literatura. Identificamos 43 revisiones sistemáticas de evidencia de conservación, 23 de las cuales hicieron algunas conclusiones concretas relevantes al manejo. La mayoría de las revisiones se dirigían a intervenciones de conservación relevantes a las decisiones políticas; sólo el 35% consideraba intervenciones de manejo sobre-la-causa prácticas. La mayoría de las revisiones cubrieron solo una pequeña fracción de la amplitud geográfica y taxonómica a la que buscaban dirigirse (mediana = 13% de los países relevantes y 16% de los taxones relevantes). La probabilidad de que las revisiones tuvieran por lo menos algunas implicaciones para el manejo tendió a incrementar conforme la cobertura geográfica incrementaba y a declinar conforme aumentaba la amplitud taxonómica. Estos resultados sugieren que la amplitud de una revisión taxonómica requiere de una consideración cuidadosa. Las revisiones identificaron una media de 312 estudios primarios relevantes pero excluyeron 88% de estos por deficiencias en el diseño o fallas para coincidir con otros criterios de inclusión. Las revisiones resumieron en promedio 248 juegos de datos y 112 años de actividad de investigación, pero la probabilidad de que sus resultados tuvieran por lo menos algunas implicaciones para el manejo no incrementaron mientras la cantidad de investigación primaria resumida aumentaba. En algunos casos, las conclusiones fueron elusivas a pesar de la inclusión de cientos de conjuntos de datos y años de actividad de investigación acumulada. Las revisiones sistemáticas son una parte importante del juego de herramientas en la toma de decisiones de conservación, aunque consideramos que los beneficios de las revisiones sistemáticas podrían ser mejorados significativamente al incrementar el número de revisiones centradas en preguntas con relevancia directa a administradores sobre-la-causa; definiendo una amplitud geográfica y taxonómica más enfocada que reflejo los datos disponibles; incluyendo un rango más amplio de tipos de evidencia; y evaluando la efectividad de costo de las intervenciones. PMID:24001025

  16. A Systematic Review of Interventions Used to Treat Catatonic Symptoms in People with Autistic Spectrum Disorders

    ERIC Educational Resources Information Center

    DeJong, Hannah; Bunton, Penny; Hare, Dougal J.

    2014-01-01

    A systematic review was conducted to examine the efficacy of a range of treatments for autistic catatonia. The review identified 22 relevant papers, reporting a total of 28 cases including both adult and paediatric patients. Treatment methods included electroconvulsive therapy (ECT), medication, behavioural and sensory interventions. Quality…

  17. A Systematic Review of Interventions Used to Treat Catatonic Symptoms in People with Autistic Spectrum Disorders

    ERIC Educational Resources Information Center

    DeJong, Hannah; Bunton, Penny; Hare, Dougal J.

    2014-01-01

    A systematic review was conducted to examine the efficacy of a range of treatments for autistic catatonia. The review identified 22 relevant papers, reporting a total of 28 cases including both adult and paediatric patients. Treatment methods included electroconvulsive therapy (ECT), medication, behavioural and sensory interventions. Quality

  18. Refeeding hypophosphatemia in adolescents with anorexia nervosa: a systematic review.

    PubMed

    O'Connor, Graeme; Nicholls, Dasha

    2013-06-01

    The rate of adolescents presenting with anorexia nervosa (AN) is increasing. Medically unstable adolescents are admitted to the hospital for nutrition restoration. A lack of global consensus on appropriate refeeding practices of malnourished patients has resulted in inconsistent refeeding practices. Refeeding hypophosphatemia (RH) is the most common complication associated with refeeding the malnourished patient. This review sought to identify the range of refeeding rates adopted globally and the implication that total energy intake and malnutrition may have on RH while refeeding adolescents with anorexia nervosa. Studies were identified by a systematic electronic search of medical databases from 1980 to September 2012. Seventeen publications were identified, including 6 chart reviews, 1 observational study, and 10 case reports, with a total of 1039 subjects. The average refeeding energy intake was 1186 kcal/d, ranging from 125-1900 kcal/d, with a mean percentage median body mass index (% mBMI) of 78%. The average incidence rate of RH was 14%. A significant correlation between malnutrition (% mBMI) and post-refeeding phosphate was identified (R (2) = 0.6, P = .01). This review highlights the disparity in refeeding rates adopted internationally in treating malnourished adolescents with anorexia nervosa. Based on this review, the severity of malnutrition seems to be a marker for the development of RH more so than total energy intake. PMID:23459608

  19. Clinical review: Medication errors in critical care

    PubMed Central

    Moyen, Eric; Camir, Eric; Stelfox, Henry Thomas

    2008-01-01

    Medication errors in critical care are frequent, serious, and predictable. Critically ill patients are prescribed twice as many medications as patients outside of the intensive care unit (ICU) and nearly all will suffer a potentially life-threatening error at some point during their stay. The aim of this article is to provide a basic review of medication errors in the ICU, identify risk factors for medication errors, and suggest strategies to prevent errors and manage their consequences. PMID:18373883

  20. Melanotic Neuroectodermal Tumor of Infancy: A Systematic Review.

    PubMed

    Rachidi, Saleh; Sood, Amit J; Patel, Krishna G; Nguyen, Shaun A; Hamilton, Heidi; Neville, Brad W; Day, Terry A

    2015-10-01

    Melanotic neuroectodermal tumor of infancy (MNTI) is a rare tumor, usually diagnosed within the first year of age, with a predilection for the maxilla. Although the tumor is usually benign, its rapidly growing nature and ability to cause major deformities in surrounding structures necessitate early diagnosis and intervention. It is important that medical and dental specialists are prepared to make the diagnosis and proceed with appropriate intervention. The authors performed a systematic review of the 472 reported cases from 1918 through 2013 and provided a comprehensive update on this rare entity that can have devastating effects on young patients. This investigation uncovered age at diagnosis as an important prognostic indicator, because younger age correlated with a higher recurrence rate. The authors also present a case report of a 5-month-old girl diagnosed with MNTI and review her clinical presentation and imaging and histopathologic findings. PMID:25936939

  1. Perinatal Major Depression Biomarkers: A systematic review.

    PubMed

    Serati, M; Redaelli, M; Buoli, M; Altamura, A C

    2016-03-15

    Postpartum depression, now termed perinatal depression by the DSM-5, is a clinically relevant disorder reaching 15% of incidence. Although it is quite frequent and associated with high social dysfunction, only recently its underpinning biological pathways have been explored, while multiple and concomitant risk factors have been identified (e.g. psychosocial stress). Peripartum depression usually has its onset during the third trimester of pregnancy or in the postpartum, being one of the most common medical complications in new mothers. Purpose of the present review is to summarize the state of art of biological biomarkers involved in the pathogenesis of perinatal depression, in view of the fact that suboptimal prenatal milieu can induce permanent damage in subsequent offspring life and have a negative impact on mother-child relationship. Furthermore, parents' biological changes due to medical/psychiatric disorders or stress exposure could influence offspring life: a concept known as 'intergenerational transmission', acting by variations into gametes and the gestational uterine environment. Given the evidence that perinatal mental disorders involve risks for the mother and offspring, the search for reliable biomarkers in high-risk mothers actually represents a medical priority to prevent perinatal depression. PMID:26802316

  2. Systematic review of public health branding.

    PubMed

    Evans, W Douglas; Blitstein, Jonathan; Hersey, James C; Renaud, Jeanette; Yaroch, Amy L

    2008-12-01

    Brands build relationships between consumers and products, services, or lifestyles by providing beneficial exchanges and adding value to their objects. Brands can be measured through associations that consumers hold for products and services. Public health brands are the associations that individuals hold for health behaviors, or lifestyles that embody multiple health behaviors. We systematically reviewed the literature on public health brands; developed a methodology for describing branded health messages and campaigns; and examined specific branding strategies across a range of topic areas, campaigns, and global settings. We searched the literature for published studies on public health branding available through all relevant, major online publication databases. Public health branding was operationalized as any manuscripts in the health, social science, and business literature on branding or brands in health promotion marketing. We developed formalized decision rules and applied them in identifying articles for review. We initially identified 154 articles and reviewed a final set of 37, 10 from Africa, Australia, and Europe. Branded health campaigns spanned most of the major domains of public health and numerous communication strategies and evaluation methodologies. Most studies provided clear information on planning, development, and evaluation of the branding effort, while some provided minimal information. Branded health messages typically are theory based, and there is a body of evidence on their behavior change effectiveness, especially in nutrition, tobacco control, and HIV/AIDS. More rigorous research is needed, however, on how branded health messages impact specific populations and behaviors. PMID:19051110

  3. Science of floorball: a systematic review

    PubMed Central

    Tervo, Taru; Nordström, Anna

    2014-01-01

    Background The purpose of this study was to comprehensively review the scientific research on floorball at the competitive and recreational levels according to field of study. Methods Full articles containing original data on floorball that had been published in English in peer-reviewed journals were considered for inclusion. Results Of 75 articles screened, 19 were included in this systematic review. One article each was identified in the fields of sports management and sports psychology, and the remaining 17 articles were in the field of sports medicine. Injury epidemiology in floorball players was the most thoroughly examined topic of research. To date, no research has been performed on the incidence of floorball-related injury, or any aspect of the sport, in children and adolescents. Conclusion Collaborative research among sports science disciplines is needed to identify strategies to reduce the incidence of injury and enhance the performance of licensed floorball players. Despite the increasing popularity of floorball in recent years, surprisingly little research has examined this sport. PMID:25349484

  4. Costs of burn care: a systematic review.

    PubMed

    Hop, M Jenda; Polinder, Suzanne; van der Vlies, Cornelis H; Middelkoop, Esther; van Baar, Margriet E

    2014-01-01

    Burn care is traditionally considered expensive care. However, detailed information about the costs of burn care is scarce despite the increased need for this information and the enhanced focus on healthcare cost control. In this study, economic literature on burn care was systematically reviewed to examine the problem of burn-related costs. Cost or economic evaluation studies on burn care that had been published in international peer-reviewed journals from 1950 to 2012 were identified. The methodology of these articles was critically appraised by two reviewers, and cost results were extracted. A total of 156 studies met the inclusion criteria. Nearly all of the studies were cost studies (n = 153) with a healthcare perspective (n = 139) from high-income countries (n = 127). Hospital charges were often used as a proxy for costs (n = 44). Three studies were cost-effectiveness analyses. The mean total healthcare cost per burn patient in high-income countries was $88,218 (range $704-$717,306; median $44,024). A wide variety of methodological approaches and cost prices was found. We recommend that cost studies and economic evaluations employ a standard approach to improve the quality and harmonization of economic evaluation studies, optimize comparability, and improve insight into burn care costs and efficiency. PMID:25041616

  5. Cognitive impairment in COPD: a systematic review*

    PubMed Central

    Torres-Sánchez, Irene; Rodríguez-Alzueta, Elisabeth; Cabrera-Martos, Irene; López-Torres, Isabel; Moreno-Ramírez, Maria Paz; Valenza, Marie Carmen

    2015-01-01

    The objectives of this study were to characterize and clarify the relationships between the various cognitive domains affected in COPD patients and the disease itself, as well as to determine the prevalence of impairment in the various cognitive domains in such patients. To that end, we performed a systematic review using the following databases: PubMed, Scopus, and ScienceDirect. We included articles that provided information on cognitive impairment in COPD patients. The review of the findings of the articles showed a significant relationship between COPD and cognitive impairment. The most widely studied cognitive domains are memory and attention. Verbal memory and learning constitute the second most commonly impaired cognitive domain in patients with COPD. The prevalence of impairment in visuospatial memory and intermediate visual memory is 26.9% and 19.2%, respectively. We found that cognitive impairment is associated with the profile of COPD severity and its comorbidities. The articles reviewed demonstrated that there is considerable impairment of the cognitive domains memory and attention in patients with COPD. Future studies should address impairments in different cognitive domains according to the disease stage in patients with COPD. PMID:25909154

  6. Topiramate and the vision: a systematic review

    PubMed Central

    Abtahi, Mohammad-Ali; Abtahi, Seyed-Hossein; Fazel, Farhad; Roomizadeh, Peyman; Etemadifar, Masoud; Jenab, Keivan; Akbari, Mojtaba

    2012-01-01

    Background and purpose Topiramate (TPM) is a sulfa-derivative monosaccharide that is used mainly for treating epilepsy and preventing migraine. Within the gamut of side effects attributable to this drug, ophthalmologic manifestations are of crucial importance. In this study, for the first time, the aim was to provide a systematic literature review regarding this issue. Methods For the time period 1996–2011, a PubMed search was made for the studies concerning the adverse/beneficial effects of TPM on vision. Overall, 404 citations out of a total of 2756 TPM-related studies were examined for relevance. Results A total of 74 relevant studies were reviewed, 65 of which comprise small observational studies describing the ophthalmic side effects of TPM in 84 patients. Of these patients, 66 were affected by ciliochoroidal effusion syndrome as the cardinal ocular side effect of TPM (17 cases of myopic shift and 49 cases of angle closure glaucoma). A comprehensive statistical analysis is provided on these 66 subjects. Other rare side effects of TPM on the vision were also reviewed, including massive choroidal effusion, ocular inflammatory reactions, visual field defects, probable effects on retina, cornea, and sclera, and neuroophthalmologic complications. In addition, a framework is provided to classify these results. Discussion Due to the expanding spectrum of indications for the administration of TPM, neurologists and psychiatrists should be aware of its diverse ocular side effects. In conclusion, ocular complications following this drug should be taken seriously and be subjected to ophthalmic counseling. PMID:22275816

  7. Systematic review on cashew nut allergy.

    PubMed

    van der Valk, J P M; Dubois, A E J; Gerth van Wijk, R; Wichers, H J; de Jong, N W

    2014-06-01

    Recent studies on cashew nut allergy suggest that the prevalence of cashew nut allergy is increasing. Cashew nut consumption by allergic patients can cause severe reactions, including anaphylaxis. This review summarizes current knowledge on cashew nut allergy to facilitate timely clinical recognition and to promote awareness of this emerging food allergy amongst clinicians. The goal of this study is to present a systematic review focused on the clinical aspects of allergy to cashew nut including the characteristics of cashew nut, the prevalence, allergenic components, cross-reactivity, diagnosis and management of cashew nut allergy. The literature search yielded 255 articles of which 40 met our selection criteria and were considered to be relevant for this review. The 40 articles included one prospective study, six retrospective studies and seven case reports. The remaining 26 papers were not directly related to cashew nut allergy. The literature suggests that the prevalence of cashew nut allergy is increasing, although the level of evidence for this is low. A minimal amount of cashew nut allergen may cause a severe allergic reaction, suggesting high potency comparable with other tree nuts and peanuts. Cashew allergy is clearly an underestimated important healthcare problem, especially in children. PMID:24734868

  8. Pediatric incidental appendectomy: a systematic review.

    PubMed

    Healy, James M; Olgun, Lena F; Hittelman, Adam B; Ozgediz, Doruk; Caty, Michael G

    2016-04-01

    Incidental appendectomy is the removal of the vermiform appendix accompanying another operation, without evidence of acute appendicitis. It is generally performed to eliminate the risk of future appendicitis. The risks and benefits of incidental appendectomy during various operations in children have been debated for over a century, but need to be revisited in light of innovations in medical practice, including minimally invasive surgery, improved imaging techniques, and use of the appendix as a tubular conduit for reconstruction. A detailed review was undertaken of the techniques, pathology, risks of appendectomy, utility of the appendix, and incidental appendectomy in the treatment of specific pediatric medical conditions. A comprehensive literature search was performed, and retrieved results were reviewed for relevance to the topic. The decision to perform a pediatric incidental appendectomy relies on informed consideration of the individual patient's co-morbid conditions, the indication for the initial operation, the future utility of the appendix, and the risk of future appendiceal pathology. The discussion includes a variety of situations and comorbid conditions that may influence a surgeon's decision to perform incidental appendectomy. PMID:26590816

  9. Depression and frailty in later life: a systematic review

    PubMed Central

    Vaughan, Leslie; Corbin, Akeesha L; Goveas, Joseph S

    2015-01-01

    Frailty and depression are important issues affecting older adults. Depressive syndrome may be difficult to clinically disambiguate from frailty in advanced old age. Current reviews on the topic include studies with wide methodological variation. This review examined the published literature on cross-sectional and longitudinal associations between frailty and depressive symptomatology with either syndrome as the outcome, moderators of this relationship, construct overlap, and related medical and behavioral interventions. Prevalence of both was reported. A systematic review of studies published from 2000 to 2015 was conducted in PubMed, the Cochrane Database of Systematic Reviews, and PsychInfo. Key search terms were “frailty”, “frail”, “frail elderly”, “depressive”, “depressive disorder”, and “depression”. Participants of included studies were ≥55 years old and community dwelling. Included studies used an explicit biological definition of frailty based on Fried et al’s criteria and a screening measure to identify depressive symptomatology. Fourteen studies met the inclusion/exclusion criteria. The prevalence of depressive symptomatology, frailty, or their co-occurrence was greater than 10% in older adults ≥55 years old, and these rates varied widely, but less in large epidemiological studies of incident frailty. The prospective relationship between depressive symptomatology and increased risk of incident frailty was robust, while the opposite relationship was less conclusive. The presence of comorbidities that interact with depressive symptomatology increased incident frailty risk. Measurement variability of depressive symptomatology and inclusion of older adults who are severely depressed, have cognitive impairment or dementia, or stroke may confound the frailty syndrome with single disease outcomes, accounting for a substantial proportion of shared variance in the syndromes. Further study is needed to identify medical and behavioral interventions for frailty and depressive symptomatology that prevent adverse sequelae such as falls, disability, and premature mortality. PMID:26719681

  10. Depression and frailty in later life: a systematic review.

    PubMed

    Vaughan, Leslie; Corbin, Akeesha L; Goveas, Joseph S

    2015-01-01

    Frailty and depression are important issues affecting older adults. Depressive syndrome may be difficult to clinically disambiguate from frailty in advanced old age. Current reviews on the topic include studies with wide methodological variation. This review examined the published literature on cross-sectional and longitudinal associations between frailty and depressive symptomatology with either syndrome as the outcome, moderators of this relationship, construct overlap, and related medical and behavioral interventions. Prevalence of both was reported. A systematic review of studies published from 2000 to 2015 was conducted in PubMed, the Cochrane Database of Systematic Reviews, and PsychInfo. Key search terms were "frailty", "frail", "frail elderly", "depressive", "depressive disorder", and "depression". Participants of included studies were ≥ 55 years old and community dwelling. Included studies used an explicit biological definition of frailty based on Fried et al's criteria and a screening measure to identify depressive symptomatology. Fourteen studies met the inclusion/exclusion criteria. The prevalence of depressive symptomatology, frailty, or their co-occurrence was greater than 10% in older adults ≥ 55 years old, and these rates varied widely, but less in large epidemiological studies of incident frailty. The prospective relationship between depressive symptomatology and increased risk of incident frailty was robust, while the opposite relationship was less conclusive. The presence of comorbidities that interact with depressive symptomatology increased incident frailty risk. Measurement variability of depressive symptomatology and inclusion of older adults who are severely depressed, have cognitive impairment or dementia, or stroke may confound the frailty syndrome with single disease outcomes, accounting for a substantial proportion of shared variance in the syndromes. Further study is needed to identify medical and behavioral interventions for frailty and depressive symptomatology that prevent adverse sequelae such as falls, disability, and premature mortality. PMID:26719681

  11. Religion and Suicide Risk: A Systematic Review.

    PubMed

    Lawrence, Ryan E; Oquendo, Maria A; Stanley, Barbara

    2016-01-01

    Although religion is reported to be protective against suicide, the empirical evidence is inconsistent. Research is complicated by the fact that there are many dimensions to religion (affiliation, participation, doctrine) and suicide (ideation, attempt, completion). We systematically reviewed the literature on religion and suicide over the last 10 years (89 articles) with a goal of identifying what specific dimensions of religion are associated with specific aspects of suicide. We found that religious affiliation does not necessarily protect against suicidal ideation, but does protect against suicide attempts. Whether religious affiliation protects against suicide attempts may depend on the culture-specific implications of affiliating with a particular religion, since minority religious groups can feel socially isolated. After adjusting for social support measures, religious service attendance is not especially protective against suicidal ideation, but does protect against suicide attempts, and possibly protects against suicide. Future qualitative studies might further clarify these associations. PMID:26192968

  12. Effectiveness of Nursing Management Information Systems: A Systematic Review

    PubMed Central

    Choi, Mona; Yang, You Lee

    2014-01-01

    Objectives The purpose of this study was to review evaluation studies of nursing management information systems (NMISs) and their outcome measures to examine system effectiveness. Methods For the systematic review, a literature search of the PubMed, CINAHL, Embase, and Cochrane Library databases was conducted to retrieve original articles published between 1970 and 2014. Medical Subject Headings (MeSH) terms included informatics, medical informatics, nursing informatics, medical informatics application, and management information systems for information systems and evaluation studies and nursing evaluation research for evaluation research. Additionally, manag* and admin*, and nurs* were combined. Title, abstract, and full-text reviews were completed by two reviewers. And then, year, author, type of management system, study purpose, study design, data source, system users, study subjects, and outcomes were extracted from the selected articles. The quality and risk of bias of the studies that were finally selected were assessed with the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS) criteria. Results Out of the 2,257 retrieved articles, a total of six articles were selected. These included two scheduling programs, two nursing cost-related programs, and two patient care management programs. For the outcome measurements, usefulness, time saving, satisfaction, cost, attitude, usability, data quality/completeness/accuracy, and personnel work patterns were included. User satisfaction, time saving, and usefulness mostly showed positive findings. Conclusions The study results suggest that NMISs were effective in time saving and useful in nursing care. Because there was a lack of quality in the reviewed studies, well-designed research, such as randomized controlled trials, should be conducted to more objectively evaluate the effectiveness of NMISs. PMID:25405060

  13. Diabetic nephropathy in Africa: A systematic review

    PubMed Central

    Noubiap, Jean Jacques N; Naidoo, Jashira; Kengne, Andre P

    2015-01-01

    AIM: To determine the prevalence and incidence of diabetic nephropathy in Africa. METHODS: We performed a systematic narrative review of published literature following the MOOSE Guidelines for Meta-Analysis and Systematic Reviews of Observational Studies. We searched PubMed-MEDLINE for all articles published in English and French languages between January 1994 and July 2014 using a predefined strategy based on the combination of relevant terms and the names of each of the 54 African countries and African sub-regions to capture the largest number of studies, and hand-searched the reference lists of retrieved articles. Included studies reported on the prevalence, incidence or determinants of chronic kidney disease (CKD) in people with diabetes within African countries. RESULTS: Overall, we included 32 studies from 16 countries; two being population-based studies and the remaining being clinic-based surveys. Most of the studies (90.6%) were conducted in urban settings. Methods for assessing and classifying CKD varied widely. Measurement of urine protein was the most common method of assessing kidney damage (62.5% of studies). The overall prevalence of CKD varied from 11% to 83.7%. Incident event rates were 94.9% for proteinuria at 10 years of follow-up, 34.7% for end-stage renal disease at 5 years of follow-up and 18.4% for mortality from nephropathy at 20 years of follow-up. Duration of diabetes, blood pressure, advancing age, obesity and glucose control were the common determinants of kidney disease. CONCLUSION: The burden of CKD is important among people with diabetes in Africa. High quality data from large population-based studies with validated measures of kidney function are still needed to better capture the magnitude and characteristics of diabetic nephropathy in Africa. PMID:26069725

  14. Acupuncture for treating sciatica: a systematic review protocol

    PubMed Central

    Qin, Zongshi; Liu, Xiaoxu; Yao, Qin; Zhai, Yanbing; Liu, Zhishun

    2015-01-01

    Introduction This systematic review aims to assess the effectiveness and safety of acupuncture for treating sciatica. Methods The following nine databases will be searched from their inception to 30 October 2014: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Chinese Biomedical Literature Database (CBM), the Chinese Medical Current Content (CMCC), the Chinese Scientific Journal Database (VIP database), the Wan-Fang Database, the China National Knowledge Infrastructure (CNKI) and Citation Information by National Institute of Informatics (CiNii). Randomised controlled trials (RCTs) of acupuncture for sciatica in English, Chinese or Japanese without restriction of publication status will be included. Two researchers will independently undertake study selection, extraction of data and assessment of study quality. Meta-analysis will be conducted after screening of studies. Data will be analysed using risk ratio for dichotomous data, and standardised mean difference or weighted mean difference for continuous data. Dissemination This systematic review will be disseminated electronically through a peer-reviewed publication or conference presentations. Trial registration number PROSPERO CRD42014015001. PMID:25922105

  15. Sunscreen use and melanocytic nevi in children: a systematic review.

    PubMed

    de Maleissye, Marie-Florence; Beauchet, Alain; Saiag, Phillippe; Corrêa, Marcelo; Godin-Beeckmann, Sophie; Haeffelin, Martial; Mahé, Emmanuel

    2013-01-01

    We conducted a systematic review of the association between melanocytic nevi (MN) in childhood and sunscreen use. A bibliographic search was conducted between November 2008 and January 2009 using the following key words on MEDLINE and EMBASE: child*, in combination with naevi, nevi, naevus, nevus and sunscreen, sun protection. We also used Medical Subject Headings [sunscreening agents], or [radiation protection] with [nevus, pigmented]. A first screening was done on title and abstract reading. Randomized trials and cohort and cross-sectional studies analyzing the relationship between the use of sunscreen and MN in children were selected. Three reviewers abstracted data from each article. The three sets of results were compared for concordance and rereviewed if necessary. Fifteen articles were included (20,743 children). The studies were not consistent in terms of the ages of the children, MN count methods, or sunscreen use assessment. Owing to this heterogeneity, we were unable to pool the studies and conduct a meta-analysis. Twelve studies did not report that the use of sunscreen had a protective effect against MN development. Three studies reported a lower MN count when sunscreen was applied. This systematic review underlines the methodologic differences between studies. Eight of 15 studies reported a positive association between sunscreen application and MN count. Differences in MN counts, overexposure to sun, and inadequate sunscreen application on fair-skinned children could explain the disparity in the results. There is still no evidence of a protective effect of sunscreen against MN development in children. PMID:22994908

  16. “Generalized Osteoarthritis”: A Systematic Review

    PubMed Central

    Nelson, Amanda E.; Smith, Michael W.; Golightly, Yvonne M.; Jordan, Joanne M.

