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Zhu XL, Zhang L, Qi SX. Association of complement components with risk of colorectal cancer: A systematic review and meta-analysis. World J Gastrointest Oncol 2024; 16:2168-2180. [PMID: 38764810 PMCID: PMC11099464 DOI: 10.4251/wjgo.v16.i5.2168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/11/2024] [Accepted: 03/04/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND Complement components could contribute to the tumor microenvironment and the systemic immune response. Nevertheless, their role in colorectal cancer (CRC) remains a contentious subject. AIM To elucidate the relationship between complement components and CRC risk and clinical characteristics. METHODS Searches were conducted in PubMed, the Cochrane Library, and the China National Knowledge Infrastructure database until June 1, 2023. We included cohort studies encompassing participants aged ≥ 18 years, investigating the association between complement components and CRC. The studies were of moderate quality or above, as determined by the Agency for Healthcare Research and Quality. The meta-analysis employed fixed-effects or random-effects models based on the I² test, utilizing risk ratio (RR) and their corresponding 95% confidence interval (CI) for outcomes. Sensitivity and subgroup analyses were performed to validate the robustness of the collective estimates and identify the source of heterogeneity. RESULTS Data from 15 studies, comprising 1631 participants that met the inclusion criteria, were included in the meta-analysis. Our findings indicated that protein levels of cluster of differentiation 46 (CD46) (RR = 3.66, 95%CI: 1.75-7.64, P < 0.001), CD59 (RR = 2.86, 95%CI: 1.36-6.01, P = 0.005), and component 1 (C1) (RR = 5.88, 95%CI: 1.75-19.73, P = 0.004) and serum levels of C3 (standardized mean difference = 1.82, 95%CI: 0.06-3.58, P = 0.040) were significantly elevated in patients with CRC compared to healthy controls. Strong expression of CD55 or CD59 was associated with a higher incidence of lymph node metastasis, whereas strong CD46 expression correlated with a higher incidence of tumor differentiation compared to low CD46 expression (P < 0.05 for all). Although specific pooled results demonstrated notable heterogeneity, subgroup analyses pointed to regional differences as the primary source of inconsistency among the studies. CONCLUSION Our analysis underscores that increased levels of specific complement components are associated with a heightened risk of CRC, emphasizing the potential significance of monitoring elevated complement component levels.
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Affiliation(s)
- Xiao-Lin Zhu
- Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao 266071, Shandong Province, China
| | - Lu Zhang
- Department of Medical Administration, Qingdao Municipal Hospital, Qingdao 266071, Shandong Province, China
| | - Su-Xia Qi
- Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao 266071, Shandong Province, China
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Cui R, Gao B, Ge R, Li M, Li M, Lu X, Jiang S. The effects of COVID-19 infection on working memory: a systematic review. Curr Med Res Opin 2024; 40:217-227. [PMID: 38008952 DOI: 10.1080/03007995.2023.2286312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/17/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Studies demonstrate that people who have been infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, have experienced cognitive dysfunction, including working memory impairment, executive dysfunction, and decreased concentration. This review aimed to explore the incidence of working memory impairment and possible concomitant symptoms in the acute phase (< 3 months) and chronic phase (> 6 months) of COVID-19. METHODS We conducted a systematic review of the following databases for inception: MEDLINE via Pub Med, Cochrane EMBASE, and Web of Science electronic databases. The search strategy was comprised of all the observational studies with COVID-19 patients confirmed by PCR or serology who were infected by SARS-CoV-2 with no previous cognitive impairment. This review protocol was recorded on PROSPERO with registration number CRD 42023413454. RESULTS A total of 16 studies from 502 retrieved articles were included. COVID-19 could cause a decline in working memory ability, the results showed that 22.5-55% of the people suffered from working memory impairment in the acute phase (< 3 months) of COVID-19, at 6 months after SARS-CoV2 infection, the impairment of working memory caused by COVID-19 still existed, the prevalence was about 6.2-10%, and 41.1% of the patients had a slight decrease in working memory or a negative change in the boundary value. Moreover, concomitant symptoms could persist for a long time. To some extent, the performance of working memory was affected by age, the time after infection, and the severity of infection (β = -.132, p <.001; β = .098, p <.001; β = .075, p = .003). The mechanism of working memory impairment after infection was mainly focused on the aspects of neuroinflammation and the nerve invasiveness of the virus; at the same time, we also noticed some changes of the brain parenchymal structure. CONCLUSION COVID-19 can cause a decline in working memory ability, accompanied by neurological symptoms. However, there is a lack of studies to identify the structural and functional changes in specific brain regions that relate to the impaired working memory.