    2014-01-01

    Objectives Given the conflicting definitions of “generalized osteoarthritis” (GOA) in the literature, we performed a systematic review of GOA definitions, risk factors, and outcomes. Methods We searched the Medline literature with terms: osteoarthritis, generalized, polyarticular, multiple joint, and multi-joint, to obtain articles related to GOA, following evidence-based guidelines. Titles and abstracts of 948 articles were reviewed, with full text review of 108. Data were extracted based on pre-specified criteria for 74 articles plus 24 identified through bibliographic review (total=98). Results Twenty-four large cohorts (n~30,000) were represented along with numerous clinical series (n~9000), across 22 countries and 60 years (1952–2012). No less than 15 definitions of GOA were given in 30 studies with a stated GOA definition; at least 6 groups used a summed score of joints or radiographic grades. Prevalence estimates based on these GOA definitions were 1–80%, although most were 5–25%. Increased risk and progression of GOA was associated with age, female sex, and genetic/familial factors. Associations with increased body mass index or bone mineral density were not consistent. One study estimated the heritability of GOA at 42%. Collagen biomarker levels increased with number of involved joints. Increased OA burden was associated with increased mortality and disability, poorer health and function. Conclusion While there remains no standard definition of GOA, this term is commonly used. The impact on health may be greater when OA is in more than one joint. A descriptive term, such as multi-joint or polyarticular OA, designating OA of multiple joints or joint groups, is recommended. PMID:24461078

  17. Iraq War mortality estimates: A systematic review

    PubMed Central

    Tapp, Christine; Burkle, Frederick M; Wilson, Kumanan; Takaro, Tim; Guyatt, Gordon H; Amad, Hani; Mills, Edward J

    2008-01-01

    Background In March 2003, the United States invaded Iraq. The subsequent number, rates, and causes of mortality in Iraq resulting from the war remain unclear, despite intense international attention. Understanding mortality estimates from modern warfare, where the majority of casualties are civilian, is of critical importance for public health and protection afforded under international humanitarian law. We aimed to review the studies, reports and counts on Iraqi deaths since the start of the war and assessed their methodological quality and results. Methods We performed a systematic search of 15 electronic databases from inception to January 2008. In addition, we conducted a non-structured search of 3 other databases, reviewed study reference lists and contacted subject matter experts. We included studies that provided estimates of Iraqi deaths based on primary research over a reported period of time since the invasion. We excluded studies that summarized mortality estimates and combined non-fatal injuries and also studies of specific sub-populations, e.g. under-5 mortality. We calculated crude and cause-specific mortality rates attributable to violence and average deaths per day for each study, where not already provided. Results Thirteen studies met the eligibility criteria. The studies used a wide range of methodologies, varying from sentinel-data collection to population-based surveys. Studies assessed as the highest quality, those using population-based methods, yielded the highest estimates. Average deaths per day ranged from 48 to 759. The cause-specific mortality rates attributable to violence ranged from 0.64 to 10.25 per 1,000 per year. Conclusion Our review indicates that, despite varying estimates, the mortality burden of the war and its sequelae on Iraq is large. The use of established epidemiological methods is rare. This review illustrates the pressing need to promote sound epidemiologic approaches to determining mortality estimates and to establish guidelines for policy-makers, the media and the public on how to interpret these estimates. PMID:18328100

  18. Systematic Review and Narrative Synthesis of the Effectiveness of Contraceptive Service Interventions for Young People, Delivered in Health Care Settings

    ERIC Educational Resources Information Center

    Blank, Lindsay; Baxter, Susan K.; Payne, Nick; Guillaume, Louise R.; Squires, Hazel

    2012-01-01

    A systematic review and narrative synthesis to determine the effectiveness of contraception service interventions for young people delivered in health care premises was undertaken. We searched 12 key health and medical databases, reference lists of included papers and systematic reviews and cited reference searches on included articles. All…

  19. NSAIDs and Acute Pancreatitis: A Systematic Review

    PubMed Central

    Pezzilli, Raffaele; Morselli-Labate, Antonio Maria; Corinaldesi, Roberto

    2010-01-01

    The resulting pain is the main symptom of acute pancreatitis and it should be alleviated as soon as possible. NSAIDs are the first line therapy for pain and they are generally administered to acute pancreatitis patients upon admission to the hospital. In addition, these drugs have also been used to prevent post-endoscopic cholangiopancreatography (ERCP) acute pancreatitis. On the other hand, there are several reports indicating that NSAIDs may be the actual cause of acute pancreatitis. We carried out a literature search on PubMed/MEDLINE; all full text papers published in from January 1966 to November 2009 on the use of NSAIDs in acute pancreatitis were collected; the literature search was also supplemented by a review of the bibliographies of the papers evaluated. Thus, in this article, we will systematically review the current literature in order to better illustrate the role of NSAIDs in acute pancreatitis, in particular: i) NSAIDs as a cause of acute pancreatitis; ii) their use to prevent post-retrograde ERCP pancreatitis and iii) their efficacy for pain relief in the acute illness of the pancreas.

  20. Fetal deaths in Brazil: a systematic review

    PubMed Central

    Barbeiro, Fernanda Morena dos Santos; Fonseca, Sandra Costa; Tauffer, Mariana Girão; Ferreira, Mariana de Souza Santos; da Silva, Fagner Paulo; Ventura, Patrícia Mendonça; Quadros, Jesirée Iglesias

    2015-01-01

    OBJECTIVE To review the frequency of and factors associated with fetal death in the Brazilian scientific literature. METHODS A systematic review of Brazilian studies on fetal deaths published between 2003 and 2013 was conducted. In total, 27 studies were analyzed; of these, 4 studies addressed the quality of data, 12 were descriptive studies, and 11 studies evaluated the factors associated with fetal death. The databases searched were PubMed and Lilacs, and data extraction and synthesis were independently performed by two or more examiners. RESULTS The level of completeness of fetal death certificates was deficient, both in the completion of variables, particularly sociodemographic variables, and in defining the underlying causes of death. Fetal deaths have decreased in Brazil; however, inequalities persist. Analysis of the causes of death indicated maternal morbidities that could be prevented and treated. The main factors associated with fetal deaths were absent or inadequate prenatal care, low education level, maternal morbidity, and adverse reproductive history. CONCLUSIONS Prenatal care should prioritize women that are most vulnerable (considering their social environment or their reproductive history and morbidities) with the aim of decreasing the fetal mortality rate in Brazil. Adequate completion of death certificates and investment in the committees that investigate fetal and infant deaths are necessary. PMID:25902565

  1. Acupuncture for Lateral Epicondylitis: A Systematic Review

    PubMed Central

    Tang, Hongzhi; Fan, Huaying; Chen, Jiao; Yang, Mingxiao; Yi, Xuebing; Dai, Guogang; Chen, Junrong; Tang, Liugang; Rong, Haibo; Wu, Junhua; Liang, Fanrong

    2015-01-01

    Objective. This systematic review aimed to assess the effectiveness and safety of acupuncture for lateral epicondylitis (LE). Methods. Seven databases and the WHO International Clinical Trials Registry Platform Search Portal were searched to identify relevant studies. The data were extracted and assessed by two independent authors, and Review Manager Software (V.5.3) was used for data synthesis with effect estimate presented as standard mean difference (SMD) and mean difference (MD) with a 95% confidence interval. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the level of evidence. Results. Four RCTs with 309 participants were included with poor methodological quality. Participants who received acupuncture and acupuncture plus moxibustion with material insulation were likely to have an improvement in elbow functional status and/or myodynamia. The overall quality rated by GRADE was from very low to low. Two studies reported that the needle pain would be the main reason for the dropout. Conclusion. For the small number of included studies with poor methodological quality, no firm conclusion can be drawn regarding the effect of acupuncture of elbow functional status and myodynamia for LE. This trial is registered with CRD42015016199. PMID:26843886

  2. Floods and human health: a systematic review.

    PubMed

    Alderman, Katarzyna; Turner, Lyle R; Tong, Shilu

    2012-10-15

    Floods are the most common type of disaster globally, responsible for almost 53,000 deaths in the last decade alone (23:1 low- versus high-income countries). This review assessed recent epidemiological evidence on the impacts of floods on human health. Published articles (2004-2011) on the quantitative relationship between floods and health were systematically reviewed. 35 relevant epidemiological studies were identified. Health outcomes were categorized into short- and long-term and were found to depend on the flood characteristics and people's vulnerability. It was found that long-term health effects are currently not well understood. Mortality rates were found to increase by up to 50% in the first year post-flood. After floods, it was found there is an increased risk of disease outbreaks such as hepatitis E, gastrointestinal disease and leptospirosis, particularly in areas with poor hygiene and displaced populations. Psychological distress in survivors (prevalence 8.6% to 53% two years post-flood) can also exacerbate their physical illness. There is a need for effective policies to reduce and prevent flood-related morbidity and mortality. Such steps are contingent upon the improved understanding of potential health impacts of floods. Global trends in urbanization, burden of disease, malnutrition and maternal and child health must be better reflected in flood preparedness and mitigation programs. PMID:22750033

  3. Toxocariasis in North America: A Systematic Review

    PubMed Central

    Bottazzi, Maria Elena; Hotez, Peter J.

    2014-01-01

    Toxocariasis is an important neglected tropical disease that can manifest as visceral or ocular larva migrans, or covert toxocariasis. All three forms pose a public health problem and cause significant morbidity in areas of high prevalence. To determine the burden of toxocariasis in North America, we conducted a systematic review of the literature following PRISMA guidelines. We found 18 articles with original prevalence, incidence, or case data for toxocariasis. Prevalence estimates ranged from 0.6% in a Canadian Inuit community to 30.8% in Mexican children with asthma. Commonly cited risk factors included: African-American race, poverty, male sex, and pet ownership or environmental contamination by animal feces. Increased prevalence of Toxocara spp. infection was linked in a group of case control studies conducted in Mexico to several high risk groups including waste pickers, asthmatic children, and inpatient psychiatry patients. Further research is needed to determine the true current burden of toxocariasis in North America; however the prevalence estimates gathered in this review suggest that the burden of disease is significant. PMID:25166906

  4. A systematic review of antiproton radiotherapy

    NASA Astrophysics Data System (ADS)

    Bittner, Martin-Immanuel; Grosu, Anca-Ligia; Wiedenmann, Nicole; Wilkens, Jan

    2014-01-01

    Antiprotons have been proposed as possible particles for radiotherapy; over the past years, the renewed interest in the potential biomedical relevance led to an increased research activity. It is the aim of this review to deliver a comprehensive overview regarding the evidence accumulated so far, analysing the background and depicting the current status of antiprotons in radiotherapy. A literature search has been conducted, including major scientific and commercial databases. All articles and a number of relevant conference abstracts published in the respective field have been included in this systematic review. The physical basis of antiproton radiotherapy is complex; however, the characterisation of the energy deposition profile supports its potential use in radiotherapy. Also the dosimetry improved considerably over the past few years. Regarding the biological properties, data on the effects on cells are presented; however, definite conclusions regarding the relative biological effectiveness cannot be made at the moment and radiobiological evidence of enhanced effectiveness remains scarce. In addition, there is new evidence supporting the potential imaging properties, for example for online dose verification. Clinical settings which might profit from the use of antiprotons have been further tracked. Judging from the evidence available so far, clinical constellations requiring optimal sparing in the entrance region of the beam and re-irradiations might profit most from antiproton radiotherapy. While several open questions remain to be answered, first steps towards a thorough characterisation of this interesting modality have been made.

  5. A systematic review of antiproton radiotherapy

    NASA Astrophysics Data System (ADS)

    Bittner, Martin-Immanuel; Grosu, Anca-Ligia; Wiedenmann, Nicole; Wilkens, Jan

    2013-01-01

    Antiprotons have been proposed as possible particles for radiotherapy; over the past years, the renewed interest in the potential biomedical relevance led to an increased research activity. It is the aim of this review to deliver a comprehensive overview regarding the evidence accumulated so far, analysing the background and depicting the current status of antiprotons in radiotherapy. A literature search has been conducted, including major scientific and commercial databases. All articles and a number of relevant conference abstracts published in the respective field have been included in this systematic review. The physical basis of antiproton radiotherapy is complex; however, the characterisation of the energy deposition profile supports its potential use in radiotherapy. Also the dosimetry improved considerably over the past few years. Regarding the biological properties, data on the effects on cells are presented; however, definite conclusions regarding the relative biological effectiveness cannot be made at the moment and radiobiological evidence of enhanced effectiveness remains scarce. In addition, there is new evidence supporting the potential imaging properties, for example for online dose verification. Clinical settings which might profit from the use of antiprotons have been further tracked. Judging from the evidence available so far, clinical constellations requiring optimal sparing in the entrance region of the beam and re-irradiations might profit most from antiproton radiotherapy. While several open questions remain to be answered, first steps towards a thorough characterisation of this interesting modality have been made.

  6. Interventions to promote cycling: systematic review

    PubMed Central

    Yang, Lin; Sahlqvist, Shannon; McMinn, Alison; Griffin, Simon J

    2010-01-01

    Objectives To determine what interventions are effective in promoting cycling, the size of the effects of interventions, and evidence of any associated benefits on overall physical activity or anthropometric measures. Design Systematic review. Data sources Published and unpublished reports in any language identified by searching 13 electronic databases, websites, reference lists, and existing systematic reviews, and papers identified by experts in the field. Review methods Controlled “before and after” experimental or observational studies of the effect of any type of intervention on cycling behaviour measured at either individual or population level. Results Twenty five studies (of which two were randomised controlled trials) from seven countries were included. Six studies examined interventions aimed specifically at promoting cycling, of which four (an intensive individual intervention in obese women, high quality improvements to a cycle route network, and two multifaceted cycle promotion initiatives at town or city level) were found to be associated with increases in cycling. Those studies that evaluated interventions at population level reported net increases of up to 3.4 percentage points in the population prevalence of cycling or the proportion of trips made by bicycle. Sixteen studies assessing individualised marketing of “environmentally friendly” modes of transport to interested households reported modest but consistent net effects equating to an average of eight additional cycling trips per person per year in the local population. Other interventions that targeted travel behaviour in general were not associated with a clear increase in cycling. Only two studies assessed effects of interventions on physical activity; one reported a positive shift in the population distribution of overall physical activity during the intervention. Conclusions Community-wide promotional activities and improving infrastructure for cycling have the potential to increase cycling by modest amounts, but further controlled evaluative studies incorporating more precise measures are required, particularly in areas without an established cycling culture. Studies of individualised marketing report consistent positive effects of interventions on cycling behaviour, but these findings should be confirmed using more robust study designs. Future research should also examine how best to promote cycling in children and adolescents and through workplaces. Whether interventions to promote cycling result in an increase in overall physical activity or changes in anthropometric measures is unclear. PMID:20959282

  7. Hypodontia and ovarian cancer: A systematic review

    PubMed Central

    Iavazzo, Christos; Papakiritsis, Matthaios; Gkegkes, Ioannis D.

    2016-01-01

    Hypodontia can be defined as the non-formation of one or more teeth during the developmental period. Mutation in several genes related to tooth formation has previously been correlated with cancer. Regarding the ovarian cancer, there are few studies that associate the presence of hypodontia with ovarian cancer. A systematic literature search was performed in PubMed and Scopus. In total, 385 patients were included in this study. Control group was present in 3 out of 4 studies (340 patients). Hypodontia was present in 56 out of 290 patients (incidence of 19.3%). Only in 2 out of 4 studies, the number of missing teeth was mentioned (47 teeth), while the majority of them were either maxillary second premolars or maxillary lateral incisors. Unilateral distribution of the missing teeth was present in 28 out of 46 patients, while bilateral distribution of the missing teeth was present in 18 out of 46 patients. The presence of ovarian cancer in the family medical history occurred in 12 out of 33 patients. Only 1 out of 4 studies examined the presence of genes with mutations in the included patients. Based on our findings, the lack of clinical studies was the principal obstacle to clarify the possible predictive value of hypodontia in the early prediction of patients with higher risk of ovarian cancer. PMID:27026778

  8. 5 CFR 1312.10 - Systematic review guidelines.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ..., DOWNGRADING, DECLASSIFICATION AND SAFEGUARDING OF NATIONAL SECURITY INFORMATION Classification and Declassification of National Security Information § 1312.10 Systematic review guidelines. The EOP Security...

  9. Involving patients in quality indicator development – a systematic review

    PubMed Central

    Kötter, Thomas; Schaefer, Friederike Anna; Scherer, Martin; Blozik, Eva

    2013-01-01

    Background Quality indicators (QI) are used in many health care areas to measure, compare, and improve the quality of care. Ideas of quality differ between health care providers and patients, yet patients are not regularly involved in QI development nor does a methodological standard for patient involvement in QI development exist. In this study we systematically reviewed the medical journal articles and gray literature for published approaches for involving patients in QI development. Methods We searched medical literature databases (Medline, Excerpta Medica database, and Cumulative Index to Nursing and Allied Health Literature), screened websites, and contacted experts in the field of QI development for publications on approaches to patient involvement in QI development. Results Eleven relevant journal articles and four web-published documents were included. Four major approaches to patient involvement were extracted from the literature: (1) focus group interviews, (2) self-administered questionnaires, (3) individual interviews, and (4) participation in panels during systematic consensus processes. Patients’ views were collected by involving patients, patient representatives, or family members. Conclusion Although there is a large body of literature on QI, publications that describe approaches to patient involvement in QI development are scarce. In principle, indirect and direct methods of patient involvement can be distinguished, and it seems most promising to combine different approaches. However, the limited number of publications identified clearly shows that further research in this field is overdue and that the quality of reporting found in studies within this field needs to be improved. PMID:23569365

  10. Adverse effects of iodine thyroid blocking: a systematic review.

    PubMed

    Spallek, L; Krille, L; Reiners, C; Schneider, R; Yamashita, S; Zeeb, H

    2012-07-01

    (131)I, when released in a radiological or nuclear accident as happened recently in Fukushima, Japan, may cause thyroid cancer as a long-term consequence. Iodine thyroid blocking (ITB) is known to reduce the risk of developing thyroid cancer. Potential adverse effects of ITB have not been systematically investigated so far. This article summarises the results of a review on adverse effects of ITB based on a systematic literature search in scientific medical databases. A meta-analysis was not performed as identified studies displayed major heterogeneity. The search resulted in 14 articles relevant to the topic, reporting mostly on surveys, ecological and intervention studies. Only one study from Poland focused on effects (both desired and adverse) of an ITB intervention following the Chernobyl accident. All other studies reported on iodine administration in a different context. Overall, the studies did not reveal severe adverse reactions to potassium iodide in the general public. Since ITB is a protective measure only applied in very specific circumstances, scientifically sound studies of adverse effects are scarce and consequently the evidence base is weak. The assessment of adverse effects of ITB relies on indirect evidence from related areas. This study may contribute to ongoing developments in pharmacoepidemiology aiming to better quantify adverse effects of medications and health care interventions including ITB. PMID:22021061

  11. [The "Medical Peer Review" curriculum of the German Medical Association].

    PubMed

    Chop, Ines

    2012-01-01

    Considering the increasing interest in peer review procedures over the past few years, the German Medical Association (Bundesärztekammer) published a curriculum document in 2011 titled "Medical Peer Review". This curriculum has been conceived to offer guidance for establishing this particularly promising voluntary instrument which links medical quality development with professional learning, focusing and promoting communication and knowledge transfer between experts. Therefore the peers' communicative and social competencies play a central role, including respect and appreciation for each other, the ability to create an atmosphere of trust, to reflect one's own role, to focus on concrete solutions and to constructively deal with conflicts, resistance and fear. For these reasons, the practice-oriented curriculum accentuates both the skills of designing, planning and conducting peer reviews and the necessary personal skills such as the techniques of solution-focused communication and conflict management. (As supplied by publisher). PMID:23084860

  12. Pentoxifylline in preterm neonates: a systematic review.

    PubMed

    Harris, Emma; Schulzke, Sven M; Patole, Sanjay K

    2010-10-01

    Sepsis, necrotizing enterocolitis (NEC), and chronic lung disease (CLD) in preterm neonates are associated with significant mortality and morbidity, including long-term neurodevelopmental impairment and socioeconomic burden. Safe and effective drugs for the prevention and treatment of these conditions are urgently needed. Pentoxifylline, a synthetic theobromine derivative, is a non-steroidal immunomodulating agent with unique hemorrheologic effects which has been used in a range of infectious, vascular, and inflammatory conditions in adults and children. The unique properties of pentoxifylline explain its potential benefits in preterm neonates with sepsis, NEC, and CLD, conditions characterized by activation of the inflammatory cytokine cascade, free radical toxicity, and impaired microcirculation. Pentoxifylline has anti-inflammatory properties resulting from inhibition of erythrocyte phosphodiesterase. It lowers blood viscosity and improves microcirculation and tissue perfusion. As a phosphodiesterase inhibitor, pentoxifylline downregulates pro-inflammatory cytokines such as tumor necrosis factor-alpha, interleukin-6, and interferon-gamma. Methylxanthines, including caffeine, theophylline, and theobromine are relatively non-toxic drugs; of these, theobromine is the least toxic. Pentoxifylline-related significant adverse events are thus very rare. Unlike other methylxanthines, pentoxifylline does not have significant cardiac and bronchodilating effects at therapeutic doses. Although it is contraindicated in adults with recent cerebral hemorrhage due to its effect on platelets, red blood cells, and plasma fibrinogen levels, no significant adverse effects including thrombocytopenia and bleeding have been reported in critically ill preterm neonates with sepsis or NEC after treatment with pentoxifylline. Based on data from pilot randomized trials and observational studies, our systematic review suggests that pentoxifylline may reduce mortality and/or morbidity in preterm neonates with sepsis, NEC, and CLD. Results of experimental studies also indicate that pentoxifylline may potentially be beneficial in meconium aspiration syndrome and hypoxic ischemic encephalopathy. Given the substantial burden of sepsis, NEC, and CLD in high-risk preterm neonates, and the findings of this systematic review, pentoxifylline needs to be evaluated urgently as a preventative and therapeutic agent for these conditions in randomized controlled trials that can detect minimal clinically significant effect sizes. Further clinical and experimental studies are also necessary to evaluate whether pentoxifylline is safe and effective in meconium aspiration syndrome and hypoxic ischemic encephalopathy. PMID:20799759

  13. Site Selection Criteria for Sheltering after Earthquakes: A Systematic Review

    PubMed Central

    Soltani, Ahmad; Ardalan, Ali; Darvishi Boloorani, Ali; Haghdoost, AliAkbar; Hosseinzadeh-Attar, Mohammad Javad

    2014-01-01

    Objective: Proper shelter site selection is necessary for long-term welfare of earthquake affected people. This study aims to explore the criteria that need to be considered after earthquakes. Methods: Through a systematic review, 273 articles found that were published till April 2014. Among these, seven articles have been selected and analyzed for the criteria that they introduced for sheltering site selection after earthquakes. Results: Out of 27 proposed criteria, accessibility and proximity to homes of affected people were stressed in all the papers. Moreover, seven other criteria were the same in most of the papers including suitable size, suitable distance from hazardous areas, geological hazards and land slope, suitable distance from medical centers, water supply and Security. We categorized all the mentioned criteria in six main categories. Size and location, disaster risk reduction, relief and rescue facilities, feasibility of the site, environmental and social aspects are the main categories. Conclusion: Selection and applying proper criteria for shelter site selection after earthquakes is a multi-disciplinary task. The decision needs relevant models and/or tools. Geographic Information System (GIS) is a useful tool for this purpose. Key words: Disaster, earthquake, shelter, site selection, systematic review PMID:25642367

  14. Guidelines on the management of fibromyalgia syndrome - a systematic review.

    PubMed

    Häuser, Winfried; Thieme, Kati; Turk, Dennis C

    2010-01-01

    We compared the methodology and the recommendations of evidence-based guidelines for the management of fibromyalgia syndrome (FMS) to give an orientation within the continuously growing number of reviews on the therapy of FMS. Systematic searches up to April 2008 of the US-American National Guideline Clearing House, the Scottish Intercollegiate Guidelines Network, the Association of the Scientific Medical Societies in Germany (AWMF) and Medline were conducted. Three evidence-based guidelines for the management of FMS published by professional organizations were identified: The American Pain Society (APS) (2005), the European League Against Rheumatism (EULAR) (2007), and the AWMF (2008). The steering committees and panels of APS and AWMF were comprised of multiple disciplines engaged in the management of FMS and included patients, whereas the task force of EULAR only consisted of physicians, predominantly rheumatologists. APS and AWMF ascribed the highest level of evidence to systematic reviews and meta-analyses, whereas EULAR credited the highest level of evidence to randomised controlled studies. Both APS and AWMF assigned the highest level of recommendation to aerobic exercise, cognitive-behavioral therapy, amitriptyline, and multicomponent treatment. In contrast, EULAR assigned the highest level of recommendation to a set of to pharmacological treatment. Although there was some consistency in the recommendations regarding pharmacological treatments among the three guidelines, the APS and AWMF guidelines assigned higher ratings to CBT and multicomponent treatments. The inconsistencies across guidelines are likely attributable to the criteria used for study inclusion, weighting systems, and composition of the panels. PMID:19264521

  15. Rural Medical Education: Review of the Literature

    ERIC Educational Resources Information Center

    Curran, Vernon R.; Bornstein, Stephen; Jong, Michael; Fleet, Lisa

    2004-01-01

    (Purpose) This report summarizes a synthesis of the literature related to the evidence, initiatives and approaches to rural/northern medical education, particularly its role in strengthening the medical workforce in rural areas. (Methodology) A literature review was conducted involving the literature databases MEDLINE (January 1990-March 2003),…

  16. Local treatments for cutaneous warts: systematic review

    PubMed Central

    Gibbs, Sam; Harvey, Ian; Sterling, Jane; Stark, Rosemary

    2002-01-01

    Objective To assess the evidence for the efficacy of local treatments for cutaneous warts. Methods Systematic review of randomised controlled trials. Main outcomes measures Total clearance of warts and adverse effects such as irritation, pain, and blistering. Study selection Randomised controlled trials of any local treatment for uncomplicated cutaneous warts. All published and unpublished material was considered, with no restriction on date or language. Results 50 included trials provided generally weak evidence because of poor methods and reporting. The best evidence was for topical treatments containing salicylic acid. Data pooled from six placebo controlled trials showed a cure rate of 75% (144 of 191) in cases compared with 48% (89 of 185) in controls (odds ratio 3.91, 95% confidence interval 2.40 to 6.36). Some evidence for the efficacy of contact immunotherapy was provided by two small trials comparing dinitrochlorobenzene with placebo. Evidence for the efficacy of cryotherapy was limited. No consistent evidence was found for the efficacy of intralesional bleomycin, and only limited evidence was found for the efficacy of topical fluorouracil, intralesional interferons, photodynamic therapy, and pulsed dye laser. Conclusions Reviewed trials of local treatments for cutaneous warts were highly variable in methods and quality, and there was a paucity of evidence from randomised, placebo controlled trials on which to base the rational use of the treatments. There is good evidence that topical treatments containing salicylic acid have a therapeutic effect and some evidence for the efficacy of dinitrochlorobenzene. Less evidence was found for the efficacy of all the other treatments reviewed, including cryotherapy. What is already known on this topicA wide range of local treatments is available for treating wartsNo one treatment is strikingly effective and little is known about the absolute and relative efficacy of these treatmentsWhat this study addsHigh quality research on the efficacy of various local treatments for warts is lackingEvidence, which is generally of a poor quality, shows a beneficial effect of topical salicylic acid and contact immunotherapy with dinitrochlorobenzeneLittle evidence exists for the efficacy of cryotherapy and no consistent evidence for the efficacy of all the other treatments reviewed PMID:12202325

  17. 14 CFR 1203.603 - Systematic review for declassification.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... INFORMATION SECURITY PROGRAM Declassification and Downgrading § 1203.603 Systematic review for... review guidelines. The Chairperson, NASA Information Security Program Committee, shall develop, in... custodian and referred to the Chairperson, NASA Information Security Program Committee. This listing...

  18. 14 CFR 1203.603 - Systematic review for declassification.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... INFORMATION SECURITY PROGRAM Declassification and Downgrading § 1203.603 Systematic review for... review guidelines. The Chairperson, NASA Information Security Program Committee, shall develop, in... custodian and referred to the Chairperson, NASA Information Security Program Committee. This listing...

  19. Smartphone Apps for Schizophrenia: A Systematic Review

    PubMed Central

    2015-01-01

    Background There is increasing interest in using mobile technologies such as smartphones for improving the care of patients with schizophrenia. However, less is known about the current clinical evidence for the feasibility and effectiveness of smartphone apps in this population. Objective To review the published literature of smartphone apps applied for the care of patients with schizophrenia and other psychotic disorders. Methods An electronic database search of Ovid MEDLINE, the Cochrane Central Register of Controlled Trials, Health Technology Assessment Database, Allied and Complementary Medicine, Health and Psychosocial Instruments, PsycINFO, and Embase was conducted on May 24, 2015. All eligible studies were systematically reviewed, and proportional meta-analyses were applied to pooled data on recruitment, retention, and adherence to examine the overall feasibility of smartphone interventions for schizophrenia. Results Our search produced 226 results from which 7 eligible articles were identified, reporting on 5 studies of smartphone apps for patients with schizophrenia. All examined feasibility, and one assessed the preliminary efficacy of a smartphone intervention for schizophrenia. Study lengths varied between 6 and 130 days. Overall retention was 92% (95% CI 82-98%). Participants consistently used the smartphone apps on more than 85% of days during the study period, averaging 3.95 interactions per person per day. Furthermore, participants responded to 71.9% of automated prompts (95% CI 65.7-77.8%). Participants reported a range of potential benefits from the various interventions, and user experience was largely positive. Conclusions Although small, the current published literature demonstrates strong evidence for the feasibility of using smartphones to enhance the care of people with schizophrenia. High rates of engagement and satisfaction with a broad range of apps suggest the nascent potential of this mobile technology. However, there remains limited data on the efficacy of such interventions. PMID:26546039

  20. Single incision laparoscopic hepatectomy: A systematic review

    PubMed Central

    Gkegkes, Ioannis D.; Iavazzo, Christos

    2014-01-01

    Single incision laparoscopic surgery is a rather innovative surgical technique. A systematic literature review was performed with the intention to evaluate the till now clinical evidence regarding the application of single incision technique on liver resections as a method of management in hepatic lesions. Twelve relative studies were found in the field including 30 patients with a age range from 29 to 90 years and a body mass index from 20.1 to 36.5 kg/m2. Primary hepatic carcinoma (40%), metastatic nodules (26.7%), hepatic cysts (16.7%), hepatic haemangiomas (13.3%) and hepatic adenoma (3.3%) were the most common indications of the lesions resected. The types of hepatectomy performed included partial hepatectomy (43.3%), segmentectomy (30%) and lobectomy (26.7%). In the majority of the patients, left lateral segments (II-III-IV) (76.7%) were resected. The median operative time was 110 min (range: 55-235) while the median quantity of blood loss was 50 ml (range: 0-100). No conversion to open surgery and no transfusion were needed. The duration of hospital stay ranged between 2 and 11 days. No complications, no cases of disease recurrence or death of patients were reported. None of the studies included described data on the cosmesis of the application of single incision laparoscopic technique on hepatic resections. Moreover, the surgical technique, as well as the different type of ports used is also presented in this review. Single site port laparoscopic surgery is a promising minimally invasive procedure for liver resections. PMID:25013325

  1. Bereavement care interventions: a systematic review

    PubMed Central

    Forte, Amanda L; Hill, Malinda; Pazder, Rachel; Feudtner, Chris

    2004-01-01

    Background Despite abundant bereavement care options, consensus is lacking regarding optimal care for bereaved persons. Methods We conducted a systematic review, searching MEDLINE, PsychINFO, CINAHL, EBMR, and other databases using the terms (bereaved or bereavement) and (grief) combined with (intervention or support or counselling or therapy) and (controlled or trial or design). We also searched citations in published reports for additional pertinent studies. Eligible studies had to evaluate whether the treatment of bereaved individuals reduced bereavement-related symptoms. Data from the studies was abstracted independently by two reviewers. Results 74 eligible studies evaluated diverse treatments designed to ameliorate a variety of outcomes associated with bereavement. Among studies utilizing a structured therapeutic relationship, eight featured pharmacotherapy (4 included an untreated control group), 39 featured support groups or counselling (23 included a control group), and 25 studies featured cognitive-behavioural, psychodynamic, psychoanalytical, or interpersonal therapies (17 included a control group). Seven studies employed systems-oriented interventions (all had control groups). Other than efficacy for pharmacological treatment of bereavement-related depression, we could identify no consistent pattern of treatment benefit among the other forms of interventions. Conclusions Due to a paucity of reports on controlled clinical trails, no rigorous evidence-based recommendation regarding the treatment of bereaved persons is currently possible except for the pharmacologic treatment of depression. We postulate the following five factors as impeding scientific progress regarding bereavement care interventions: 1) excessive theoretical heterogeneity, 2) stultifying between-study variation, 3) inadequate reporting of intervention procedures, 4) few published replication studies, and 5) methodological flaws of study design. PMID:15274744

  2. Dietary patterns in India: a systematic review.

    PubMed

    Green, Rosemary; Milner, James; Joy, Edward J M; Agrawal, Sutapa; Dangour, Alan D

    2016-07-01

    Dietary patterns analysis is an emerging area of research. Identifying distinct patterns within a large dietary survey can give a more accurate representation of what people are eating. Furthermore, it allows researchers to analyse relationships between non-communicable diseases (NCD) and complete diets rather than individual food items or nutrients. However, few such studies have been conducted in developing countries including India, where the population has a high burden of diabetes and CVD. We undertook a systematic review of published and grey literature exploring dietary patterns and relationships with diet-related NCD in India. We identified eight studies, including eleven separate models of dietary patterns. Most dietary patterns were vegetarian with a predominance of fruit, vegetables and pulses, as well as cereals; dietary patterns based on high-fat, high-sugar foods and more meat were also identified. There was large variability between regions in dietary patterns, and there was some evidence of change in diets over time, although no evidence of different diets by sex or age was found. Consumers of high-fat dietary patterns were more likely to have greater BMI, and a dietary pattern high in sweets and snacks was associated with greater risk of diabetes compared with a traditional diet high in rice and pulses, but other relationships with NCD risk factors were less clear. This review shows that dietary pattern analyses can be highly valuable in assessing variability in national diets and diet-disease relationships. However, to date, most studies in India are limited by data and methodological shortcomings. PMID:27146890

  3. Volatile Metabolites of Pathogens: A Systematic Review

    PubMed Central

    Bos, Lieuwe D. J.; Sterk, Peter J.; Schultz, Marcus J.

    2013-01-01

    Ideally, invading bacteria are detected as early as possible in critically ill patients: the strain of morbific pathogens is identified rapidly, and antimicrobial sensitivity is known well before the start of new antimicrobial therapy. Bacteria have a distinct metabolism, part of which results in the production of bacteria-specific volatile organic compounds (VOCs), which might be used for diagnostic purposes. Volatile metabolites can be investigated directly in exhaled air, allowing for noninvasive monitoring. The aim of this review is to provide an overview of VOCs produced by the six most abundant and pathogenic bacteria in sepsis, including Staphylococcus aureus, Streptococcus pneumoniae, Enterococcus faecalis, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli. Such VOCs could be used as biological markers in the diagnostic approach of critically ill patients. A systematic review of existing literature revealed 31 articles. All six bacteria of interest produce isopentanol, formaldehyde, methyl mercaptan, and trimethylamine. Since humans do not produce these VOCs, they could serve as biological markers for presence of these pathogens. The following volatile biomarkers were found for identification of specific strains: isovaleric acid and 2-methyl-butanal for Staphylococcus aureus; 1-undecene, 2,4-dimethyl-1-heptane, 2-butanone, 4-methyl-quinazoline, hydrogen cyanide, and methyl thiocyanide for Pseudomonas aeruginosa; and methanol, pentanol, ethyl acetate, and indole for Escherichia coli. Notably, several factors that may effect VOC production were not controlled for, including used culture media, bacterial growth phase, and genomic variation within bacterial strains. In conclusion, VOCs produced by bacteria may serve as biological markers for their presence. Goal-targeted studies should be performed to identify potential sets of volatile biological markers and evaluate the diagnostic accuracy of these markers in critically ill patients. PMID:23675295

  4. Phenobarbital for childhood epilepsy: systematic review

    PubMed Central

    Pal, Deb K

    2006-01-01

    Introduction Against a background of concern about the safety of new pharmaceutical products, there has been renewed interest in one of the oldest antiepileptic drugs (AEDs), phenobarbital. Although still in widespread use in developing countries, its popularity has slipped in Western countries over the past century, partly because of controversy about its adverse effect profile. This critical review examines the evidence supporting its effectiveness and its associated behavioural adverse effects for febrile convulsions and childhood epilepsy. Methods Relevant randomised controlled trials (RCTs) of phenobarbital vs other antiepileptic drugs or placebo between 1970-2005 were identified through a comprehensive manual and computer database search of the world biomedical literature. Eleven RCTs of febrile convulsions and nine RCTs of childhood epilepsy were systematically reviewed against a conventional set of quality criteria. Results With a few exceptions, the overall quality of clinical trial methodology, especially in the early studies conducted in the 1970s and 1980s, was poor. There is no evidence for a difference in antiepileptic efficacy between phenobarbital and any other compared AED, yet no evidence for absolute efficacy. No convincing evidence exists for an excess of behavioural adverse effects, over other AEDs, attributable to phenobarbital. Masked studies of phenobarbital in childhood epilepsy have shown no significant differences in behavioural or cognitive adverse effects compared to other AEDs. This is in contrast to the excess of such adverse effects reported in studies open to observer bias. However, the one finding of reduction in cognitive ability associated with phenobarbital treatment for febrile convulsions remains a concern. Future areas of clinical and genetic epidemiological research are outlined. PMID:17356688

  5. Primary adrenal lymphoma: a systematic review.

    PubMed

    Rashidi, Armin; Fisher, Stephen I

    2013-12-01

    Fewer than 200 cases of primary adrenal lymphoma (PAL) have been reported. We have systematically reviewed all 187 cases of PAL reported in the English literature until June 2013, from which we drew the following conclusions: PAL is typically a highly symptomatic and aggressive, metabolically hyperactive, hypovascular, hypoechoic (and heterogeneous on ultrasound), hypodense (with slight to moderate enhancement on computed tomography), high-grade lymphoma, primarily affecting elderly males and presenting with large bilateral adrenal masses. Most cases have adrenal insufficiency, B-symptoms, and elevated lactate dehydrogenase. Hepatosplenomegaly, lymphadenopathy, concurrent or prior immune dysregulation, and bone marrow involvement are uncommon. Epstein-Barr virus positivity is observed in more than half of cases and the disease is disseminated at presentation in 18 % of cases. The two most common WHO 2008-defined PAL subtypes are diffuse large B cell lymphoma (78 %) and peripheral T cell lymphoma (7 %). The prognosis of PAL has improved with the advent of rituximab-containing chemotherapeutic regimens. According to our results, administration of chemotherapy and adrenal insufficiency are significant independent predictors of prognosis. PMID:23771429

  6. Cyberbullying and adolescent mental health: systematic review.

    PubMed

    Bottino, Sara Mota Borges; Bottino, Cássio M C; Regina, Caroline Gomez; Correia, Aline Villa Lobo; Ribeiro, Wagner Silva

    2015-03-01

    Cyberbullying is a new form of violence that is expressed through electronic media and has given rise to concern for parents, educators and researchers. In this paper, an association between cyberbullying and adolescent mental health will be assessed through a systematic review of two databases: PubMed and Virtual Health Library (BVS). The prevalence of cyberbullying ranged from 6.5% to 35.4%. Previous or current experiences of traditional bullying were associated with victims and perpetrators of cyberbullying. Daily use of three or more hours of Internet, web camera, text messages, posting personal information and harassing others online were associated with cyberbullying. Cybervictims and cyberbullies had more emotional and psychosomatic problems, social difficulties and did not feel safe and cared for in school. Cyberbullying was associated with moderate to severe depressive symptoms, substance use, ideation and suicide attempts. Health professionals should be aware of the violent nature of interactions occurring in the virtual environment and its harm to the mental health of adolescents. PMID:25859714

  7. Systematic Review of Pears and Health

    PubMed Central

    Reiland, Holly; Slavin, Joanne

    2015-01-01

    Fruit consumption is universally promoted, yet consumption of fruit remains low in the United States. We conducted a systematic review on pear consumption and health outcomes searching both PubMed and Agricola from 1970 to present. The genus Pyrus L. consists of species of pears cultivated in Europe, parts of Asia, South America, and North America. Like most fruit, pears are concentrated in water and sugar. Pears are high in dietary fiber, containing 6 g per serving. Pears, similar to apples, are concentrated in fructose, and the high fiber and fructose in pears probably explain the laxative properties. Pears contain antioxidants and provide between 27 and 41 mg of phenolics per 100 g. Animal studies with pears suggest that pears may regulate alcohol metabolism, protect against ulcers, and lower plasma lipids. Human feeding studies with pears have not been conducted. In epidemiological studies, pears are combined with all fresh fruits or with apples, because they are most similar in composition. The high content of dietary fiber in pears and their effects on gut health set pears apart from other fruit and deserves study. PMID:26663955

  8. Acupuncture for Erectile Dysfunction: A Systematic Review

    PubMed Central

    Cui, Xiaoming; Zhou, Jing; Qin, Zongshi; Liu, Zhishun

    2016-01-01

    Background. Acupuncture is increasingly used to treat patients with erectile dysfunction (ED), and our systematic review aimed to evaluate the current evidence for the efficacy and safety of acupuncture in treating ED. Methods. An electronic search was conducted in eight databases to identify randomized controlled trials (RCTs) of acupuncture for treating erectile dysfunction that were published in English and Chinese. The Cochrane Risk of Bias tool was used to assess the risk of bias. Results. Three RCTs with a total of 183 participants met the inclusion criteria. One trial showed the beneficial effects of acupuncture compared with sham acupuncture while the others did not. One trial suggested that acupuncture combined with psychological therapy was superior to psychological therapy alone. However, the overall methodological and reporting quality of the studies was low. The safety of acupuncture for ED was unclear because there were too few reports on this topic. Conclusion. The available evidence supporting that acupuncture alone improves ED was insufficient and the available studies failed to show the specific therapeutic effect of acupuncture. Future well-designed and rigorous RCTs with a large sample size are required. This trial is registered with CRD42014013575. PMID:26885501

  9. Olfaction in allergic rhinitis: A systematic review.

    PubMed

    Stuck, Boris A; Hummel, Thomas

    2015-12-01

    Olfactory dysfunction is a key symptom in patients with allergic rhinitis (AR). Despite the implications for quality of life, relatively few articles have tested olfactory function in their investigations. The current systematic review aimed to investigate the following 2 questions: (1) What does AR do to human olfaction? (2) How effective is the treatment of AR in restoring the sense of smell? A comprehensive literature search was performed, and human studies of any design were included. A total of 420 articles were identified, and 36 articles were considered relevant. Data indicate that the frequency of olfactory dysfunction increases with the duration of the disorder, and most studies report a frequency in the range of 20% to 40%. Although olfactory dysfunction does not appear to be very severe in patients with AR, its presence seems to increase with the severity of the disease. There is very limited evidence that antihistamines improve olfactory function. In addition, there is limited evidence that topical steroids improve the sense of smell, especially in patients with seasonal AR. This is also the case for specific immunotherapy. However, many questions remain unanswered because randomized controlled trials are infrequent and only a few studies rely on quantitative measurement of olfactory function. PMID:26409662

  10. Peripheral biomarkers of endometriosis: a systematic review

    PubMed Central

    May, K.E.; Conduit-Hulbert, S.A.; Villar, J.; Kirtley, S.; Kennedy, S.H.; Becker, C.M.