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Affiliation(s)
- Rui Cui
- College of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - BeiYao Gao
- Department of Rehabilitation Medicine, The China-Japan Friendship Hospital, Beijing, China
| | - RuiDong Ge
- Department of Rehabilitation Medicine, The China-Japan Friendship Hospital, Beijing, China
| | - MingZhen Li
- Department of Rehabilitation Medicine, The China-Japan Friendship Hospital, Beijing, China
| | - Min Li
- Department of Rehabilitation Medicine, The China-Japan Friendship Hospital, Beijing, China
| | - Xi Lu
- Department of Rehabilitation Medicine, The China-Japan Friendship Hospital, Beijing, China
| | - Shan Jiang
- Department of Rehabilitation Medicine, The China-Japan Friendship Hospital, Beijing, China
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Solow M, Perry TE. Change Management and Health Care Culture. Anesthesiol Clin 2023; 41:693-705. [PMID: 37838377 DOI: 10.1016/j.anclin.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Change management in health care is the process of implementing new policies, procedures, and practices in order to improve the quality of patient care. It involves understanding the need for change, identifying the stakeholders involved, and developing a plan to implement and manage the change. Change management in health care requires a comprehensive and collaborative approach to ensure that changes are properly implemented, communicated, and monitored. It is essential for health care providers to be aware of the current trends in health care and to stay up to date with the latest technology in order to provide the best care possible.
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Affiliation(s)
- Maxamillian Solow
- Department of Anesthesiology, University of Minnesota, 420 Delaware Street, Southeast, Minneapolis, MN 55455, USA
| | - Tjorvi E Perry
- Division of Cardiothoracic Anesthesia, Department of Anesthesiology, University of Minnesota, 420 Delaware Street Southeast, MMC 294, Mayo Memorial Building, 8294A, Minneapolis, MN 55455, USA.
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Pardavila-Belio MI, Moreno-Arroyo C, Romero-Clará O, Tricas-Sauras S, Barroso T, Duaso M, Vilaplana J, Agüera Z, Canga-Armayor N, Demedts D, Elliott R, Godin I, Fernández E, Hawkins S, Marques MID, Lavedan-Santamaria A, Pueyo-Garrigues M, Puig M, Roca J, Sancho R, Torne-Ruiz A, Martínez C. Adaptation, implementation, and evaluation of an online health sciences training program for brief smoking intervention: A pre-post study in four European countries. NURSE EDUCATION TODAY 2023; 130:105924. [PMID: 37677986 DOI: 10.1016/j.nedt.2023.105924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/01/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Tobacco cessation intervention has a positive impact on quality of care. For health professionals, limited competency in this area may be associated with poor training during their academic programs. There is a clear need to further develop and implement training programs to improve tobacco cessation knowledge, skills, and attitudes among healthcare students. OBJECTIVES The aim of this study was to assess the effectiveness of the innovative online training program "Brief Intervention in Smoking Cessation" for healthcare students to improve their knowledge, skills, and attitudes. DESIGN A pre-post evaluation study with a satisfaction assessment tool was used. SETTING Seven universities from four European countries, including Belgium, Portugal, Spain, and the United Kingdom, participated. PARTICIPANTS One thousand and seventy-two (1072) undergraduate students participated, with 851 completing the online program. METHODS All participants completed the "Brief Intervention in Smoking Cessation" online program, which consisted of five theoretical modules, five videos, and three virtual simulation cases between January 2020 and June 2022. Knowledge was assessed by a multiple-choice test, and practical skills were assessed by a simulation algorithm, both of which were developed by education and smoking cessation experts. Competency was achieved when students successfully completed both assessments. Satisfaction was measured using an ad hoc 16-item questionnaire. Pre-post changes in knowledge were assessed using a paired Student's t-test. RESULTS Eighty-six percent of the students achieved smoking cessation competency. Students significantly improved their knowledge score on a scale of 0 to 10 points, with a mean pre-program score of 3.79 vs a mean post-program score of 7.33 ([-3.7 - -3.4] p < 0.001), acquiring sufficient attitudes and skills (simulation mean of 7.4 out of 10 points). Students were highly satisfied with the program (8.2 out of 10) and recommended it to other students (8.4 out of 10). CONCLUSIONS The "Brief Intervention in Smoking Cessation" online training program is effective for the acquisition of smoking cessation competencies among European health profession students.