    2010-01-01

    BACKGROUND Endometriosis is estimated to affect 1 in 10 women during the reproductive years. There is often delay in making the diagnosis, mainly due to the non-specific nature of the associated symptoms and the need to verify the disease surgically. A biomarker that is simple to measure could help clinicians to diagnose (or at least exclude) endometriosis; it might also allow the effects of treatment to be monitored. If effective, such a marker or panel of markers could prevent unnecessary diagnostic procedures and/or recognize treatment failure at an early stage. METHODS We used QUADAS (Quality Assessment of Diagnostic Accuracy Studies) criteria to perform a systematic review of the literature over the last 25 years to assess critically the clinical value of all proposed biomarkers for endometriosis in serum, plasma and urine. RESULTS We identified over 100 putative biomarkers in publications that met the selection criteria. We were unable to identify a single biomarker or panel of biomarkers that have unequivocally been shown to be clinically useful. CONCLUSIONS Peripheral biomarkers show promise as diagnostic aids, but further research is necessary before they can be recommended in routine clinical care. Panels of markers may allow increased sensitivity and specificity of any diagnostic test. PMID:20462942

  11. Hospital Disaster Preparedness Tools: a Systematic Review

    PubMed Central

    Heidaranlu, Esmail; Ebadi, Abbas; Khankeh, Hamid Reza; Ardalan, Ali

    2015-01-01

    Aim: Evaluating hospital disaster preparedness is one the best ways for hospital accreditation. The aim of this study was to evaluate the quality of outcome measure that offer the level of measurement, reliability and validity that are known as the ‘ psychometric properties’ of the current hospital disaster preparedness tools. Methods: In total, 140 studies were retrieved. Studies which had been published from 2000 to 2014 and had used hospital disaster preparedness tools were appraised by using the PRISMA guideline. The content quality and the quality of the psychometric properties of the retrieved tools were assessed by using the World Health Organization Criteria for Hospital Preparedness as well as the COSMIN criteria. Findings: Only 33 studies met the inclusion criteria. In total, eleven hospital disaster preparedness tools had been used in these 33 studies. These tools mainly focused on evaluating structural and non-structural aspects of hospital preparedness and paid little attention, if any, to the key functional aspect. Conclusion: Given the paramount importance of evaluating hospital disaster preparedness and the weaknesses of current preparedness evaluation tools, valid and reliable tools should be developed by using experts’ knowledge and experience through the processes of tool development and psychometric evaluation. Keywords: Hospital preparedness, Measurement tool, Disaster, Systematic review PMID:26425401

  12. Autism and social robotics: A systematic review.

    PubMed

    Pennisi, Paola; Tonacci, Alessandro; Tartarisco, Gennaro; Billeci, Lucia; Ruta, Liliana; Gangemi, Sebastiano; Pioggia, Giovanni

    2016-02-01

    Social robotics could be a promising method for Autism Spectrum Disorders (ASD) treatment. The aim of this article is to carry out a systematic literature review of the studies on this topic that were published in the last 10 years. We tried to address the following questions: can social robots be a useful tool in autism therapy? We followed the PRISMA guidelines, and the protocol was registered within PROSPERO database (CRD42015016158). We found many positive implications in the use of social robots in therapy as for example: ASD subjects often performed better with a robot partner rather than a human partner; sometimes, ASD patients had, toward robots, behaviors that TD patients had toward human agents; ASDs had a lot of social behaviors toward robots; during robotic sessions, ASDs showed reduced repetitive and stereotyped behaviors and, social robots manage to improve spontaneous language during therapy sessions. Therefore, robots provide therapists and researchers a means to connect with autistic subjects in an easier way, but studies in this area are still insufficient. It is necessary to clarify whether sex, intelligence quotient, and age of participants affect the outcome of therapy and whether any beneficial effects only occur during the robotic session or if they are still observable outside the clinical/experimental context. Autism Res 2016, 9: 165-183. © 2015 International Society for Autism Research, Wiley Periodicals, Inc. PMID:26483270

  13. The Safety of Cruciferous Plants in Humans: A Systematic Review

    PubMed Central

    Scott, Ori; Galicia-Connolly, Elaine; Adams, Denise; Surette, Soleil; Vohra, Sunita; Yager, Jerome Y.

    2012-01-01

    Some cruciferous plants may serve as preventive treatments for several medical conditions; our objective was to systematically investigate their safety in humans. Four electronic databases were searched, and, of 10,831 references identified, 50 were included. Data were extracted by two independent reviewers, whereafter the association between interventions and adverse events was assessed. Adverse events in 53 subjects were identified through clinical trials; of these, altered drug metabolism was rated as certainly/likely caused by cruciferous plants. Adverse events in 1247 subjects were identified through observational studies, of which none received high causality ratings. Adverse events in 35 subjects were identified through case reports, of which allergies and warfarin resistance were rated as certainly/likely caused by cruciferous plants. We conclude that cruciferous plants are safe in humans, with the exception of allergies. Individuals treated with warfarin should consult their physician. Further investigation of uses of cruciferous plants in preventative medicine is warranted. PMID:22500092

  14. Systematic review of the surgical treatment for symptomatic os acromiale

    PubMed Central

    Harris, Joshua D.; Griesser, Michael J.; Jones, Grant L.

    2011-01-01

    The optimal surgical treatment for symptomatic os acromiale that has failed nonoperative management is unclear in the literature. We conducted a systematic review of multiple medical databases for level I–IV evidence. Both radiographic and clinical outcomes were analyzed. Nine studies met the inclusion criteria (118 subjects, 125 shoulders). One hundred and fifteen subjects were treated surgically (122 shoulders). The mean age of the subjects was 49±11 years. The mean preoperative duration of symptoms was 12±8.6 months. Mesoacromiale was the most common type treated (94%). Internal fixation was the most common surgical technique used (60%), followed by excision (27%) and acromioplasty (13%). Rotator cuff repair was the most common concurrent surgical technique (performed in 59% of the surgically treated shoulders), followed by distal clavicle excision (25%). All surgical techniques resulted in improvement in clinical outcomes. Surgical management of symptomatic os acromiale that has failed nonoperative measures may predictably lead to improved outcomes. PMID:21660192

  15. Financial evaluations of antibiotic stewardship programs—a systematic review

    PubMed Central

    Dik, Jan-Willem H.; Vemer, Pepijn; Friedrich, Alex W.; Hendrix, Ron; Lo-Ten-Foe, Jerome R.; Sinha, Bhanu; Postma, Maarten J.

    2015-01-01

    Introduction: There is an increasing awareness to counteract problems due to incorrect antimicrobial use. Interventions that are implemented are often part of an Antimicrobial Stewardship Program (ASPs). Studies publishing results from these interventions are increasing, including reports on the economical effects of ASPs. This review will look at the economical sections of these studies and the methods that were used. Methods: A systematic review was performed of articles found in the PubMed and EMBASE databases published from 2000 until November 2014. Included studies found were scored for various aspects and the quality of the papers was assessed following an appropriate check list (CHEC criteria list). Results: 1233 studies were found, of which 149 were read completely. Ninety-nine were included in the final review. Of these studies, 57 only mentioned the costs associated with the antimicrobial medication. Others also included operational costs (n = 23), costs for hospital stay (n = 18), and/or other costs (n = 19). Nine studies were further assessed for their quality. These studies scored between 2 and 14 out of a potential total score of 19. Conclusions: This review gives an extensive overview of the current financial evaluation of ASPs and the quality of these economical studies. We show that there is still major potential to improve financial evaluations of ASPs. Studies do not use similar nor consistent methods or outcome measures, making it impossible draw sound conclusions and compare different studies. Finally, we make some recommendations for the future. PMID:25932024

  16. Antipsychotic Therapy During Early and Late Pregnancy. A Systematic Review

    PubMed Central

    Gentile, Salvatore

    2010-01-01

    Objective: Both first- (FGAs) and second-generation antipsychotics (SGAs) are routinely used in treating severe and persistent psychiatric disorders. However, until now no articles have analyzed systematically the safety of both classes of psychotropics during pregnancy. Data sources and search strategy: Medical literature information published in any language since 1950 was identified using MEDLINE/PubMed, TOXNET, EMBASE, and The Cochrane Library. Additional references were identified from the reference lists of published articles. Bibliographical information, including contributory unpublished data, was also requested from companies developing drugs. Search terms were pregnancy, psychotropic drugs, (a)typical-first-second-generation antipsychotics, and neuroleptics. A separate search was also conducted to complete the safety profile of each reviewed medication. Searches were last updated on July 2008. Data selection: All articles reporting primary data on the outcome of pregnancies exposed to antipsychotics were acquired, without methodological limitations. Conclusions: Reviewed information was too limited to draw definite conclusions on structural teratogenicity of FGAs and SGAs. Both classes of drugs seem to be associated with an increased risk of neonatal complications. However, most SGAs appear to increase risk of gestational metabolic complications and babies large for gestational age and with mean birth weight significantly heavier as compared with those exposed to FGAs. These risks have been reported rarely with FGAs. Hence, the choice of the less harmful option in pregnancy should be limited to FGAs in drug-naive patients. When pregnancy occurs during antipsychotic treatment, the choice to continue the previous therapy should be preferred. PMID:18787227

  17. Treatment of Female Sexual Pain Disorders: A Systematic Review.

    PubMed

    Al-Abbadey, Miznah; Liossi, Christina; Curran, Natasha; Schoth, Daniel E; Graham, Cynthia A

    2016-02-17

    Sexual pain disorders affect women's sexual and reproductive health and are poorly understood. Although many treatments have been evaluated, there is no one "gold standard" treatment. The aim of this systematic review was to investigate what treatments for female sexual pain have been evaluated in clinical studies and their effectiveness. The search strategy resulted in 65 papers included in this review. The articles were divided into the following categories: medical treatments; surgical treatments; physical therapies; psychological therapies; comparative treatment studies; and miscellaneous and combined treatments. Topical and systemic medical treatments have generally been found to lead to improvements in, but not complete relief of, pain, and side effects are quite common. Surgical procedures have demonstrated very high success rates, although there has been variability in complete relief of pain after surgery, which suggests less invasive treatments should be considered first. Physical therapies and psychological therapies have been shown to be promising treatments, supporting a biopsychosocial approach to sexual pain disorders. Although most of the interventions described have been reported as effective, many women still experience pain. A multidisciplinary team with active patient involvement may be needed to optimize treatment outcome. PMID:26036302

  18. 42 CFR 405.2113 - Medical review board.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Medical review board. 405.2113 Section 405.2113...-Stage Renal Disease (ESRD) Services § 405.2113 Medical review board. (a) General. The medical review... least one patient representative. (b) Restrictions on medical review board members. (1) A medical...

  19. 42 CFR 405.2113 - Medical review board.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Medical review board. 405.2113 Section 405.2113...-Stage Renal Disease (ESRD) Services § 405.2113 Medical review board. (a) General. The medical review... least one patient representative. (b) Restrictions on medical review board members. (1) A medical...

  20. Assessing the Strengths of Mental Health Consumers: A Systematic Review

    ERIC Educational Resources Information Center

    Bird, Victoria J.; Le Boutillier, Clair; Leamy, Mary; Larsen, John; Oades, Lindsay G.; Williams, Julie; Slade, Mike

    2012-01-01

    Strengths assessments focus on the individual's talents, abilities, resources, and strengths. No systematic review of strengths assessments for use within mental health populations has been published. The aims of this study were to describe and evaluate strengths assessments for use within mental health services. A systematic review identified 12

  1. 22 CFR 9.11 - Systematic declassification review.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Systematic declassification review. 9.11 Section 9.11 Foreign Relations DEPARTMENT OF STATE GENERAL SECURITY INFORMATION REGULATIONS § 9.11 Systematic declassification review. The Information and Privacy Coordinator shall be responsible...

  2. 22 CFR 9.11 - Systematic declassification review.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Systematic declassification review. 9.11 Section 9.11 Foreign Relations DEPARTMENT OF STATE GENERAL SECURITY INFORMATION REGULATIONS § 9.11 Systematic declassification review. The Information and Privacy Coordinator shall be responsible...

  3. 22 CFR 9.11 - Systematic declassification review.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Systematic declassification review. 9.11 Section 9.11 Foreign Relations DEPARTMENT OF STATE GENERAL SECURITY INFORMATION REGULATIONS § 9.11 Systematic declassification review. The Information and Privacy Coordinator shall be responsible...

  4. 22 CFR 9.11 - Systematic declassification review.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Systematic declassification review. 9.11 Section 9.11 Foreign Relations DEPARTMENT OF STATE GENERAL SECURITY INFORMATION REGULATIONS § 9.11 Systematic declassification review. The Information and Privacy Coordinator shall be responsible...

  5. 22 CFR 9.11 - Systematic declassification review.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Systematic declassification review. 9.11 Section 9.11 Foreign Relations DEPARTMENT OF STATE GENERAL SECURITY INFORMATION REGULATIONS § 9.11 Systematic declassification review. The Information and Privacy Coordinator shall be responsible...

  6. Action Learning Research: A Systematic Review and Conceptual Framework

    ERIC Educational Resources Information Center

    Cho, Yonjoo; Egan, Toby Marshall

    2009-01-01

    Despite considerable interest in action learning, no systematic investigation of action learning literature has been reported. Two purposes of this study are (a) to systematically access and examine recent empirical studies on action learning and related themes using Garrard's Matrix Method for reviewing literature (the review of the literature…

  7. 32 CFR 2001.31 - Systematic declassification review.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 6 2011-07-01 2011-07-01 false Systematic declassification review. 2001.31 Section 2001.31 National Defense Other Regulations Relating to National Defense INFORMATION SECURITY... Declassification § 2001.31 Systematic declassification review. (a) General. Agencies shall establish...

  8. 32 CFR 2001.31 - Systematic declassification review.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Systematic declassification review. 2001.31 Section 2001.31 National Defense Other Regulations Relating to National Defense INFORMATION SECURITY... Declassification § 2001.31 Systematic declassification review. (a) General. Agencies shall establish...

  9. 14 CFR 1203.603 - Systematic review for declassification:

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false Systematic review for declassification: 1203.603 Section 1203.603 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION INFORMATION SECURITY PROGRAM Declassification and Downgrading § 1203.603 Systematic review for declassification: (a) General. (1) NASA must establish...

  10. Assessing the Strengths of Mental Health Consumers: A Systematic Review

    ERIC Educational Resources Information Center

    Bird, Victoria J.; Le Boutillier, Clair; Leamy, Mary; Larsen, John; Oades, Lindsay G.; Williams, Julie; Slade, Mike

    2012-01-01

    Strengths assessments focus on the individual's talents, abilities, resources, and strengths. No systematic review of strengths assessments for use within mental health populations has been published. The aims of this study were to describe and evaluate strengths assessments for use within mental health services. A systematic review identified 12…

  11. Gynecomastia in Patients with Prostate Cancer: A Systematic Review

    PubMed Central

    Cormio, Luigi; Palangi, Lina; Lewin, Richard; Santanelli di Pompeo, Fabio; Elander, Anna

    2015-01-01

    Introduction Gynecomastia and/or mastodynia is a common medical problem in patients receiving antiandrogen (bicalutamide or flutamide) treatment for prostate cancer; up to 70% of these patients result to be affected; furthermore, this can jeopardise patients’ quality of life. Aims To systematically review the quality of evidence of the current literature regarding treatment options for bicalutamide-induced gynecomastia, including efficacy, safety and patients’ quality of life. Methods The PubMed, Medline, Scopus, The Cochrane Library and SveMed+ databases were systematically searched between January 1, 2000 and December 31, 2014. All searches were undertaken between January and February 2015. The search phrase used was:”gynecomastia AND treatment AND prostate cancer”. Two reviewers assessed 762 titles and abstracts identified. The search and review process was done in accordance with the PRISMA statement. The PICOS (patients, intervention, comparator, outcomes and study design) process was used to specify inclusion criteria. Quality of evidence was rated according to GRADE. Main Outcome Measures Primary outcomes were: treatment effects, number of complications and side effects. Secondary outcome was: Quality of Life. Results Eleven studies met the inclusion criteria and are analysed in this review. Five studies reported pharmacological intervention with tamoxifen and/or anastrozole, either as prophylactic or therapeutic treatment. Four studies reported radiotherapy as prophylactic and/or therapeutic treatment. Two studies compared pharmacological treatment to radiotherapy. Most of the studies were randomized with varying risk of bias. According to GRADE, quality of evidence was moderate to high. Conclusions Bicalutamide-induced gynecomastia and/or mastodynia can effectively be managed by oral tamoxifen (10–20 mg daily) or radiotherapy without relevant side effects. Prophylaxis or therapeutic treatment with tamoxifen results to be more effective than radiotherapy. PMID:26308532

  12. Eating Disorders, Physical Fitness and Sport Performance: A Systematic Review

    PubMed Central

    El Ghoch, Marwan; Soave, Fabio; Calugi, Simona; Dalle Grave, Riccardo

    2013-01-01

    Background: Eating disorders are health problems that are particularly prevalent in adolescents and young adults. They are associated with considerable physical health and psychosocial morbidity, and increased risk of mortality. We set out to conduct a systematic review to determine their effect on physical fitness in the general population and on sport performance in athletes. Methods/Design: A systematic review of the relevant peer-reviewed literature was performed. For inclusion, articles retrieved from PubMed had to be published in English between 1977 and 2013. Wherever possible, methods and reporting adhere to the guidelines outlined in the PRISMA statement. Some additional studies were retrieved from among those cited in the reference lists of included studies and from non-electronic databases. Literature searches, study selection, method and quality appraisal were performed independently by two authors, and data was synthesized using a narrative approach. Results: Of the 1183 articles retrieved, twenty-nine studies met the inclusion criteria and were consequently analysed. The available data indicate that eating disorders have a negative effect on physical fitness and sport performance by causing low energy availability, excessive loss of fat and lean mass, dehydration, and electrolyte disturbance. Discussion: Although the paucity of the available data mean that findings to date should be interpreted with caution, the information collated in this review has several practical implications. First, eating disorders have a negative effect on both physical fitness and sport performance. Second athletics coaches should be targeted for education about the risk factors of eating disorders, as deterioration in sport performance in athletes, particularly if they are underweight or show other signs of an eating disorder, may indicate the need for medical intervention. However, future studies are needed, especially to assess the direct effect of eating disorders on sport performance. PMID:24352092

  13. Weight recidivism post-bariatric surgery: a systematic review.

    PubMed

    Karmali, Shahzeer; Brar, Balpreet; Shi, Xinzhe; Sharma, Arya M; de Gara, Christopher; Birch, Daniel W

    2013-11-01

    Obesity is considered a worldwide health problem of epidemic proportions. Bariatric surgery remains the most effective treatment for patients with severe obesity, resulting in improved obesity-related co-morbidities and increased overall life expectancy. However, weight recidivism has been observed in a subset of patients post-bariatric surgery. Weight recidivism has significant medical, societal and economic ramifications. Unfortunately, there is a very limited understanding of how to predict which bariatric surgical patients are more likely to regain weight following surgery and how to appropriately treat patients who have regained weight. The objective of this paper is to systematically review the existing literature to assess the incidence and causative factors associated with weight regain following bariatric surgery. An electronic literature search was performed of the Medline, Embase and Cochrane library databases along with the PubMed US national library from January 1950 to December 2012 to identify relevant articles. Following an initial screen of 2,204 titles, 1,437 abstracts were reviewed and 1,421 met exclusion criteria. Sixteen studies were included in this analysis: seven case series, five surveys and four non-randomized controlled trials, with a total of 4,864 patients for analysis. Weight regain in these patients appeared to be multi-factorial and overlapping. Aetiologies were categorized as patient specific (psychiatric, physical inactivity, endocrinopathies/metabolic and dietary non-compliance) and operation specific. Weight regain following bariatric surgery varies according to duration of follow-up and the bariatric surgical procedure performed. The underlying causes leading to weight regain are multi-factorial and related to patient- and procedure-specific factors. Addressing post-surgical weight regain requires a systematic approach to patient assessment focusing on contributory dietary, psychologic, medical and surgical factors. PMID:23996349

  14. Tuberculosis Incidence in Prisons: A Systematic Review

    PubMed Central

    Baussano, Iacopo; Williams, Brian G.; Nunn, Paul; Beggiato, Marta; Fedeli, Ugo; Scano, Fabio

    2010-01-01

    Background Transmission of tuberculosis (TB) in prisons has been reported worldwide to be much higher than that reported for the corresponding general population. Methods and Findings A systematic review has been performed to assess the risk of incident latent tuberculosis infection (LTBI) and TB disease in prisons, as compared to the incidence in the corresponding local general population, and to estimate the fraction of TB in the general population attributable (PAF%) to transmission within prisons. Primary peer-reviewed studies have been searched to assess the incidence of LTBI and/or TB within prisons published until June 2010; both inmates and prison staff were considered. Studies, which were independently screened by two reviewers, were eligible for inclusion if they reported the incidence of LTBI and TB disease in prisons. Available data were collected from 23 studies out of 582 potentially relevant unique citations. Five studies from the US and one from Brazil were available to assess the incidence of LTBI in prisons, while 19 studies were available to assess the incidence of TB. The median estimated annual incidence rate ratio (IRR) for LTBI and TB were 26.4 (interquartile range [IQR]: 13.0–61.8) and 23.0 (IQR: 11.7–36.1), respectively. The median estimated fraction (PAF%) of tuberculosis in the general population attributable to the exposure in prisons for TB was 8.5% (IQR: 1.9%–17.9%) and 6.3% (IQR: 2.7%–17.2%) in high- and middle/low-income countries, respectively. Conclusions The very high IRR and the substantial population attributable fraction show that much better TB control in prisons could potentially protect prisoners and staff from within-prison spread of TB and would significantly reduce the national burden of TB. Future studies should measure the impact of the conditions in prisons on TB transmission and assess the population attributable risk of prison-to-community spread. Please see later in the article for the Editors' Summary PMID:21203587

  15. Systematic review A systematic review of metabolite profiling in gestational diabetes mellitus

    PubMed Central

    Huynh, Jennifer; Xiong, Grace; Bentley-Lewis, Rhonda

    2014-01-01

    Aims/hypothesis Gestational diabetes mellitus is associated with adverse maternal and fetal outcomes during, as well as subsequent to, pregnancy, including increased risk of type 2 diabetes and cardiovascular disease. Because of the importance of early risk stratification in preventing these complications, improved first-trimester biomarker determination for diagnosing gestational diabetes would enhance our ability to optimise both maternal and fetal health. Metabolomic profiling, the systematic study of small molecule products of biochemical pathways, has shown promise in the identification of key metabolites associated with the pathogenesis of several metabolic diseases, including gestational diabetes. This article provides a systematic review of the current state of research on biomarkers and gestational diabetes and discusses the clinical relevance of metabolomics in the prediction, diagnosis and management of gestational diabetes. Methods We conducted a systematic search of MEDLINE (PubMed) up to the end of February 2014 using the key term combinations of ‘metabolomics,’ ‘metabonomics,’ ‘nuclear magnetic spectroscopy,’ ‘mass spectrometry,’ ‘metabolic profiling’ and ‘amino acid profile’ combined (AND) with ‘gestational diabetes’. Additional articles were identified through searching the reference lists from included studies. Quality assessment of included articles was conducted through the use of QUADOMICS. Results This systematic review included 17 articles. The biomarkers most consistently associated with gestational diabetes were asymmetric dimethylarginine and NEFAs. After QUADOMICS analysis, 13 of the 17 included studies were classified as ‘high quality’. Conclusions/interpretation Existing metabolomic studies of gestational diabetes present inconsistent findings regarding metabolite profile characteristics. Further studies are needed in larger, more racially/ethnically diverse populations. PMID:25193282

  16. Clinical trials registries are under-utilized in the conduct of systematic reviews: a cross-sectional analysis

    PubMed Central

    2014-01-01

    Background Publication bias is a major threat to the validity of systematic reviews. Searches of clinical trials registries can help to identify unpublished trials, though little is known about how often these resources are utilized. We assessed the usage and results of registry searches reported in systematic reviews published in major general medical journals. Methods This cross-sectional analysis includes data from systematic reviews assessing medical interventions which were published in one of six major general medical journals between July 2012 and June 2013. Two authors independently examined each published systematic review and all available supplementary materials to determine whether at least one clinical trials registry was searched. Results Of the 117 included systematic reviews, 41 (35%) reported searching a trials registry. Of the 29 reviews which also provided detailed registry search results, 15 (52%) identified at least one completed trial and 18 (62%) identified at least one ongoing trial. Conclusions Clinical trials registry searches are not routinely included in systematic reviews published in major medical journals. Routine examination of registry databases may allow a more accurate characterization of publication and outcome reporting biases and improve the validity of estimated effects of medical treatments. PMID:25348628

  17. Online Alcohol Interventions: A Systematic Review

    PubMed Central

    Kavanagh, David; Stallman, Helen; Klein, Britt; Kay-Lambkin, Frances; Proudfoot, Judy; Drennan, Judy; Connor, Jason; Baker, Amanda; Hines, Emily; Young, Ross

    2010-01-01

    Background There has been a significant increase in the availability of online programs for alcohol problems. A systematic review of the research evidence underpinning these programs is timely. Objectives Our objective was to review the efficacy of online interventions for alcohol misuse. Systematic searches of Medline, PsycINFO, Web of Science, and Scopus were conducted for English abstracts (excluding dissertations) published from 1998 onward. Search terms were: (1) Internet, Web*; (2) online, computer*; (3) alcohol*; and (4) E\\effect*, trial*, random* (where * denotes a wildcard). Forward and backward searches from identified papers were also conducted. Articles were included if (1) the primary intervention was delivered and accessed via the Internet, (2) the intervention focused on moderating or stopping alcohol consumption, and (3) the study was a randomized controlled trial of an alcohol-related screen, assessment, or intervention. Results The literature search initially yielded 31 randomized controlled trials (RCTs), 17 of which met inclusion criteria. Of these 17 studies, 12 (70.6%) were conducted with university students, and 11 (64.7%) specifically focused on at-risk, heavy, or binge drinkers. Sample sizes ranged from 40 to 3216 (median 261), with 12 (70.6%) studies predominantly involving brief personalized feedback interventions. Using published data, effect sizes could be extracted from 8 of the 17 studies. In relation to alcohol units per week or month and based on 5 RCTs where a measure of alcohol units per week or month could be extracted, differential effect sizes to posttreatment ranged from 0.02 to 0.81 (mean 0.42, median 0.54). Pre-post effect sizes for brief personalized feedback interventions ranged from 0.02 to 0.81, and in 2 multi-session modularized interventions, a pre-post effect size of 0.56 was obtained in both. Pre-post differential effect sizes for peak blood alcohol concentrations (BAC) ranged from 0.22 to 0.88, with a mean effect size of 0.66. Conclusions The available evidence suggests that users can benefit from online alcohol interventions and that this approach could be particularly useful for groups less likely to access traditional alcohol-related services, such as women, young people, and at-risk users. However, caution should be exercised given the limited number of studies allowing extraction of effect sizes, the heterogeneity of outcome measures and follow-up periods, and the large proportion of student-based studies. More extensive RCTs in community samples are required to better understand the efficacy of specific online alcohol approaches, program dosage, the additive effect of telephone or face-to-face interventions, and effective strategies for their dissemination and marketing. PMID:21169175

  18. A Systematic Review of Interspinous Dynamic Stabilization

    PubMed Central

    Lee, Seon-Heui; Seol, Aram; Cho, Tae-Young; Kim, Soo-Young; Lim, Hyung-Mook

    2015-01-01

    Background A systematic literature review of interspinous dynamic stabilization, including DIAM, Wallis, Coflex, and X-STOP, was conducted to assess its safety and efficacy. Methods The search was done in Korean and English, by using eight domestic databases which included KoreaMed and international databases, such as Ovid Medline, Embase, and the Cochrane Library. A total of 306 articles were identified, but the animal studies, preclinical studies, and studies that reported the same results were excluded. As a result, a total of 286 articles were excluded and the remaining 20 were included in the final assessment. Two assessors independently extracted data from these articles using predetermined selection criteria. Qualities of the articles included were assessed using Scottish Intercollegiate Guidelines Network (SIGN). Results The complication rate of interspinous dynamic stabilization has been reported to be 0% to 32.3% in 3- to 41-month follow-up studies. The complication rate of combined interspinous dynamic stabilization and decompression treatment (32.3%) was greater than that of decompression alone (6.5%), but no complication that significantly affected treatment results was found. Interspinous dynamic stabilization produced slightly better clinical outcomes than conservative treatments for spinal stenosis. Good outcomes were also obtained in single-group studies. No significant difference in treatment outcomes was found, and the studies compared interspinous dynamic stabilization with decompression or fusion alone. Conclusions No particular problem was found regarding the safety of the technique. Its clinical outcomes were similar to those of conventional techniques, and no additional clinical advantage could be attributed to interspinous dynamic stabilization. However, few studies have been conducted on the long-term efficacy of interspinous dynamic stabilization. Thus, the authors suggest further clinical studies be conducted to validate the theoretical advantages and clinical efficacy of this technique. PMID:26330954

  19. Flax and Breast Cancer: A Systematic Review.

    PubMed

    Flower, Gillian; Fritz, Heidi; Balneaves, Lynda G; Verma, Shailendra; Skidmore, Becky; Fernandes, Rochelle; Kennedy, Deborah; Cooley, Kieran; Wong, Raimond; Sagar, Stephen; Fergusson, Dean; Seely, Dugald

    2014-05-01

    Background Flax is a food and dietary supplement commonly used for menopausal symptoms. Flax is known for its lignan, α-linolenic acid, and fiber content, components that may possess phytogestrogenic, anti-inflammatory, and hormone modulating effects, respectively. We conducted a systematic review of flax for efficacy in improving menopausal symptoms in women living with breast cancer and for potential impact on risk of breast cancer incidence or recurrence.Methods We searched MEDLINE, Embase, the Cochrane Library, and AMED from inception to January 2013 for human interventional or observational data pertaining to flax and breast cancer.Results Of 1892 records, we included a total of 10 studies: 2 randomized controlled trials, 2 uncontrolled trials, 1 biomarker study, and 5 observational studies. Nonsignificant (NS) decreases in hot flash symptomatology were seen with flax ingestion (7.5 g/d). Flax (25 g/d) increased tumor apoptotic index (P< .05) and decreased HER2 expression (P< .05) and cell proliferation (Ki-67 index; NS) among newly diagnosed breast cancer patients when compared with placebo. Uncontrolled and biomarker studies suggest beneficial effects on hot flashes, cell proliferation, atypical cytomorphology, and mammographic density, as well as possible anti-angiogenic activity at doses of 25 g ground flax or 50 mg secoisolariciresinol diglycoside daily. Observational data suggests associations between flax and decreased risk of primary breast cancer (adjusted odds ratio [AOR] = 0.82; 95% confidence interval [CI] = 0.69-0.97), better mental health (AOR = 1.76; 95% CI = 1.05-2.94), and lower mortality (multivariate hazard ratio = 0.69; 95% CI = 0.50-0.95) among breast cancer patients.Conclusions Current evidence suggests that flax may be associated with decreased risk of breast cancer. Flax demonstrates antiproliferative effects in breast tissue of women at risk of breast cancer and may protect against primary breast cancer. Mortality risk may also be reduced among those living with breast cancer. PMID:24013641

  20. A systematic review of integrative oncology programs

    PubMed Central

    Seely, D.M.; Weeks, L.C.; Young, S.

    2012-01-01

    Objective This systematic review set out to summarize the research literature describing integrative oncology programs. Methods Searches were conducted of 9 electronic databases, relevant journals (hand searched), and conference abstracts, and experts were contacted. Two investigators independently screened titles and abstracts for reports describing examples of programs that combine complementary and conventional cancer care. English-, French-, and German-language articles were included, with no date restriction. From the articles located, descriptive data were extracted according to 6 concepts: description of article, description of clinic, components of care, administrative structure, process of care, and measurable outcomes used. Results Of the 29 programs included, most were situated in the United States (n = 12, 41%) and England (n = 10, 34%). More than half (n = 16, 55%) operate within a hospital, and 7 (24%) are community-based. Clients come through patient self-referral (n = 15, 52%) and by referral from conventional health care providers (n = 9, 31%) and from cancer agencies (n = 7, 24%). In 12 programs (41%), conventional care is provided onsite; 7 programs (24%) collaborate with conventional centres to provide integrative care. Programs are supported financially through donations (n = 10, 34%), cancer agencies or hospitals (n = 7, 24%), private foundations (n = 6, 21%), and public funds (n = 3, 10%). Nearly two thirds of the programs maintain a research (n = 18, 62%) or evaluation (n = 15, 52%) program. Conclusions The research literature documents a growing number of integrative oncology programs. These programs share a common vision to provide whole-person, patient-centred care, but each program is unique in terms of its structure and operational model. PMID:23300368

  1. Suicide in India: a systematic review

    PubMed Central

    RANE, Anil; NADKARNI, Abhijit

    2014-01-01

    Background Suicide is an important cause of death in India but estimated suicide rates based on data from India’s National Crime Records Bureau are unreliable. Aim Systematically review existing literature on suicide and the factors associated with suicide in India. Methods PubMed, PsycINFO, EMBASE, Global Health, Google Scholar and IndMED were searched using appropriate search terms. The abstracts of relevant papers were independently examined by both authors for possible inclusion. A standardized set of data items were abstracted from the full text of the selected papers. Results Thirty-six papers met inclusion criteria for the analysis. The heterogeneity of sampling procedures and methods of the studies made meta-analysis of the results infeasible. Verbal autopsy studies in several rural locations in India report high suicide rates, from 82 to 95 per 100,000 population – up to 8-fold higher than the official national suicide rates. Suicide rates are highest in persons 20 to 29 years of age. Female suicide rates are higher than male rates in persons under 30 years of age but the opposite is true in those 30 years of age or older. Hanging and ingestion of organophosphate pesticides are the most common methods of suicide. Among women, self-immolation is also a relatively common method of suicide. Low socioeconomic status, mental illness (especially alcohol misuse) and inter-personal difficulties are the factors that are most closely associated with suicide. Conclusion The quality of the information about suicide in India is quite limited, but it is clearly an important and growing public health problem. Compared to suicides in high-income countries, suicide in India is more prevalent in women (particularly young women), is much more likely to involve ingestion of pesticides, is more closely associated with poverty, and is less closely associated with mental illness. PMID:25092952

  2. Scales for hyperkinetic disorders: A systematic review.

    PubMed

    Pietracupa, Sara; Bruno, Elisa; Cavanna, Andrea E; Falla, Marika; Zappia, Mario; Colosimo, Carlo

    2015-11-15

    Hyperkinetic movement disorders represent a heterogeneous group of disorders in which involuntary movements are the prevalent clinical symptoms. The five main categories of hyperkinetic disorders are tremor, dystonia, tics,myoclonus and drug-induced dyskinesia.The severity of hyperkinetic disorders is assessed by all clinicians when they examine a patient; quantifying the severity also provides a means of studying the natural history of a given disorder and the possible effect of new therapeutic interventions. This means that good rating instruments are required in both everyday practice and experimental settings. Unfortunately, the clinical evaluation of these disorders is complicated by the inherent nature and variability over time of involuntary movements. A number of scales have been proposed over the years to study the various hyperkinetic disorders. The aim of this review is to systematically identify all the clinical scales that have been proposed and to classify them according to the criteria developed by the Movement Disorder Society (MDS) task force for rating scales in Parkinson's disease.On the basis of this methodology, a scale may be defined as 'Recommended', 'Suggested' or 'Listed' in decreasing order of value.We found that, although numerous scales aimed at assessing hyperkinetic disorders have been published, their variability in terms of clinimetric properties, availability and effort required to administer them is high. In this evaluation, we identified scales defined as 'Recommended' for the assessment of all forms of hyperkinetic disorders. The situation highlighted by our analysis varies considerably, with several 'Recommended' scales being available for some conditions such as tics or dystonia, but only one being available for myoclonus. This gap needs to be filled by the scientific community through both the development of new clinical tools and there finement of existing ones. PMID:26428309

  3. Patient engagement in research: a systematic review

    PubMed Central

    2014-01-01

    Background A compelling ethical rationale supports patient engagement in healthcare research. It is also assumed that patient engagement will lead to research findings that are more pertinent to patients’ concerns and dilemmas. However; it is unclear how to best conduct this process. In this systematic review we aimed to answer 4 key questions: what are the best ways to identify patient representatives? How to engage them in designing and conducting research? What are the observed benefits of patient engagement? What are the harms and barriers of patient engagement? Methods We searched MEDLINE, EMBASE, PsycInfo, Cochrane, EBSCO, CINAHL, SCOPUS, Web of Science, Business Search Premier, Academic Search Premier and Google Scholar. Included studies were published in English, of any size or design that described engaging patients or their surrogates in research design. We conducted an environmental scan of the grey literature and consulted with experts and patients. Data were analyzed using a non-quantitative, meta-narrative approach. Results We included 142 studies that described a spectrum of engagement. In general, engagement was feasible in most settings and most commonly done in the beginning of research (agenda setting and protocol development) and less commonly during the execution and translation of research. We found no comparative analytic studies to recommend a particular method. Patient engagement increased study enrollment rates and aided researchers in securing funding, designing study protocols and choosing relevant outcomes. The most commonly cited challenges were related to logistics (extra time and funding needed for engagement) and to an overarching worry of a tokenistic engagement. Conclusions Patient engagement in healthcare research is likely feasible in many settings. However, this engagement comes at a cost and can become tokenistic. Research dedicated to identifying the best methods to achieve engagement is lacking and clearly needed. PMID:24568690

  4. Depressogenic effects of medications: a review

    PubMed Central

    Celano, Christopher M.; Freudenreich, Oliver; Fernandez-Robles, Carlos; Stern, Theodore A.; Caro, Mario A.; Huffman, Jeff C.

    2011-01-01

    The literature is filled with reports that link medications with the onset or progression of depression. Because depression is so common in patients with medical illness, assessing whether a medication has in fact caused depression, or whether the relationship is coincidental, can be challenging. In this article, we review the literature on the association between medications and depression. For most agents, there are case reports or small studies linking the medication with the onset of depression, but more rigorous prospective studies are either lacking or found no association between the agent and depression. However, several medications, (eg, barbiturates, vigabatrin, topiramate, flunarizine, corticosteroids, mefloquine, efavirenz, and interferon-α) do appear to cause depression in some patients and should be used with caution in patients at risk for depression. PMID:21485751

  5. Steps in the undertaking of a systematic review in orthopaedic surgery.

    PubMed

    Sambunjak, Dario; Franić, Miljenko

    2012-03-01

    In the last decades of the twentieth century it became obvious that modern medical care is replete with data and information, but in need of reliable evidence. This has led to an increased effort to systematically synthesise medical research and make it more useful for practitioners. Systematic reviews use an approach to research synthesis that minimises the risk of misinterpreting a body of evidence due to incomprehensive search or subjective opinion. Carrying out a systematic review is a rigorous procedure which corresponds to standard methodological steps in primary research studies. It involves posing a well-defined question, developing a robust search strategy, screening for relevant primary studies, critical appraisal of included studies, data extraction and processing, analysis and interpretation of results. In some, but not all systematic reviews it is appropriate to conduct a meta-analysis, which is a statistical procedure that integrates the results of several independent studies. Results of meta-analysis are graphically presented in forest plots, with pooled point estimate and its confidence interval represented as a rhombus, usually called a "diamond". Methodological quality of systematic reviews should not be judged by the quality of primary studies included, but by a distinct set of criteria specified in assessment tools such as AMSTAR. Systematic reviews and meta-analyses should be reported according to the PRISMA checklist. A major contribution to the development of methodological standards has been given by The Cochrane Collaboration, whose Handbook of Systematic Reviews of Interventions is the primary reference for all authors and referees of systematic reviews in health care. PMID:22198362

  6. The librarian's roles in the systematic review process: a case study*

    PubMed Central

    Harris, Martha R.

    2005-01-01

    Question/Setting: Although the systematic review has become a research standard, little information addresses the actions of the librarian on a systematic review team. Method: This article is an observational case study that chronicles a librarian's required involvement, skills, and responsibilities in each stage of a real-life systematic review. Main Results: Examining the review process reveals that the librarian's multiple roles as an expert searcher, organizer, and analyzer form an integral part of the Cochrane Collaboration's criteria for conducting systematic reviews. Moreover, the responsibilities of the expert searcher directly reflect the key skills and knowledge depicted in the “Definition of Expert Searching” section of the Medical Library Association's policy statement, “Role of Expert Searching in Health Sciences Libraries.” Conclusion: Although the librarian's multiple roles are important in all forms of medical research, they are crucial in a systematic review. As an expert searcher, the librarian must interact with the investigators to develop the terms required for a comprehensive search strategy in multiple appropriate sources. As an organizer and analyzer, the librarian must effectively manage the articles and document the search, retrieval, and archival processes. PMID:15685279

  7. Adoption of Clinical Decision Support in Multimorbidity: A Systematic Review

    PubMed Central

    Arguello Casteleiro, Mercedes; Ainsworth, John; Buchan, Iain

    2015-01-01

    Background Patients with multiple conditions have complex needs and are increasing in number as populations age. This multimorbidity is one of the greatest challenges facing health care. Having more than 1 condition generates (1) interactions between pathologies, (2) duplication of tests, (3) difficulties in adhering to often conflicting clinical practice guidelines, (4) obstacles in the continuity of care, (5) confusing self-management information, and (6) medication errors. In this context, clinical decision support (CDS) systems need to be able to handle realistic complexity and minimize iatrogenic risks. Objective The aim of this review was to identify to what extent CDS is adopted in multimorbidity. Methods This review followed PRISMA guidance and adopted a multidisciplinary approach. Scopus and PubMed searches were performed by combining terms from 3 different thesauri containing synonyms for (1) multimorbidity and comorbidity, (2) polypharmacy, and (3) CDS. The relevant articles were identified by examining the titles and abstracts. The full text of selected/relevant articles was analyzed in-depth. For articles appropriate for this review, data were collected on clinical tasks, diseases, decision maker, methods, data input context, user interface considerations, and evaluation of effectiveness. Results A total of 50 articles were selected for the full in-depth analysis and 20 studies were included in the final review. Medication (n=10) and clinical guidance (n=8) were the predominant clinical tasks. Four studies focused on merging concurrent clinical practice guidelines. A total of 17 articles reported their CDS systems were knowledge-based. Most articles reviewed considered patients’ clinical records (n=19), clinical practice guidelines (n=12), and clinicians’ knowledge (n=10) as contextual input data. The most frequent diseases mentioned were cardiovascular (n=9) and diabetes mellitus (n=5). In all, 12 articles mentioned generalist doctor(s) as the decision maker(s). For articles reviewed, there were no studies referring to the active involvement of the patient in the decision-making process or to patient self-management. None of the articles reviewed adopted mobile technologies. There were no rigorous evaluations of usability or effectiveness of the CDS systems reported. Conclusions This review shows that multimorbidity is underinvestigated in the informatics of supporting clinical decisions. CDS interventions that systematize clinical practice guidelines without considering the interactions of different conditions and care processes may lead to unhelpful or harmful clinical actions. To improve patient safety in multimorbidity, there is a need for more evidence about how both conditions and care processes interact. The data needed to build this evidence base exist in many electronic health record systems and are underused. PMID:25785897

  8. Acupuncture for Low Back Pain: An Overview of Systematic Reviews

    PubMed Central

    Liu, Lizhou; Skinner, Margot; McDonough, Suzanne; Mabire, Leon; Baxter, George David

    2015-01-01

    Objective. As evidence of the effectiveness of acupuncture for low back pain (LBP) is inconsistent, we aimed to critically appraise the evidence from relevant systematic reviews. Methods. Systematic reviews of randomized controlled trials (RCTs) concerning acupuncture and LBP were searched in seven databases. Internal validity and external validity of systematic reviews were assessed. Systematic reviews were categorized and high quality reviews assigned greater weightings. Conclusions were generated from a narrative synthesis of the outcomes of subgroup comparisons. Results. Sixteen systematic reviews were appraised. Overall, the methodological quality was low and external validity weak. For acute LBP, evidence that acupuncture has a more favorable effect than sham acupuncture in relieving pain was inconsistent; it had a similar effect on improving function. For chronic LBP, evidence consistently demonstrated that acupuncture provides short-term clinically relevant benefits for pain relief and functional improvement compared with no treatment or acupuncture plus another conventional intervention. Conclusion. Systematic reviews of variable quality showed that acupuncture, either used in isolation or as an adjunct to conventional therapy, provides short-term improvements in pain and function for chronic LBP. More efforts are needed to improve both internal and external validity of systematic reviews and RCTs in this area. PMID:25821485

  9. Clinical Problems in the Hospitalized Parkinson's Disease Patient: Systematic Review

    PubMed Central

    Gerlach, Oliver HH; Winogrodzka, Ania; Weber, Wim EJ

    2011-01-01

    The problems Parkinson's disease (PD) patients encounter when admitted to a hospital, are known to be numerous and serious. These problems have been inventoried through a systematic review of literature on reasons for emergency and hospital admissions in PD patients, problems encountered during hospitalization, and possible solutions for the encountered problems using the Pubmed database. PD patients are hospitalized in frequencies ranging from 7 to 28% per year. PD/parkinsonism patients are approximately one and a half times more frequently and generally 2 to 14 days longer hospitalized than non-PD patients. Acute events occurring during hospitalization were mainly urinary infection, confusion, and pressure ulcers. Medication errors were also frequent adverse events. During and after surgery PD patients had an increased incidence of infections, confusion, falls, and decubitus, and 31% of patients was dissatisfied in the way their PD was managed. There are only two studies on medication continuation during surgery and one analyzing the effect of an early postoperative neurologic consultation, and numerous case reports, and opinionated views and reviews including other substitutes for dopaminergic medication intraoperatively. In conclusion, most studies were retrospective on small numbers of patients. The major clinical problems are injuries, infections, poor control of PD, and complications of PD treatment. There are many (un-researched) proposals for improvement. A substantial number of PD patients' admissions might be prevented. There should be guidelines concerning the hospitalized PD patients, with accent on early neurological consultation and team work between different specialities, and incorporating nonoral dopaminergic replacement therapy when necessary. © 2011 Movement Disorder Society PMID:21284037

  10. Clinical management of alcohol withdrawal: A systematic review.

    PubMed

    Kattimani, Shivanand; Bharadwaj, Balaji

    2013-07-01

    Alcohol withdrawal is commonly encountered in general hospital settings. It forms a major part of referrals received by a consultation-liaison psychiatrist. This article aims to review the evidence base for appropriate clinical management of the alcohol withdrawal syndrome. We searched Pubmed for articles published in English on pharmacological management of alcohol withdrawal in humans with no limit on the date of publication. Articles not relevant to clinical management were excluded based on the titles and abstract available. Full-text articles were obtained from this list and the cross-references. There were four meta-analyses, 9 systematic reviews, 26 review articles and other type of publications like textbooks. Alcohol withdrawal syndrome is a clinical diagnosis. It may vary in severity. Complicated alcohol withdrawal presents with hallucinations, seizures or delirium tremens. Benzodiazepines have the best evidence base in the treatment of alcohol withdrawal, followed by anticonvulsants. Clinical institutes withdrawal assessment-alcohol revised is useful with pitfalls in patients with medical comorbidities. Evidence favors an approach of symptom-monitored loading for severe withdrawals where an initial dose is guided by risk factors for complicated withdrawals and further dosing may be guided by withdrawal severity. Supportive care and use of vitamins is also discussed. PMID:25013309

  11. Incentivizing health care behaviors in emerging adults: a systematic review

    PubMed Central

    Yu, Catherine H; Guarna, Giuliana; Tsao, Pamela; Jesuthasan, Jude R; Lau, Adrian NC; Siddiqi, Ferhan S; Gilmour, Julie Anne; Ladha, Danyal; Halapy, Henry; Advani, Andrew