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Affiliation(s)
- Miren Idoia Pardavila-Belio
- University of Navarra, School of Nursing, Department of Community, Maternity and Pediatric Nursing, Campus Universitario, 31008 Pamplona, Spain; IdiSNA, Navarra Institute for Health Research.
| | - Carmen Moreno-Arroyo
- Department of Fundamental Care and Medical-Surgical Nursing, Faculty of Nursing, University of Barcelona, Barcelona, Spain; Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.
| | - Olga Romero-Clará
- E-oncologia Virtual Training Unit, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Spain.
| | - Sandra Tricas-Sauras
- Social Approaches to Health Research Center (CRISS-CR5), School of Public Health, Université Libre de Bruxelles, Brussels, Belgium; Eurocare, The European Alcohol Policy Alliance, Brussels, Belgium.
| | - Tereza Barroso
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal.
| | - María Duaso
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom.
| | - Jordi Vilaplana
- Department of Computer Science, University of Lleida, Lleida, Spain.
| | - Zaida Agüera
- Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing, University of Barcelona, L'Hospitalet de Llobregat, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28015 Madrid, Spain.
| | - Navidad Canga-Armayor
- University of Navarra, School of Nursing, Department of Community, Maternity and Pediatric Nursing, Campus Universitario, 31008 Pamplona, Spain; IdiSNA, Navarra Institute for Health Research.
| | - Dennis Demedts
- BRUCHI Expertise Center, Department of Health, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium.
| | - Rebecca Elliott
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom.
| | - Isabelle Godin
- Social Approaches to Health Research Center (CRISS-CR5), School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
| | - Esteve Fernández
- WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, L'Hospitalet del Llobregat, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - Sian Hawkins
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom.
| | - Maria Isabel Dias Marques
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal.
| | - Ana Lavedan-Santamaria
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain; Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain.
| | - María Pueyo-Garrigues
- University of Navarra, School of Nursing, Department of Community, Maternity and Pediatric Nursing, Campus Universitario, 31008 Pamplona, Spain; IdiSNA, Navarra Institute for Health Research.
| | - Montse Puig
- Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing, University of Barcelona, L'Hospitalet de Llobregat, Spain.
| | - Judith Roca
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain; Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain.
| | - Raúl Sancho
- Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing, University of Barcelona, L'Hospitalet de Llobregat, Spain.
| | - Alba Torne-Ruiz
- Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing, University of Barcelona, L'Hospitalet de Llobregat, Spain.
| | - Cristina Martínez
- WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Nursing, University of Barcelona, L'Hospitalet del Llobregat, Spain; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, United States of America.
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Nicolau V, Brandão D, Rua T, Escoval A. Organisation and integrated healthcare approaches for people living with HIV, multimorbidity, or both: a systematic review. BMC Public Health 2023; 23:1579. [PMID: 37596539 PMCID: PMC10439547 DOI: 10.1186/s12889-023-16485-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Universal recommendation for antiretroviral drugs and their effectiveness has put forward the challenge of assuring a chronic and continued care approach to PLHIV (People Living with HIV), pressured by aging and multimorbidity. Integrated approaches are emerging which are more responsive to that reality. Studying those approaches, and their relation to the what of delivery arrangements and the how of implementation processes, may support future strategies to attain more effective organizational responses. METHODS We reviewed empirical studies on either HIV, multimorbidity, or both. The studies were published between 2011 and 2020, describing integrated approaches, their design, implementation, and evaluation strategy. Quantitative, qualitative, or mixed methods were included. Electronic databases reviewed cover PubMed, SCOPUS, and Web of Science. A narrative analysis was conducted on each study, and data extraction was accomplished according to the Effective Practice and Organisation of Care taxonomy of health systems interventions. RESULTS A total of 30 studies, reporting 22 different interventions, were analysed. In general, interventions were grounded and guided by models and frameworks, and focused on specific subpopulations, or priority groups at increased risk of poorer outcomes. Interventions mixed multiple integrated components. Delivery arrangements targeted more frequently clinical integration (n = 13), and care in proximity, community or online-telephone based (n = 15). Interventions reported investments in the role of users, through self-management support (n = 16), and in coordination, through multidisciplinary teams (n = 9) and continuity of care (n = 8). Implementation strategies targeted educational and training activities (n = 12), and less often, mechanisms of iterative improvement (n = 3). At the level of organizational design and governance, interventions mobilised users and communities through representation, at boards and committees, and through consultancy, along different phases of the design process (n = 11). CONCLUSION The data advance important lessons and considerations to take steps forward from disease-focused care to integrated care at two critical levels: design and implementation. Multidisciplinary work, continuity of care, and meaningful engagement of users seem crucial to attain care that is comprehensive and more proximal, within or cross organizations, or sectors. Promising practices are advanced at the level of design, implementation, and evaluation, that set integration as a continued process of improvement and value professionals and users' knowledge as assets along those phases. TRIAL REGISTRATION PROSPERO number CRD42020194117.