    2016-01-01

    Purpose For emerging adults with chronic medical diseases, the transition from pediatric to adult health care is often a time of great upheaval, commonly associated with unhealthy self-management choices, loss to follow-up, and adverse outcomes. We conducted a systematic review to examine the use of incentive strategies to promote positive health-related behaviors in young adults with chronic medical diseases. Methods The Medline, CINAHL, Embase, PsycInfo, and Cochrane databases were searched through June 2014. Studies of any design where an incentive was used to achieve a target behavior or outcome in a pediatric or emerging adult population (age <30 years) with chronic medical conditions including addictions, were included. Results A total of 26 studies comprising 10,880 patients met our inclusion criteria after screening 10,305 abstracts and 301 full-text articles. Of these studies, 20 examined the effects of behavioral incentives on cigarette smoking or substance abuse, including alcohol; four studies explored behavioral incentives in the setting of HIV or sexual health; and two articles studied individuals with other chronic medical conditions. Seventeen articles reported a statistically significant benefit of the behavioral incentive on one or more outcomes, although only half reported follow-up after the incentive period was terminated. Conclusion While the majority of studies reported positive outcomes, these studies focused on promoting the cessation of adverse behaviors rather than promoting positive behaviors. In addition, conclusions were limited by the high risk of bias present in the majority of studies, as well as lack of follow-up after the incentive period. Whether behavioral incentives facilitate the adoption of positive health choices in this population remains to be determined. PMID:27069356

  12. A review of medical imaging informatics.

    PubMed

    Sinha, Usha; Bui, Alex; Taira, Ricky; Dionisio, John; Morioka, Craig; Johnson, David; Kangarloo, Hooshang

    2002-12-01

    This review of medical imaging informatics is a survey of current developments in an exciting field. The focus is on informatics issues rather than traditional data processing and information systems, such as picture archiving and communications systems (PACS) and image processing and analysis systems. In this review, we address imaging informatics issues within the requirements of an informatics system defined by the American Medical Informatics Association. With these requirements as a framework, we review, in four sections: (1) Methods to present imaging and associated data without causing an overload, including image study summarization, content-based medical image retrieval, and natural language processing of text data. (2) Data modeling techniques to represent clinical data with focus on an image data model, including general-purpose time-based multimedia data models, health-care-specific data models, knowledge models, and problem-centric data models. (3) Methods to integrate medical data information from heterogeneous clinical data sources. Advances in centralized databases and mediated architectures are reviewed along with a discussion on our efforts at data integration based on peer-to-peer networking and shared file systems. (4) Visualization schemas to present imaging and clinical data: the large volume of medical data presents a daunting challenge for an efficient visualization paradigm. In this section we review current multimedia visualization methods including temporal modeling, problem-specific data organization, including our problem-centric, context and user-specific visualization interface. PMID:12594089

  13. Homeopathy for allergic rhinitis: protocol for a systematic review

    PubMed Central

    2014-01-01

    Background Allergic rhinitis is a global health problem that is often treated with homeopathy. The objective of this review will be to evaluate the effectiveness of homeopathic treatment of allergic rhinitis. Methods/Design The authors will conduct a systematic review. We will search Medline, CENTRAL, CINAHL, EMBASE, AMED, CAM-Quest, Google Scholar and reference lists of identified studies up to December 2013. The review will include randomized controlled trials that evaluate homeopathic treatment of allergic rhinitis. Studies with participants of all ages, with acute or chronic comorbidities will be included. Patients with immunodeficiency will not be included. The diagnosis will be based on the published guidelines of diagnosis and classification. Studies of all homeopathy modalities (clinical, complex and classical homeopathy, and isopathy) will be included. We will include trials with both active controls (conventional therapy, standard care) and placebo controls. The primary outcomes are: an improvement of global symptoms recorded in validated daily or weekly diaries and any scores from validated visual analogue scales; the total Quality of Life Score (such as the Juniper RQLQ);individual symptoms scores which include any appropriate measures of nasal obstruction, runny nose, sneezing, itching, and eye symptoms; and number of days requiring medication. Secondary outcomes selected will include serum immunoglobin E (IgE) levels, individual ocular symptoms, adverse events, and the use of rescue medication. Treatment effects will be measured by calculating the mean difference and the standardized mean difference with 95% confidence interval (CI) for continuous data. Risk ratio or, if feasible, odds ratio will be calculated with 95% CI for dichotomous data. After assessing clinical and statistical heterogeneity, meta-analysis will be performed, if appropriate. The individual participant will be the unit of analysis. Descriptive information on missing data will be included about participants missing due to drop out, whether there was intention to treat or per protocol analysis and missing statistics. A number of subgroups, homeopathic potency, age groups, and types of allergic rhinitis (seasonal or perennial) will be analyzed. Sensitivity analysis will be performed to explore the impact of risk of bias on overall treatment effect. Systematic review registration PROSPERO CRD42013006741 PMID:24913155

  14. Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

    PubMed

    Vrabel, Mark

    2015-09-01

    The number of systematic reviews in the literature has increased substantially to include "umbrella reviews" (Conn & Coon Sells, 2014) and systematic reviews of systematic reviews (Adam, Bond, & Murchie, 2015; Corry, While, Neenan, & Smith, 2015). The overall goal of a systematic review is to synthesize and appraise all relevant high-quality research in an effort to answer a specific research or clinical question. The key steps in a systematic review include "the selection of predefined objectives and eligibility criteria for studies, a reproducible methodology, a systematic search targeting all studies that meet the eligibility criteria, an evaluation of the validity of the study findings, and a synthesis and presentation of the findings of the included studies" (Cope, 2014, p. 208). These steps, particularly the reproducible methodology, demonstrate the importance of rigor and consistency to achieve reliable, valid research findings. Consistency is not only critical for the research process, but also is critical in research reporting. Several guidelines exist to promote consistency in research reporting. This article will present the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and discuss implications and use in oncology nursing research.. PMID:26302284

  15. Worksite primary care clinics: a systematic review.

    PubMed

    Shahly, Victoria; Kessler, Ronald C; Duncan, Ian

    2014-10-01

    Despite levels of health spending that are higher per capita and as share of gross domestic product than any country worldwide, the US health care system is fragmented, technology and administration heavy, and primary care deficient. Studies of regional variations in US health care show similar "disconnects" between higher spending and better health outcomes. Faced with rising health benefit costs and suboptimal workforce health amid economic downturn, concerned US employers have implemented innovative payment and health care delivery strategies such as consumer-driven health plans and targeted prevention programs. The former may impose undue cost shifting, prohibitive out-of-pocket expenses, and health literacy challenges, while the latter have shown inconsistent near-term economic returns and long-term clinical efficacy. Employers have begun exploring more comprehensive health delivery platforms such as integrated worksite primary care clinics that have potential to cost-effectively address several pressing problems with current US health care: the growing primary care physician shortage, poor access to routine care, lack of coordinated and patient-centered treatment models, low rates of childhood immunizations, and "quality-blind" fee-for-service payment mechanisms. Such on-site medical clinics exploit one of the rare comparative strengths of the US health care system-its plentiful supply of highly skilled registered nurses-to offer workers and their dependents convenient, high-quality, affordable care. A relatively recent health care paradigm, worksite clinics must yet develop consistent reporting strategies and credible demonstration of outcomes. This review explores available evidence regarding worksite primary care clinics, including current rationale, historical trends, prevalence and projected growth, expected health and financial benefits, challenges, and future research directions. PMID:24835541

  16. Systematic Review Checklist: A Standardized Technique for Assessing and Reporting Reviews of Life Cycle Assessment Data

    PubMed Central

    Zumsteg, Jennifer M.; Cooper, Joyce S.; Noon, Michael S.

    2015-01-01

    Summary Systematic review, including meta-analysis, is increasingly utilized in life cycle assessment (LCA). There are currently no widely recognized guidelines for designing, conducting, or reporting systematic reviews in LCA. Other disciplines such as medicine, ecology, and software engineering have both recognized the utility of systematic reviews and created standardized protocols for conducting and reporting systematic reviews. Based largely on the 2009 Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, which updated the preferred format for reporting of such reviews in biomedical research, we provide an introduction to the topic and a checklist to guide the reporting of future LCA reviews in a standardized format. The standardized technique for assessing and reporting reviews of LCA (STARR-LCA) checklist is a starting point for improving the utility of systematic reviews in LCA. PMID:26069437

  17. Establishing a new journal for systematic review products.

    PubMed

    Moher, David; Stewart, Lesley; Shekelle, Paul

    2012-01-01

    Welcome to a new age in publishing systematic reviews. We hope the launch of Systematic Reviews will resonate with a broad spectrum of readers interested in using them in a variety of ways, such as providing comprehensive and up to date evidence for patient management, informing health policy, and developing rigorous practice guidelines. Systematic reviews are increasingly popular. Our journal is committed to publishing a wide variety of well conducted and transparently reported systematic reviews and associated research. We are open access and electronic and not confined by space and so offer scope for publishing reviews in detail and providing a modern and innovative approach to publishing. We look forward to participating in the voyage with all of our readers. PMID:22587946

  18. Treatment of generalized granuloma annulare - a systematic review.

    PubMed

    Lukács, J; Schliemann, S; Elsner, P

    2015-08-01

    Granuloma annulare (GA) is a benign inflammatory skin disease. Localized GA is likely to resolve spontaneously, while generalized GA (GGA) is rare and may persist for decades. GGA usually is resistant to a variety of therapeutic modalities and takes a chronic course. The objective of this study was to summarize all reported treatments of generalized granuloma annulare. This is a systematic review based on MEDLINE, Embase and Cochrane Central Register search of articles in English and German and a manual search, between 1980 and 2013, to summarize the treatment of generalized granuloma annulare. Most medical literature on treatment of GGA is limited to individual case reports and small series of patients treated without a control group. Randomized controlled clinical studies are missing. Multiple treatment modalities for GGA were reported including topical and systemic steroids, PUVA, isotretinoin, dapsone, pentoxifylline, hydroxychloroquine, cyclosporine, IFN-γ, potassium iodide, nicotinamide, niacinamide, salicylic acid, dipyridamole, PDT, fumaric acid ester, etanercept, infliximab, adalimumab. While there are numerous case reports of successful treatments in the literature including surgical, medical and phototherapy options, well-designed, randomized, controlled clinical trials are required for an evidence-based treatment of GGA. PMID:25651003

  19. Integrated primary care: a systematic review of program characteristics.

    PubMed

    Martin, Matthew P; White, Mark B; Hodgson, Jennifer L; Lamson, Angela L; Irons, Thomas G

    2014-03-01

    The integration of behavioral health services into primary care medical settings may be part of the solution to the fragmented health care system currently found in the United States. Although integrated primary care (IPC) is implemented in various locations across the United States, little information is available about how IPC is specifically practiced. Using a systematic review design, we extracted data from 76 articles to examine 6 categories of IPC program characteristics, including collaboration practices (e.g., shared decision-making, written communication, hallway conversations), program models, behavioral health interventions, behavioral health training and supervision, behavioral health provider type, and setting. Findings show that most IPC programs include psychoeducation, medication, follow-up contact, psychotherapy, and at least 1 care management strategy as part of treatment. Fewer than half of researchers report communication between providers, and even fewer report collaboration as a "shared decision making process." A third of researchers report training and/or supervising behavioral health providers to work in an IPC program, and a fourth report recruiting nurses as behavioral health providers. Of all the studies, family-based interventions were used in 1. We recommend that future researchers report more information about collaboration processes as well as training and supervision of behavioral health providers. We also recommend that researchers develop IPC programs that involve family members in treatment and better implement theory into future IPC programs to support conceptualization and replication of IPC program models. PMID:24684155

  20. Home Visiting and Outcomes of Preterm Infants: A Systematic Review

    PubMed Central

    Teeters, Angelique; Ammerman, Robert T.

    2013-01-01

    BACKGROUND AND OBJECTIVES: Home visiting is 1 strategy to improve child health and parenting. Since implementation of home visiting trials 2 decades ago, US preterm births (<37 weeks) have risen by 20%. The objective of this study was to review evidence regarding home visiting and outcomes of preterm infants METHODS: Searches of Medline, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Cochrane Controlled Trial Register, PsycINFO, and Embase were conducted. Criteria for inclusion were (1) cohort or controlled trial designs; (2) home-based, preventive services for infants at medical or social risk; and (3) outcomes reported for infants born preterm or low birth weight (<2500 g). Data from eligible reports were abstracted by 2 reviewers. Random effects meta-analysis was used to synthesize data for developmental and parent interaction measures. RESULTS: Seventeen studies (15 controlled trials, 2 cohort studies) were reviewed. Five outcome domains were identified: infant development, parent-infant interaction, morbidity, abuse/neglect, and growth/nutrition. Six studies (n = 336) demonstrated a pooled standardized mean difference of 0.79 (95% confidence interval 0.57 to 1.02) in Home Observation for Measurement of the Environment Inventory scores at 1 year in the home-visited groups versus control. Evidence for other outcomes was limited. Methodological limitations were common. CONCLUSIONS: Reviewed studies suggest that home visiting for preterm infants promotes improved parent-infant interaction. Further study of interventions targeting preterm infants within existing programs may strengthen the impact and cost benefits of home visiting in at-risk populations. PMID:23940238

  1. Magnetically driven medical devices: a review.

    PubMed

    Sliker, Levin; Ciuti, Gastone; Rentschler, Mark; Menciassi, Arianna

    2015-01-01

    A widely accepted definition of a medical device is an instrument or apparatus that is used to diagnose, prevent or treat disease. Medical devices take a broad range of forms and utilize various methods to operate, such as physical, mechanical or thermal. Of particular interest in this paper are the medical devices that utilize magnetic field sources to operate. The exploitation of magnetic fields to operate or drive medical devices has become increasingly popular due to interesting characteristics of magnetic fields that are not offered by other phenomena, such as mechanical contact, hydrodynamics and thermodynamics. Today, there is a wide range of magnetically driven medical devices purposed for different anatomical regions of the body. A review of these devices is presented and organized into two groups: permanent magnetically driven devices and electromagnetically driven devices. Within each category, the discussion will be further segregated into anatomical regions (e.g., gastrointestinal, ocular, abdominal, thoracic, etc.). PMID:26295303

  2. A Systematic Summary of Systematic Reviews on the Topic of the Anterior Cruciate Ligament

    PubMed Central

    Anderson, Michael J.; Browning, William M.; Urband, Christopher E.; Kluczynski, Melissa A.; Bisson, Leslie J.

    2016-01-01

    Background: There has been a substantial increase in the amount of systematic reviews and meta-analyses published on the anterior cruciate ligament (ACL). Purpose: To quantify the number of systematic reviews and meta-analyses published on the ACL in the past decade and to provide an overall summary of this literature. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of all ACL-related systematic reviews and meta-analyses published between January 2004 and September 2014 was performed using PubMed, MEDLINE, and the Cochrane Database. Narrative reviews and non-English articles were excluded. Results: A total of 1031 articles were found, of which 240 met the inclusion criteria. Included articles were summarized and divided into 17 topics: anatomy, epidemiology, prevention, associated injuries, diagnosis, operative versus nonoperative management, graft choice, surgical technique, fixation methods, computer-assisted surgery, platelet-rich plasma, rehabilitation, return to play, outcomes assessment, arthritis, complications, and miscellaneous. Conclusion: A summary of systematic reviews on the ACL can supply the surgeon with a single source for the most up-to-date synthesis of the literature. PMID:27047983

  3. Class II functional orthopaedic treatment: a systematic review of systematic reviews.

    PubMed

    D'Antò, V; Bucci, R; Franchi, L; Rongo, R; Michelotti, A; Martina, R

    2015-08-01

    This Systematic Review (SR) aims to assess the quality of SRs and Meta-Analyses (MAs) on functional orthopaedic treatment of Class II malocclusion and to summarise and rate the reported effects. Electronic and manual searches were conducted until June 2014. SRs and MAs focusing on the effects of functional orthopaedic treatment of Class II malocclusion in growing patients were included. The methodological quality of the included papers was assessed using the AMSTAR (Assessment of Multiple Systematic Reviews). The design of the primary studies included in each SR was assessed with Level of Research Design scoring. The evidence of the main outcomes was summarised and rated according to a scale of statements. 14 SRs fulfilled the inclusion criteria. The appliances evaluated were as follows: Activator (2 studies), Twin Block (4 studies), headgear (3 studies), Herbst (2 studies), Jasper Jumper (1 study), Bionator (1 study) and Fränkel-2 (1 study). Four studies reviewed several functional appliances, as a group. The mean AMSTAR score was 6 (ranged 2-10). Six SRs included only controlled clinical trials (CCTs), three SRs included only randomised controlled trials (RCTs), four SRs included both CCTs and RCTs and one SR included also expert opinions. There was some evidence of reduction of the overjet, with different appliances except from headgear; there was some evidence of small maxillary growth restrain with Twin Block and headgear; there was some evidence of elongation of mandibular length, but the clinical relevance of this results is still questionable; there was insufficient evidence to determine an effect on soft tissues. PMID:25824331

  4. Ayurvedic management of pulmonary tuberculosis: A systematic review

    PubMed Central

    Samal, Janmejaya

    2016-01-01

    Background: Tuberculosis (TB) is a global public health crisis. 25% of world’s TB cases are found in India. Ayurveda, an ancient medical science may offer some solution to this problem. Hence, a systematic review was carried out to assess the role of Ayurveda for the management of TB. Methodology: A systematic review was carried out using published literature obtained through “PubMed” until April 2015. The key words used for literature search include “Ayurveda, role and TB.” Results and Discussion: It was observed that a couple of single and compound drugs have been used for the management of TB. However, none of the studies could reflect the true anti-TB activities of any drug, both single and compound. Two of the studies revealed in vitro anti-TB properties of some herbs which can potentially be brought into the realm of a clinical trial to test their efficacy in a human subject. Most of these Ayurvedic therapeutic preparations studied in different clinical settings primarily reflected their adjunct properties for the management of TB. These studies revealed that Ayurvedic therapeutics was able to reduce associated symptoms and the adverse drug effects of ATDs (anti-TB drugs). Furthermore, some of the preparations showed potential hepato-protective properties that can be simultaneously administered with ATDs. Conclusion: Distressingly research on the role of Ayurveda in the management of TB is very scanty and mostly limited to adjunct or supportive therapy. Being a global public health crisis, it is highly recommended to carry out clinical trials on TB patients using Ayurvedic drugs and therapeutic regimens. PMID:27069721

  5. Cognitive Impairment in Bipolar Disorder and Schizophrenia: A Systematic Review

    PubMed Central

    Vöhringer, Paul A.; Barroilhet, Sergio A.; Amerio, Andrea; Reale, Maria Laura; Alvear, Katherine; Vergne, Derick; Ghaemi, S. Nassir

    2013-01-01

    Aims: Previous comparisons of cognitive decline among patients with bipolar disorder (BD) and schizophrenia (SZ) have found somehow quite similar profiles of deficits, but results have varied between studies. Therefore an extensive and thoughtful systematic review of the matter is warranted. Methods: Studies were found through systematic search (PubMed) following PRISMA guidelines. To be included, studies must have assessed the following cognitive functions: executive functions, memory, IQ, attention-concentration, and perceptuomotor function. In order to make comparison between the two entities, studies should include BD patients with operationally defined euthymia, schizophrenic patients in remission, and third group of healthy control patients. Comparisons were made after controlling for years of schooling and residual affective symptoms. Results: We found that overall both SZ and BD patients present deficits on all neurocognitive measures compared to healthy controls. In particular, SZ patients show more severe and pervasive cognitive deficits while BD patients present a milder and more confined impairment. In addition, evidence from the literature suggests that SZ and BD patients share a similar cognitive impairment profile with different degrees of deficits. Therefore, the difference between the two groups seems to be more quantitative (degree of deficit) rather than qualitative (profile), supporting a dimensional approach to the two clinical entities. Limitations of the present review includes the impossibility to control for effects of medication, varying time required for assessment across studies, illness diagnosis reliability, and course severity. Conclusion: Patients with BD might exhibit a cognitive impairment that could be similar to SZ in terms of their profile, although patients with SZ may have more severe and widespread impairments. PMID:23964248

  6. The correlation between stress and economic crisis: a systematic review

    PubMed Central

    Mucci, Nicola; Giorgi, Gabriele; Roncaioli, Mattia; Fiz Perez, Javier; Arcangeli, Giulio

    2016-01-01

    In 2008 a deep economic crisis started in the US and rapidly spread around the world. The crisis severely affected the labor market and employees’ well-being. Hence, the aim of this work is to implement a systematic review of the principal studies that analyze the impact of the economic crisis on the health of workers. We conducted our search on the PubMed database, and a total of 19 articles were selected for review. All studies showed that the economic crisis was an important stressor that had a negative impact on workers’ mental health. Most of the studies documented that a rise in unemployment, increased workload, staff reduction, and wages reduction were linked to an increased rate of mood disorders, anxiety, depression, dysthymia, and suicide. Some studies showed that problems related to the crisis may have also affected the general health of workers by increasing the risk of such health problems as cardiovascular and respiratory diseases. Finally, some studies looked at the impact of the crisis on health care services. These studies demonstrated that the reduction in public expenditure on health care services, and the reduction of public hospital budgets due to the recession, led to organizational problems (eg, medical supply shortages). PMID:27143898

  7. Patient engagement in the inpatient setting: a systematic review

    PubMed Central

    Prey, Jennifer E; Woollen, Janet; Wilcox, Lauren; Sackeim, Alexander D; Hripcsak, George; Bakken, Suzanne; Restaino, Susan; Feiner, Steven; Vawdrey, David K

    2014-01-01

    Objective To systematically review existing literature regarding patient engagement technologies used in the inpatient setting. Methods PubMed, Association for Computing Machinery (ACM) Digital Library, Institute of Electrical and Electronics Engineers (IEEE) Xplore, and Cochrane databases were searched for studies that discussed patient engagement (‘self-efficacy’, ‘patient empowerment’, ‘patient activation’, or ‘patient engagement’), (2) involved health information technology (‘technology’, ‘games’, ‘electronic health record’, ‘electronic medical record’, or ‘personal health record’), and (3) took place in the inpatient setting (‘inpatient’ or ‘hospital’). Only English language studies were reviewed. Results 17 articles were identified describing the topic of inpatient patient engagement. A few articles identified design requirements for inpatient engagement technology. The remainder described interventions, which we grouped into five categories: entertainment, generic health information delivery, patient-specific information delivery, advanced communication tools, and personalized decision support. Conclusions Examination of the current literature shows there are considerable gaps in knowledge regarding patient engagement in the hospital setting and inconsistent use of terminology regarding patient engagement overall. Research on inpatient engagement technologies has been limited, especially concerning the impact on health outcomes and cost-effectiveness. PMID:24272163

  8. Complications Associated with Decompressive Craniectomy: A Systematic Review

    PubMed Central

    Kurland, David B.; Khaladj-Ghom, Ariana; Stokum, Jesse A.; Carusillo, Brianna; Karimy, Jason K.; Gerzanich, Volodymyr; Sahuquillo, Juan

    2015-01-01

    Decompressive craniectomy (DC) has been used for many years in the management of patients with elevated intracranial pressure and cerebral edema. Ongoing clinical trials are investigating the clinical and cost effectiveness of DC in trauma and stroke. While DC has demonstrable efficacy in saving life, it is accompanied by a myriad of non-trivial complications that have been inadequately highlighted in prospective clinical trials. Missing from our current understanding is a comprehensive analysis of all potential complications associated with DC. Here, we review the available literature, we tabulate all reported complications, and we calculate their frequency for specific indications. Of over 1500 records initially identified, a final total of 142 eligible records were included in our comprehensive analysis. We identified numerous complications related to DC that have not been systematically reviewed. Complications were of three major types: (1) Hemorrhagic (2) Infectious/Inflammatory, and (3) Disturbances of the CSF compartment. Complications associated with cranioplasty fell under similar major types, with additional complications relating to the boneflap. Overall, one of every ten patients undergoing DC may suffer a complication necessitating additional medical and/or neurosurgical intervention. While DC has received increased attention as a potential therapeutic option in a variety of situations, like any surgical procedure, DC is not without risk. Neurologists and neurosurgeons must be aware of all the potential complications of DC in order to properly advise their patients. PMID:26032808

  9. Weight bias reduction in health professionals: a systematic review.

    PubMed

    Alberga, A S; Pickering, B J; Alix Hayden, K; Ball, G D C; Edwards, A; Jelinski, S; Nutter, S; Oddie, S; Sharma, A M; Russell-Mayhew, S

    2016-06-01

    Innovative and coordinated strategies to address weight bias among health professionals are urgently needed. We conducted a systematic literature review of empirical peer-reviewed published studies to assess the impact of interventions designed to reduce weight bias in students or professionals in a health-related field. Combination sets of keywords based on three themes (1: weight bias/stigma; 2: obesity/overweight; 3: health professional) were searched within nine databases. Our search yielded 1447 individual records, of which 17 intervention studies satisfied the inclusion criteria. Most studies (n = 15) included medical, dietetic, health promotion, psychology and kinesiology students, while the minority included practicing health professionals (n = 2). Studies utilized various bias-reduction strategies. Many studies had methodological weaknesses, including short assessment periods, lack of randomization, lack of control group and small sample sizes. Although many studies reported changes in health professionals' beliefs and knowledge about obesity aetiology, evidence of effectiveness is poor, and long-term effects of intervention strategies on weight bias reduction remain unknown. The findings highlight the lack of experimental research to reduce weight bias among health professionals. Although changes in practice will likely require multiple strategies in various sectors, well-designed trials are needed to test the impact of interventions to decrease weight bias in healthcare settings. PMID:27166133

  10. Experience of menopause in aboriginal women: a systematic review.

    PubMed

    Chadha, N; Chadha, V; Ross, S; Sydora, B C

    2016-01-01

    Every woman experiences the menopause transition period in a very individual way. Menopause symptoms and management are greatly influenced by socioeconomic status in addition to genetic background and medical history. Because of their very unique cultural heritage and often holistic view of health and well-being, menopause symptoms and management might differ greatly in aboriginals compared to non-aboriginals. Our aim was to investigate the extent and scope of the current literature in describing the menopause experience of aboriginal women. Our systematic literature review included nine health-related databases using the keywords 'menopause' and 'climacteric symptoms' in combination with various keywords describing aboriginal populations. Data were collected from selected articles and descriptive analysis was applied. Twenty-eight relevant articles were included in our analysis. These articles represent data from 12 countries and aboriginal groups from at least eight distinctive geographical regions. Knowledge of menopause and symptom experience vary greatly among study groups. The average age of menopause onset appears earlier in most aboriginal groups, often attributed to malnutrition and a harsher lifestyle. This literature review highlights a need for further research of the menopause transition period among aboriginal women to fully explore understanding and treatment of menopause symptoms and ultimately advance an important dialogue about women's health care. PMID:26653073

  11. Teamwork Assessment Tools in Modern Surgical Practice: A Systematic Review

    PubMed Central

    Whittaker, George; Abboudi, Hamid; Khan, Muhammed Shamim; Dasgupta, Prokar; Ahmed, Kamran

    2015-01-01

    Introduction. Deficiencies in teamwork skills have been shown to contribute to the occurrence of adverse events during surgery. Consequently, several teamwork assessment tools have been developed to evaluate trainee nontechnical performance. This paper aims to provide an overview of these instruments and review the validity of each tool. Furthermore, the present paper aims to review the deficiencies surrounding training and propose several recommendations to address these issues. Methods. A systematic literature search was conducted to identify teamwork assessment tools using MEDLINE (1946 to August 2015), EMBASE (1974 to August 2015), and PsycINFO (1806 to August 2015) databases. Results. Eight assessment tools which encompass aspects of teamwork were identified. The Nontechnical Skills for Surgeons (NOTSS) assessment was found to possess the highest level of validity from a variety of sources; reliability and acceptability have also been established for this tool. Conclusions. Deficits in current surgical training pathways have prompted several recommendations to meet the evolving requirements of surgeons. Recommendations from the current paper include integration of teamwork training and assessment into medical school curricula, standardised formal training of assessors to ensure accurate evaluation of nontechnical skill acquisition, and integration of concurrent technical and nontechnical skills training throughout training. PMID:26425732

  12. Systematic review of chronic pain in persons with Marfan syndrome.

    PubMed

    Velvin, G; Bathen, T; Rand-Hendriksen, S; Geirdal, A Ø

    2016-06-01

    The purpose of this study was to explore the literature on chronic pain in adults with Marfan syndrome (MFS), critically appraising and synthesizing relevant literature. A systematic review was conducted by searching the published literature databases using available medical, physical, psychological, social databases and other sources. All studies that addressed pain in MFS, published in peer-reviewed journals were assessed. Of 351 search results, 18 articles satisfied the eligibility criteria. All studies were cross-sectional and quantitative; no randomized controlled trials or intervention studies were found. Most studies had small sample sizes, low response rates and mainly dealt with other aspects of the diagnosis than pain. Only one article dealt mainly with pain. The research on chronic pain in MFS is limited in size and quality. Despite these limitations, studies describe that the prevalence of pain in patients with MFS is high, varying from 47 to 92% and affecting several anatomic sites. In addition, chronic pain limits daily function and few studies describe treatment options for pain in patients with MFS. Research is needed to obtain more evidence-based knowledge for developing more appropriate rehabilitation programs for people with MFS. PMID:26607862

  13. Systematic Review of Pancreatic Cyst Fluid Biomarkers: The Path Forward

    PubMed Central

    Thiruvengadam, Nikhil; Park, Walter G

    2015-01-01

    There is significant research interest in developing and validating novel pancreatic cyst-fluid biomarkers given the increasing recognition of the prevalence of pancreatic cysts and their associated malignant potential. Although current international consensus guidelines are helpful, they fail to diagnose with certainty the cyst type and the level of epithelial dysplasia. They also fall short in predicting the future likelihood of malignant transformation. A systematic review was performed with the objective of summarizing cyst-fluid-based biomarkers that have been published in the medical literature over the past 10 years and characterizing the current quality of evidence. Our review demonstrates that there is an increasing interest in this topic with several different and innovative approaches including DNA, RNA, proteomic, and metabolomics profiling. Further techniques to improve upon cytological yield have also been studied. Besides identifying potentially useful clinical biomarkers, these empiric approaches have provided further insight into their pathogenesis. The level of evidence for the vast majority of these studies, however, is limited to retrospective early validation studies. The path forward will be to select out the most promising biomarkers and develop multicenter consortiums capable of capturing adequate sample sizes with appropriate study designs. PMID:26065716

  14. Incorporating Qualitative Evidence in Systematic Reviews: Strategies and Challenges

    ERIC Educational Resources Information Center

    Caracelli, Valerie J.; Cooksy, Leslie J.

    2013-01-01

    The quality of mixed methods systematic reviews relies on the quality of primary-level studies. The synthesis of qualitative evidence and the recent development of synthesizing mixed methods studies hold promise, but also pose challenges to evidence synthesis.

  15. 14 CFR 1203.603 - Systematic review for declassification.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... National Security Agency. (3) Systematic review for declassification of classified information pertaining... coordinated through the Central Intelligence Agency. (4) The Chairperson, NASA Information Security Program... guidelines. The Chairperson, NASA Information Security Program Committee, shall develop, in coordination...

  16. Incidental findings in imaging diagnostic tests: a systematic review

    PubMed Central

    Lumbreras, B; Donat, L; Hernández-Aguado, I

    2010-01-01

    The objective of this review is to summarise the available evidence on the frequency and management of incidental findings in imaging diagnostic tests. Original articles were identified by a systematic search of the MEDLINE, EMBASE and Cochrane Library Plus databases using appropriate medical headings. Extracted variables were study design; sample size; type of imaging test; initial diagnosis; frequency and location of incidental findings; whether clinical follow-up was performed; and whether a definitive diagnosis was made. Study characteristics were assessed by one reviewer and checked by a second reviewer. Any disagreement was solved by consensus. The relationship between the frequency of incidental findings and the study characteristics was assessed using a one-way ANOVA test, as was the frequency of follow-up of incidental findings and the frequency of confirmation. 251 potentially relevant abstracts were identified and 44 articles were finally included in the review. Overall, the mean frequency of incidental findings was 23.6% (95% confidence interval (CI) 15.8–31.3%). The frequency of incidental findings was higher in studies involving CT technology (mean 31.1%, 95% CI 20.1–41.9%), in patients with an unspecific initial diagnosis (mean 30.5, 95% CI 0–81.6) and when the location of the incidental findings was unspecified (mean 33.9%, 95% CI 18.1–49.7). The mean frequency of clinical follow-up was 64.5% (95% CI 52.9–76.1%) and mean frequency of clinical confirmation was 45.6% (95% CI 32.1–59.2%). Although the optimal strategy for the management of these abnormalities is still unclear, it is essential to be aware of the low clinical confirmation in findings of moderate and major importance. PMID:20335439

  17. Economic evaluations of implantable cardioverter defibrillators: a systematic review.

    PubMed

    García-Pérez, Lidia; Pinilla-Domínguez, Pilar; García-Quintana, Antonio; Caballero-Dorta, Eduardo; García-García, F Javier; Linertová, Renata; Imaz-Iglesia, Iñaki

    2015-11-01

    The aim of this paper was to review the cost-effectiveness studies of implantable cardioverter defibrillators (ICD) for primary or secondary prevention of sudden cardiac death (SCD). A systematic review of the literature published in English or Spanish was performed by electronically searching MEDLINE and MEDLINE in process, EMBASE, NHS-EED, and EconLit. Some keywords were implantable cardioverter defibrillator, heart failure, heart arrest, myocardial infarction, arrhythmias, syncope, sudden death. Selection criteria were the following: (1) full economic evaluations published after 1995, model-based studies or alongside clinical trials (2) that explored the cost-effectiveness of ICD with or without associated treatment compared with placebo or best medical treatment, (3) in adult patients for primary or secondary prevention of SCD because of ventricular arrhythmias. Studies that fulfilled these criteria were reviewed and data were extracted by two reviewers. The methodological quality of the studies was assessed and a narrative synthesis was prepared. In total, 24 studies were included: seven studies on secondary prevention and 18 studies on primary prevention. Seven studies were performed in Europe. For secondary prevention, the results showed that the ICD is considered cost-effective in patients with more risk. For primary prevention, the cost-effectiveness of ICD has been widely studied, but uncertainty about its cost-effectiveness remains. The cost-effectiveness ratios vary between studies depending on the patient characteristics, methodology, perspective, and national settings. Among the European studies, the conclusions are varied, where the ICD is considered cost-effective or not dependent on the study. PMID:25323413

  18. Economic evaluations in gastroenterology in Brazil: A systematic review

    PubMed Central

    de Paiva Haddad, Luciana Bertocco; Decimoni, Tassia Cristina; Turri, Jose Antonio; Leandro, Roseli; de Soárez, Patrícia Coelho

    2016-01-01

    AIM: To systematically review economic evaluations in gastroenterology, relating to Brazil, published between 1980 and 2013. METHODS: We selected full and partial economic evaluations from among those retrieved by searching the following databases: MEDLINE (PubMed); Excerpta Medica; the Latin American and Caribbean Health Sciences Literature database; the Scientific Electronic Library Online; the database of the Centre for Reviews and Dissemination; the National Health Service (NHS) Economic Evaluation Database; the NHS Health Technology Assessment database; the Health Economics database of the Brazilian Virtual Library of Health; Scopus; Web of Science; and the Brazilian Network for the Evaluation of Health Technologies. Two researchers, working independently, selected the studies and extracted the data. RESULTS: We identified 535 health economic evaluations relating to Brazil and published in the 1980-2013 period. Of those 535 articles, only 40 dealt with gastroenterology. Full and partial economic evaluations respectively accounted for 23 (57.5%) and 17 (42.5%) of the 40 studies included. Among the 23 full economic evaluations, there were 11 cost-utility analyses, seven cost-effectiveness analyses, four cost-consequence analyses, and one cost-minimization analysis. Of the 40 studies, 25 (62.5%) evaluated medications; 7 (17.5%) evaluated procedures; and 3 (7.5%) evaluated equipment. Most (55%) of the studies were related to viral hepatitis, and most (63.4%) were published after 2010. Other topics included gastrointestinal cancer, liver transplantation, digestive diseases and hernias. Over the 33-year period examined, the number of such economic evaluations relating to Brazil, especially of those evaluating medications for the treatment of hepatitis, increased considerably. CONCLUSION: Further studies are needed in order to ensure that expenditures on health care in Brazil are made as fairly and efficiently as possible. PMID:26855823

  19. Epidemiology and burden of alopecia areata: a systematic review

    PubMed Central

    Villasante Fricke, Alexandra C; Miteva, Mariya

    2015-01-01

    Background Alopecia areata (AA) is an autoimmune disorder characterized by patches of non-scarring alopecia affecting scalp and body hair that can be psychologically devastating. AA is clinically heterogenous, and its natural history is unpredictable. There is no preventative therapy or cure. Objective The objective of this study is to provide an evidence-based systematic review on the epidemiology and the burden of AA. Methods and selection criteria A search was conducted of the published, peer-reviewed literature via PubMed, Embase, and Web of Science. Studies published in English within the last 51 years that measured AA’s incidence, prevalence, distribution, disability-adjusted life years (DALYs), quality of life, and associated psychiatric and medical comorbidities were included. Two authors assessed studies and extracted the data. Results The lifetime incidence of AA is approximately 2% worldwide. Both formal population studies found no sex predominance. First onset is most common in the third and fourth decades of life but may occur at any age. An earlier age of first onset corresponds with an increased lifetime risk of extensive disease. Global DALYs for AA were calculated at 1,332,800 in 2010. AA patients are at risk for depression and anxiety, atopy, vitiligo, thyroid disease, and other autoimmune conditions. Conclusion AA is the most prevalent autoimmune disorder and the second most prevalent hair loss disorder after androgenetic alopecia, and the lifetime risk in the global population is approximately 2%. AA is associated with psychiatric and medical comorbidities including depression, anxiety, and several autoimmune disorders, and an increased global burden of disease. PMID:26244028

  20. A Web-based archive of systematic review data

    PubMed Central

    2012-01-01

    Systematic reviews have become increasingly critical to informing healthcare policy; however, they remain a time-consuming and labor-intensive activity. The extraction of data from constituent studies comprises a significant portion of this effort, an activity which is often needlessly duplicated, such as when attempting to update a previously conducted review or in reviews of overlapping topics. In order to address these inefficiencies, and to improve the speed and quality of healthcare policy- and decision-making, we have initiated the development of the Systematic Review Data Repository, an open collaborative Web-based repository of systematic review data. As envisioned, this resource would serve as both a central archive and data extraction tool, shared among and freely accessible to organizations producing systematic reviews worldwide. A suite of easy-to-use software tools with a Web frontend would enable researchers to seamlessly search for and incorporate previously deposited data into their own reviews, as well as contribute their own. In developing this resource, we identified a number of technical and non-technical challenges, as well as devised a number of potential solutions, including proposals for systems and software tools to assure data quality, stratify and control user access effectively and flexibly accommodate all manner of study data, as well as means by which to govern and foster adoption of this new resource. Herein we provide an account of the rationale and development of the Systematic Review Data Repository thus far, as well as outline its future trajectory. PMID:22588052

  1. Introduction to systematic reviews and meta-analysis.

    PubMed

    McKenzie, Joanne E; Beller, Elaine M; Forbes, Andrew B

    2016-05-01

    Systematic reviews provide a method for collating and synthesizing research, and are used to inform healthcare decision making by clinicians, consumers and policy makers. A core component of many systematic reviews is a meta-analysis, which is a statistical synthesis of results across studies. In this review article, we introduce meta-analysis, focusing on the different meta-analysis models, their interpretation, how a model should be selected and discuss potential threats to the validity of meta-analyses. We illustrate the application of meta-analysis using data from a review examining the effects of early use of inhaled corticosteroids in the emergency department treatment of acute asthma. PMID:27099100

  2. Not all systematic reviews are systematic: a meta-review of the quality of systematic reviews for non-invasive remote monitoring in heart failure.

    PubMed

    Conway, Aaron; Inglis, Sally C; Chang, Anne M; Horton-Breshears, Margaret; Cleland, John G F; Clark, Robyn A

    2013-09-01

    We carried out a critical appraisal and synthesis of the systematic reviews and meta-analyses of remote monitoring for heart failure. A comprehensive literature search identified 65 relevant publications from 3333 citations. Seventeen studies fulfilled the inclusion and exclusion criteria. Seven (41%) systematic reviews pooled results for meta-analysis. Eight (47%) considered all non-invasive remote monitoring strategies. Five (29%) focused on telemonitoring. Four (24%) included both non-invasive and invasive technologies. The reviews were appraised by two independent reviewers for their quality and risk of bias using the AMSTAR tool. According to the AMSTAR criteria, ten (58%) systematic reviews were of poor methodological quality. In the high quality reviews, the relative risk of mortality in patients who received remote monitoring ranged from 0.53 to 0.88. The high quality reviews also reported that remote monitoring reduced the relative risk of all-cause (0.52 to 0.96) and heart failure-related hospitalizations (0.72 to 0.79) and, as a consequence, healthcare costs. However, further research is required before considering widespread implementation of remote monitoring. The subset of the heart failure population that derives the most benefit from intensive monitoring, the best technology, and the optimum duration of monitoring, all need to be identified. PMID:24163297

  3. Integration of existing systematic reviews into new reviews: identification of guidance needs

    PubMed Central

    2014-01-01

    Background An exponential increase in the number of systematic reviews published, and constrained resources for new reviews, means that there is an urgent need for guidance on explicitly and transparently integrating existing reviews into new systematic reviews. The objectives of this paper are: 1) to identify areas where existing guidance may be adopted or adapted, and 2) to suggest areas for future guidance development. Methods We searched documents and websites from healthcare focused systematic review organizations to identify and, where available, to summarize relevant guidance on the use of existing systematic reviews. We conducted informational interviews with members of Evidence-based Practice Centers (EPCs) to gather experiences in integrating existing systematic reviews, including common issues and challenges, as well as potential solutions. Results There was consensus among systematic review organizations and the EPCs about some aspects of incorporating existing systematic reviews into new reviews. Current guidance may be used in assessing the relevance of prior reviews and in scanning references of prior reviews to identify studies for a new review. However, areas of challenge remain. Areas in need of guidance include how to synthesize, grade the strength of, and present bodies of evidence composed of primary studies and existing systematic reviews. For instance, empiric evidence is needed regarding how to quality check data abstraction and when and how to use study-level risk of bias assessments from prior reviews. Conclusions There remain areas of uncertainty for how to integrate existing systematic reviews into new reviews. Methods research and consensus processes among systematic review organizations are needed to develop guidance to address these challenges. PMID:24956937

  4. Optimal strategies to consider when peer reviewing a systematic review and meta-analysis.

    PubMed

    Moher, David

    2015-01-01

    Systematic reviews are popular. A recent estimate indicates that 11 new systematic reviews are published daily. Nevertheless, evidence indicates that the quality of reporting of systematic reviews is not optimal. One likely reason is that the authors' reports have received inadequate peer review. There are now many different types of systematic reviews and peer reviewing them can be enhanced by using a reporting guideline to supplement whatever template the journal editors have asked you, as a peer reviewer, to use. Additionally, keeping up with the current literature, whether as a content expert or being aware of advances in systematic review methods is likely be make for a more comprehensive and effective peer review. Providing a brief summary of what the systematic review has reported is an important first step in the peer review process (and not performed frequently enough). At its core, it provides the authors with some sense of what the peer reviewer believes was performed (Methods) and found (Results). Importantly, it also provides clarity regarding any potential problems in the methods, including statistical approaches for meta-analysis, results, and interpretation of the systematic review, for which the peer reviewer can seek explanations from the authors; these clarifications are best presented as questions to the authors. PMID:26521692

  5. Systematic Reviews Published in the October 2015 Issue of the Cochrane Library.

    PubMed

    Wiffen, Philip J

    2016-03-01

    The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online (http://www.thecochranelibrary.com). The October 2015 issue (fourth DVD for 2015) contains 6622 complete reviews, 2429 protocols for reviews in production, and 36,600 short summaries of systematic reviews published in the general medical literature (this short summary database is no longer being updated). In addition, there are citations of 848,000 randomized controlled trials, and 15,700 cited papers in the Cochrane Methodology Register. The Health Technology Assessment database contains some 15,000 citations. One hundred and nine new reviews have been published in the previous 3 months, of which six have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 5.939. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided. PMID:27007584

  6. Systematic Reviews Published in the July 2015 Issue of the Cochrane Library.

    PubMed

    Wiffen, Philip J

    2015-12-01

    The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online ( http://www.thecochranelibrary.com ). The July 2015 issue (third DVD for 2015) contains 6506 complete reviews, 2431 protocols for reviews in production, and 36,600 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 871,000 randomized controlled trials, and 15,700 cited papers in the Cochrane Methodology Register. The Health Technology Assessment database contains some 15,000 citations. One hundred and seven new reviews have been published in the previous 3 months, of which seven have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 5.939. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided. PMID:26654419

  7. Antarctica: a review of recent medical research.

    PubMed

    Olson, James J

    2002-10-01

    This article reviews recent developments and areas of research in Antarctic medical science. Nineteen nations are part of the Antarctic treaty and undertake research programmes in Antarctica. Medical science is a small but important part of these programmes. Areas that have been studied include aspects of cold physiology, ultraviolet light effects, endocrine changes (including polar T3 syndrome), alterations in immune function, chronobiology, psychology, microbiology, epidemiology and telemedicine. Antarctica has been recognized as the closest thing on Earth to a testing ground for aspects of space exploration and as such has been termed a space analogue. PMID:12368074

  8. Developing Medical Geology in Uruguay: A Review

    PubMed Central

    Mañay, Nelly

    2010-01-01

    Several disciplines like Environmental Toxicology, Epidemiology, Public Health and Geology have been the basis of the development of Medical Geology in Uruguay during the last decade. The knowledge and performance in environmental and health issues have been improved by joining similar aims research teams and experts from different institutions to face environmental problems dealing with the population’s exposure to metals and metalloids and their health impacts. Some of the Uruguayan Medical Geology examples are reviewed focusing on their multidisciplinary approach: Lead pollution and exposed children, selenium in critically ill patients, copper deficiency in cattle and arsenic risk assessment in ground water. Future actions are also presented. PMID:20623004

  9. Creative Learning Environments in Education--A Systematic Literature Review

    ERIC Educational Resources Information Center

    Davies, Dan; Jindal-Snape, Divya; Collier, Chris; Digby, Rebecca; Hay, Penny; Howe, Alan

    2013-01-01

    This paper reports on a systematic review of 210 pieces of educational research, policy and professional literature relating to creative environments for learning in schools, commissioned by Learning and Teaching Scotland (LTS). Despite the volume of academic literature in this field, the team of six reviewers found comparatively few empirical

  10. 10 CFR 1045.43 - Systematic review for declassification.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Systematic review for declassification. 1045.43 Section 1045.43 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) NUCLEAR CLASSIFICATION AND DECLASSIFICATION Generation and Review of Documents Containing Restricted Data and Formerly Restricted Data §...

  11. Teaching Reading for Students with Intellectual Disabilities: A Systematic Review

    ERIC Educational Resources Information Center

    Alnahdi, Ghaleb Hamad

    2015-01-01

    A systematic review of the literature related to instructional strategies to improve reading skills for students with intellectual disabilities was conducted. Studies reviewed were within three categories; early reading approaches, comprehensive approaches, and one method approach. It was concluded that students with intellectual disabilities are…

  12. Evidence-Based Health Policy: A Preliminary Systematic Review

    ERIC Educational Resources Information Center

    Morgan, Gareth

    2010-01-01

    Objective: The development of evidence-based health policy is challenging. This study has attempted to identify some of the underpinning factors that promote the development of evidence based health policy. Methods: A preliminary systematic literature review of published reviews with "evidence based health policy" in their title was conducted…

  13. Pharmaceutical company funding and its consequences: a qualitative systematic review.

    PubMed

    Sismondo, Sergio

    2008-03-01

    This article systematically reviews published studies of the association of pharmaceutical industry funding and clinical trial results, as well a few closely related studies. It reviews two earlier results, and surveys the recent literature. Results are clear: Pharmaceutical company sponsorship is strongly associated with results that favor the sponsors' interests. PMID:17919992

  14. Creative Learning Environments in Education--A Systematic Literature Review

    ERIC Educational Resources Information Center

    Davies, Dan; Jindal-Snape, Divya; Collier, Chris; Digby, Rebecca; Hay, Penny; Howe, Alan

    2013-01-01

    This paper reports on a systematic review of 210 pieces of educational research, policy and professional literature relating to creative environments for learning in schools, commissioned by Learning and Teaching Scotland (LTS). Despite the volume of academic literature in this field, the team of six reviewers found comparatively few empirical…

  15. Research on Teaching Practicum--A Systematic Review

    ERIC Educational Resources Information Center

    Lawson, Tony; Çakmak, Melek; Gündüz, Müge; Busher, Hugh

    2015-01-01

    The aim of the present study is to conduct a systematic review research which focuses on research studies into the school practicum. In order to identify the main issues and also to provide a contemporary picture of practicum, 114 studies published on the topic are reviewed and analysed in terms of: (i) aims, (ii) main participants, (iii)…

  16. Family Adjustment to Childhood Cancer: A Systematic Review

    ERIC Educational Resources Information Center

    Long, Kristin A.; Marsland, Anna L.

    2011-01-01

    This systematic review integrates qualitative and quantitative research findings regarding family changes in the context of childhood cancer. Twenty-eight quantitative, 42 qualitative, and one mixed-method studies were reviewed. Included studies focused on family functioning, marital quality, and/or parenting in the context of pediatric cancer,…

  17. A Systematic Review of Whole School Improvement Models

    ERIC Educational Resources Information Center

    Kidron, Yael; Darwin, Marlene J.

    2007-01-01

    This article presents a review of widely implemented, externally developed whole school improvement models. The models serve elementary, middle, and high schools and schools operated by education service providers. A systematic review of the research was conducted using rigorous evidence standards. Across models, the whole school improvement

  18. Testing Scientific Software: A Systematic Literature Review

    PubMed Central

    Kanewala, Upulee; Bieman, James M.

    2014-01-01

    Context Scientific software plays an important role in critical decision making, for example making weather predictions based on climate models, and computation of evidence for research publications. Recently, scientists have had to retract publications due to errors caused by software faults. Systematic testing can identify such faults in code. Objective This study aims to identify specific challenges, proposed solutions, and unsolved problems faced when testing scientific software. Method We conducted a systematic literature survey to identify and analyze relevant literature. We identified 62 studies that provided relevant information about testing scientific software. Results We found that challenges faced when testing scientific software fall into two main categories: (1) testing challenges that occur due to characteristics of scientific software such as oracle problems and (2) testing challenges that occur due to cultural differences between scientists and the software engineering community such as viewing the code and the model that it implements as inseparable entities. In addition, we identified methods to potentially overcome these challenges and their limitations. Finally we describe unsolved challenges and how software engineering researchers and practitioners can help to overcome them. Conclusions Scientific software presents special challenges for testing. Specifically, cultural differences between scientist developers and software engineers, along with the characteristics of the scientific software make testing more difficult. Existing techniques such as code clone detection can help to improve the testing process. Software engineers should consider special challenges posed by scientific software such as oracle problems when developing testing techniques. PMID:25125798

  19. Diffusion of Innovations in Service Organizations: Systematic Review and Recommendations

    PubMed Central

    Greenhalgh, Trisha; Robert, Glenn; Macfarlane, Fraser; Bate, Paul; Kyriakidou, Olivia

    2004-01-01

    This article summarizes an extensive literature review addressing the question, How can we spread and sustain innovations in health service delivery and organization? It considers both content (defining and measuring the diffusion of innovation in organizations) and process (reviewing the literature in a systematic and reproducible way). This article discusses (1) a parsimonious and evidence-based model for considering the diffusion of innovations in health service organizations, (2) clear knowledge gaps where further research should be focused, and (3) a robust and transferable methodology for systematically reviewing health service policy and management. Both the model and the method should be tested more widely in a range of contexts. PMID:15595944

  20. Nongenetic Determinants of Age at Menarche: A Systematic Review

    PubMed Central

    2014-01-01

    Background. The acceleration of pubertal development is an important medical and social problem, as it may result in increased morbidity and mortality in later life. This systematic review summarizes relevant data about nongenetic factors, which contribute to age at menarche (AAM), and suggests those which may be the most important. Methods. The available literature from 1980 till July 2013 was searched using PubMed and Google Scholar databases. Finally, 154 papers were selected for the analysis. Results. Environmental factors, which may affect AAM, vary in populations of different ethnicity. The prenatal, infancy, and early childhood periods are the most susceptible to these factors. Body weight, high animal protein intake, family stressors (e.g., single parenting), and physical activity seem to influence AAM in most populations. Conclusions. The data about influence of nongenetic factors on AAM are still inconsistent. The factors affecting prenatal and early childhood growth seem to have a larger effect on further sexual maturation. Further studies are needed in order to validate the association between other environmental determinants and AAM in different ethnical groups. PMID:25050345

  1. Artificial Sweeteners: A Systematic Review and Primer for Gastroenterologists.

    PubMed

    Spencer, Marisa; Gupta, Amit; Dam, Lauren Van; Shannon, Carol; Menees, Stacy; Chey, William D

    2016-04-30

    Artificial sweeteners (AS) are ubiquitous in food and beverage products, yet little is known about their effects on the gastrointestinal (GI) tract, and whether they play a role in the development of GI symptoms, especially in patients with irritable bowel syndrome. Utilizing the PubMed and Embase databases, we conducted a search for articles on individual AS and each of these terms: fermentation, absorption, and GI tract. Standard protocols for a systematic review were followed. At the end of our search, we found a total of 617 eligible papers, 26 of which were included. Overall, there is limited medical literature available on this topic. The 2 main areas on which there is data to suggest that AS affect the GI tract include motility and the gut microbiome, though human data is lacking, and most of the currently available data is derived from in vivo studies. The effect on motility is mainly indirect via increased incretin secretion, though the clinical relevance of this finding is unknown as the downstream effect on motility was not studied. The specific effects of AS on the microbiome have been conflicting and the available studies have been heterogeneous in terms of the population studied and both the AS and doses evaluated. Further research is needed to assess whether AS could be a potential cause of GI symptoms. This is especially pertinent in patients with irritable bowel syndrome, a population in whom dietary interventions are routinely utilized as a management strategy. PMID:26932837

  2. Artificial Sweeteners: A Systematic Review and Primer for Gastroenterologists

    PubMed Central

    Spencer, Marisa; Gupta, Amit; Van Dam, Lauren; Shannon, Carol; Menees, Stacy; Chey, William D

    2016-01-01

    Artificial sweeteners (AS) are ubiquitous in food and beverage products, yet little is known about their effects on the gastrointestinal (GI) tract, and whether they play a role in the development of GI symptoms, especially in patients with irritable bowel syndrome. Utilizing the PubMed and Embase databases, we conducted a search for articles on individual AS and each of these terms: fermentation, absorption, and GI tract. Standard protocols for a systematic review were followed. At the end of our search, we found a total of 617 eligible papers, 26 of which were included. Overall, there is limited medical literature available on this topic. The 2 main areas on which there is data to suggest that AS affect the GI tract include motility and the gut microbiome, though human data is lacking, and most of the currently available data is derived from in vivo studies. The effect on motility is mainly indirect via increased incretin secretion, though the clinical relevance of this finding is unknown as the downstream effect on motility was not studied. The specific effects of AS on the microbiome have been conflicting and the available studies have been heterogeneous in terms of the population studied and both the AS and doses evaluated. Further research is needed to assess whether AS could be a potential cause of GI symptoms. This is especially pertinent in patients with irritable bowel syndrome, a population in whom dietary interventions are routinely utilized as a management strategy. PMID:26932837

  3. Antihistamines and Birth Defects: A Systematic Review of the Literature

    PubMed Central

    Gilboa, Suzanne M.; Ailes, Elizabeth C.; Rai, Ramona P.; Anderson, Jaynia A.; Honein, Margaret A.

    2015-01-01

    Introduction Approximately 10-15% of women reportedly take an antihistamine during pregnancy for the relief of nausea and vomiting, allergy and asthma symptoms, or indigestion. Antihistamines include histamine H1-receptor and H2-receptor antagonists. Areas covered This is a systematic evaluation of the peer-reviewed epidemiologic literature published through February 2014 on the association between prenatal exposure to antihistamines and birth defects. Papers addressing histamine H1- or H2-receptor antagonists are included. Papers addressing pyridoxine plus doxylamine (Bendectin in the United States, Debendox in the United Kingdom, Diclectin in Canada, Lenotan and Merbental in other countries) prior to the year 2001 were excluded post-hoc because of several previously published meta-analyses and commentaries on this medication. Expert opinion The literature on the safety of antihistamine use during pregnancy with respect to birth defects is generally reassuring though the positive findings from a few large studies warrant corroboration in other populations. The findings in the literature are considered in light of three critical methodological issues: (1) selection of appropriate study population; (2) ascertainment of antihistamine exposures; and (3) ascertainment of birth defects outcomes. Selected antihistamines have been very well-studied (e.g. loratadine); others, especially H2- receptor antagonists, require additional study before an assessment of safety with respect to birth defects risk could be made. PMID:25307228

  4. Cytomegalovirus in inflammatory bowel disease: A systematic review

    PubMed Central

    Römkens, Tessa EH; Bulte, Geert J; Nissen, Loes HC; Drenth, Joost PH

    2016-01-01

    AIM: To identify definitions of cytomegalovirus (CMV) infection and intestinal disease, in inflammatory bowel disease (IBD), to determine the prevalence associated with these definitions. METHODS: We conducted a systematic review and interrogated PubMed, EMBASE and Cochrane for literature on prevalence and diagnostics of CMV infection and intestinal disease in IBD patients. As medical headings we used “cytomegalovirus” OR “CMV” OR “cytomegalo virus” AND “inflammatory bowel disease” OR “IBD” OR “ulcerative colitis” OR “colitis ulcerosa” OR “Crohn’s disease”. Both MeSH-terms and free searches were performed. We included all types of English-language (clinical) trials concerning diagnostics and prevalence of CMV in IBD. RESULTS: The search strategy identified 924 citations, and 52 articles were eligible for inclusion. We identified 21 different definitions for CMV infection, 8 definitions for CMV intestinal disease and 3 definitions for CMV reactivation. Prevalence numbers depend on used definition, studied population and region. The highest prevalence for CMV infection was found when using positive serum PCR as a definition, whereas for CMV intestinal disease this applies to the use of tissue PCR > 10 copies/mg tissue. Most patients with CMV infection and intestinal disease had steroid refractory disease and came from East Asia. CONCLUSION: We detected multiple different definitions used for CMV infection and intestinal disease in IBD patients, which has an effect on prevalence numbers and eventually on outcome in different trials. PMID:26811669

  5. Albumin Dialysis for Liver Failure: A Systematic Review.

    PubMed

    Tsipotis, Evangelos; Shuja, Asim; Jaber, Bertrand L

    2015-09-01

    Albumin dialysis is the best-studied extracorporeal nonbiologic liver support system as a bridge or destination therapy for patients with liver failure awaiting liver transplantation or recovery of liver function. We performed a systematic review to examine the efficacy and safety of 3 albumin dialysis systems (molecular adsorbent recirculating system [MARS], fractionated plasma separation, adsorption and hemodialysis [Prometheus system], and single-pass albumin dialysis) in randomized trials for supportive treatment of liver failure. PubMed, Ovid, EMBASE, Cochrane's Library, and ClinicalTrials.gov were searched. Two authors independently screened citations and extracted data on patient characteristics, quality of reports, efficacy, and safety end points. Ten trials (7 of MARS and 3 of Prometheus) were identified (620 patients). By meta-analysis, albumin dialysis achieved a net decrease in serum total bilirubin level relative to standard medical therapy of 8.0 mg/dL (95% confidence interval [CI], -10.6 to -5.4) but not in serum ammonia or bile acids. Albumin dialysis achieved an improvement in hepatic encephalopathy relative to standard medical therapy with a risk ratio of 1.55 (95% CI, 1.16-2.08) but had no effect survival with a risk ratio of 0.95 (95% CI, 0.84-1.07). Because of inconsistency in the reporting of adverse events, the safety analysis was limited but did not demonstrate major safety concerns. Use of albumin dialysis as supportive treatment for liver failure is successful at removing albumin-bound molecules, such as bilirubin and at improving hepatic encephalopathy. Additional experience is required to guide its optimal use and address safety concerns. PMID:26311600

  6. Measuring the Outcome of Biomedical Research: A Systematic Literature Review

    PubMed Central

    Thonon, Frédérique; Boulkedid, Rym; Delory, Tristan; Rousseau, Sophie; Saghatchian, Mahasti; van Harten, Wim; O’Neill, Claire; Alberti, Corinne

    2015-01-01

    Background There is an increasing need to evaluate the production and impact of medical research produced by institutions. Many indicators exist, yet we do not have enough information about their relevance. The objective of this systematic review was (1) to identify all the indicators that could be used to measure the output and outcome of medical research carried out in institutions and (2) enlist their methodology, use, positive and negative points. Methodology We have searched 3 databases (Pubmed, Scopus, Web of Science) using the following keywords: [Research outcome* OR research output* OR bibliometric* OR scientometric* OR scientific production] AND [indicator* OR index* OR evaluation OR metrics]. We included articles presenting, discussing or evaluating indicators measuring the scientific production of an institution. The search was conducted by two independent authors using a standardised data extraction form. For each indicator we extracted its definition, calculation, its rationale and its positive and negative points. In order to reduce bias, data extraction and analysis was performed by two independent authors. Findings We included 76 articles. A total of 57 indicators were identified. We have classified those indicators into 6 categories: 9 indicators of research activity, 24 indicators of scientific production and impact, 5 indicators of collaboration, 7 indicators of industrial production, 4 indicators of dissemination, 8 indicators of health service impact. The most widely discussed and described is the h-index with 31 articles discussing it. Discussion The majority of indicators found are bibliometric indicators of scientific production and impact. Several indicators have been developed to improve the h-index. This indicator has also inspired the creation of two indicators to measure industrial production and collaboration. Several articles propose indicators measuring research impact without detailing a methodology for calculating them. Many bibliometric indicators identified have been created but have not been used or further discussed. PMID:25837969

  7. Making literature reviews more reliable through application of lessons from systematic reviews.

    PubMed

    Haddaway, N R; Woodcock, P; Macura, B; Collins, A

    2015-12-01

    Review articles can provide valuable summaries of the ever-increasing volume of primary research in conservation biology. Where findings may influence important resource-allocation decisions in policy or practice, there is a need for a high degree of reliability when reviewing evidence. However, traditional literature reviews are susceptible to a number of biases during the identification, selection, and synthesis of included studies (e.g., publication bias, selection bias, and vote counting). Systematic reviews, pioneered in medicine and translated into conservation in 2006, address these issues through a strict methodology that aims to maximize transparency, objectivity, and repeatability. Systematic reviews will always be the gold standard for reliable synthesis of evidence. However, traditional literature reviews remain popular and will continue to be valuable where systematic reviews are not feasible. Where traditional reviews are used, lessons can be taken from systematic reviews and applied to traditional reviews in order to increase their reliability. Certain key aspects of systematic review methods that can be used in a context-specific manner in traditional reviews include focusing on mitigating bias; increasing transparency, consistency, and objectivity, and critically appraising the evidence and avoiding vote counting. In situations where conducting a full systematic review is not feasible, the proposed approach to reviewing evidence in a more systematic way can substantially improve the reliability of review findings, providing a time- and resource-efficient means of maximizing the value of traditional reviews. These methods are aimed particularly at those conducting literature reviews where systematic review is not feasible, for example, for graduate students, single reviewers, or small organizations. PMID:26032263

  8. Comparative efficacy and tolerability of first-generation and newer-generation antidepressant medications for depressive disorders in children and adolescents: study protocol for a systematic review and network meta-analysis

    PubMed Central

    Zhou, Xinyu; Qin, Bin; Whittington, Craig; Cohen, David; Liu, Yiyun; Del Giovane, Cinzia; Michael, Kurt D; Zhang, Yuqing; Xie, Peng

    2015-01-01

    Introduction Depressive disorders are among the most common psychiatric disorders in children and adolescents, and have adverse effects on their psychosocial functioning. Questions concerning the efficacy and safety of antidepressant medications in the treatment of depression in children and adolescents, led us to integrate the direct and indirect evidence using network meta-analysis to create hierarchies of these drugs. Methods and analysis Seven databases with PubMed, EMBASE, the Cochrane Library, Web of Science, CINAHL, LiLACS and PsycINFO will be searched from 1966 to December 2013 (updated to May, 2015). There are no restrictions on language or type of publication. Randomised clinical trials assessing first-generation and newer-generation antidepressant medications against active comparator or placebo as acute treatment for depressive disorders in children and adolescents (under 18 years of age) will be included. The primary outcome for efficacy will be mean improvement in depressive symptoms, as measured by the mean change score of a depression rating scale from baseline to post-treatment. The tolerability of treatment will be defined as side effect discontinuation, as defined by the proportion of patients who discontinued treatment due to adverse events during the trial. We will also assess the secondary outcome for efficacy (response rate), acceptability (all-cause discontinuation) and suicide-related outcomes. We will perform the Bayesian network meta-analyses for all relative outcome measures. Subgroup analyses and sensitivity analyses will be conducted to assess the robustness of the findings. Dissemination The network meta-analysis will provide useful information on antidepressant treatment for child and adolescent depression. The results will be disseminated through peer-reviewed publication or conference presentations. Trial registration number PROSPERO CRD42015016023. PMID:26353868

  9. Resilience through the lens of interactionism: a systematic review.

    PubMed

    Pangallo, Antonio; Zibarras, Lara; Lewis, Rachel; Flaxman, Paul

    2015-03-01

    This systematic review presents findings from a conceptual and methodological review of resilience measures using an interactionist theoretical framework. The review is also intended to update findings from previous systematic reviews. Two databases (EBSCOHost and Scopus) were searched to retrieve empirical studies published up until 2013, with no lower time limit. All articles had to meet specific inclusion criteria, which resulted in 17 resilience measures selected for full review. Measures were conceptually evaluated against an interactionist framework and methodologically reviewed using Skinner's (1981) validity evidence framework. We conclude that inconsistencies associated with the definition and operationalization of resilience warrant further conceptual development to explain resilience as a dynamic and interactive phenomenon. In particular, measures of resilience may benefit from a greater focus on within-person variance typically associated with behavioral consistency across situations. The use of alternative measurement modalities to self-report scales, such as situational judgment tests, is proposed as a way of advancing knowledge in this area. PMID:25222438

  10. Systematic review of suicide in economic recession

    PubMed Central

    Oyesanya, Mayowa; Lopez-Morinigo, Javier; Dutta, Rina

    2015-01-01

    AIM: To provide a systematic update of the evidence concerning the relationship between economic recession and suicide. METHODS: A keyword search of Ovid Medline, Embase, Embase Classic, PsycINFO and PsycARTICLES was performed to identify studies that had investigated the association between economic recession and suicide. RESULTS: Thirty-eight studies met predetermined selection criteria and 31 of them found a positive association between economic recession and increased suicide rates. Two studies reported a negative association, two articles failed to find such an association, and three studies were inconclusive. CONCLUSION: Economic recession periods appear to increase overall suicide rates, although further research is warranted in this area, particularly in low income countries. PMID:26110126

  11. Medical marijuana and driving: a review.

    PubMed

    Neavyn, Mark J; Blohm, Eike; Babu, Kavita M; Bird, Steven B

    2014-09-01

    Medical marijuana remains a highly debated treatment regimen despite removal of state penalties against care providers prescribing the drug and patients treated with the drug in many areas of the USA. The utility of marijuana in specific medical conditions has been studied at length, but its effects on driving performance and risk of motor vehicle collision remain unclear. As with other medications that affect psychomotor function, the healthcare provider should be informed of the potential risks of driver safety prior to prescribing this psychotropic drug to give appropriate anticipatory guidance for appropriate use. The goal of this narrative review is to assess the current literature regarding marijuana as it relates to driving performance and traffic safety. With a foundation in the pharmacology of cannabinoids, we consider the limitations of testing cannabinoid and metabolite concentration. In addition, we will review studies on driving performance and epidemiological studies implicating marijuana in motor vehicle collisions. The increasing prevalence of medical marijuana laws in the USA suggests that clinicians should be aware of marijuana's influence on public safety. Patients should abstain from driving for 8h if they achieve a subjective "high" from self-treatment with smoked marijuana and should be aware of the cumulative effects of alcohol and other psychoactive xenobiotics. PMID:24648180

  12. Alignment of systematic reviews published in the Cochrane Database of Systematic Reviews and the Database of Abstracts and Reviews of Effectiveness with global burden-of-disease data: a bibliographic analysis

    PubMed Central

    Yoong, Sze Lin; Hall, Alix; Williams, Christopher M; Skelton, Eliza; Oldmeadow, Christopher; Wiggers, John; Karimkhani, Chante; Boyers, Lindsay N; Dellavalle, Robert P; Hilton, John; Wolfenden, Luke

    2015-01-01

    Background Systematic reviews of high-quality evidence are used to inform policy and practice. To improve community health, the production of such reviews should align with burden of disease. This study aims to assess if the volume of research output from systematic reviews proportionally aligns with burden of disease assessed using percentages of mortality and disability-adjusted life years (DALYs). Methods A cross-sectional audit of reviews published between January 2012 and August 2013 in the Cochrane Database of Systematic Reviews (CDSR) and Database of Abstracts of Reviews of Effects (DARE) was undertaken. Percentages of mortality and DALYs were obtained from the 2010 Global Burden of Disease study. Standardised residual differences (SRD) based on percentages of mortality and DALYs were calculated, where conditions with SRD of more than or less than three were considered overstudied or understudied, respectively. Results 1029 reviews from CDSR and 1928 reviews from DARE were examined. There was a significant correlation between percentage DALYs and systematic reviews published in CDSR and DARE databases (CDSR: r=0.68, p=0.001; DARE: r=0.60, p<0.001). There was no significant correlation between percentage mortality and number of systematic reviews published in either database (CDSR: r=0.34, p=0.14; DARE: r=0.22, p=0.34). Relative to percentage of mortality, mental and behavioural disorders, musculoskeletal conditions and other non-communicable diseases were overstudied. Maternal disorders were overstudied relative to percentages of mortality and DALYs in CDSR. Conclusions The focus of systematic reviews is moderately correlated with DALYs. A number of conditions may be overstudied relative to percentage of mortality particularly in the context of health and medical reviews. PMID:25888595

  13. Erectile dysfunction in hemodialysis: A systematic review

    PubMed Central

    El-Assmy, Ahmed

    2012-01-01

    Men with chronic renal failure (CRF) on hemodialysis have been frequently associated with erectile dysfunction (ED), with an of between 20% to 87.7%. As a result of the multi-system disease processes present in many uremic men, it is apparent that