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Affiliation(s)
- Vanessa Nicolau
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal.
| | - Daniela Brandão
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | | | - Ana Escoval
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
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Kahwati LC, Kelly BJ, Johnson M, Clark RT, Viswanathan M. End-user understanding of qualitative comparative analysis used within evidence synthesis: A mixed-methods study. Res Synth Methods 2023; 14:180-192. [PMID: 36175386 DOI: 10.1002/jrsm.1602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 08/09/2022] [Accepted: 09/21/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Enhanced uptake of systematic reviews that use qualitative comparative analyses (QCA) requires knowing how end-users interpret such findings. The study purpose was to identify effective approaches to communicating results from a QCA within a systematic review. METHODS Sequential exploratory mixed methods design; thematic analysis of interviews with 11 end-users followed by a randomized experiment with 254 participants that provided QCA results for a hypothetical review presented through three formats (text, table, and figure). A survey administered after the experiment assessed subjective and objective comprehension of QCA results. RESULTS Interview themes included use of jargon; appropriate use of appendices, tables, figures; and integration of QCA results within the systematic review. In the experiment, we observed a significant difference (p = 0.035) in subjective comprehension across the three presentation formats. Participants randomized to the figure and text formats scored higher compared to the table. No significant differences were observed for objective comprehension overall (p = 0.11). However, for parameter interpretation (a unique component of QCA results), scores among participants that received the figure format were significantly higher than scores for participants who received the text (p = 0.001) or table (p = 0.004). No significant differences (p = 0.09) were observed in objective comprehension for configuration interpretation. CONCLUSIONS End-users of systematic reviews saw value in the use of QCA, but unfamiliar methods and terminology were barriers to full understanding of the findings. When presenting results, a figure format appears to be superior to text or table formats based on measures of subjective comprehension and some measures of objective comprehension.
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Affiliation(s)
- Leila C Kahwati
- RTI-University of North Carolina Evidence Based Practice Center, Research Triangle Park, Durham, North Carolina, USA.,RTI International, Research Triangle Park, Durham, North Carolina, USA
| | - Bridget J Kelly
- RTI International, Research Triangle Park, Durham, North Carolina, USA
| | - Mihaela Johnson
- RTI International, Research Triangle Park, Durham, North Carolina, USA
| | - Rachel T Clark
- RTI International, Research Triangle Park, Durham, North Carolina, USA.,Komodo Health, San Francisco, California, USA
| | - Meera Viswanathan
- RTI-University of North Carolina Evidence Based Practice Center, Research Triangle Park, Durham, North Carolina, USA.,RTI International, Research Triangle Park, Durham, North Carolina, USA
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Pizarro-Mena R, Duran-Aguero S, Parra-Soto S, Vargas-Silva F, Bello-Lepe S, Fuentes-Alburquenque M. Effects of a Structured Multicomponent Physical Exercise Intervention on Quality of Life and Biopsychosocial Health among Chilean Older Adults from the Community with Controlled Multimorbidity: A Pre-Post Design. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15842. [PMID: 36497916 PMCID: PMC9735590 DOI: 10.3390/ijerph192315842] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
Structured multicomponent physical exercise (PE) for older adults, with a combination of strength, aerobic, flexibility, and balance exercises, has been shown to have benefits for physical, cognitive, social, and metabolic functioning, as well as counteracting chronic pathologies and geriatric syndromes. However, little is known about the effect of these interventions in Chilean older adults. Our objective was to determine the effect of a structured multicomponent PE intervention on the quality of life (QoL) and biopsychosocial factors of community-living older adults. We conducted a pre-post intervention without control group, with a face-to-face structured multicomponent PE intervention (cardiovascular, strength/power, flexibility, static and dynamic balance, other psychomotor components, and education), based on FITT-VP principles (frequency, intensity, type, time, volume, and progression of exercise), at moderate intensity, 60 min per session, three times per week, and 12 weeks in duration, among 45 persons with an average age of 70.74 years. Participants were evaluated at the beginning and end of the intervention with different instruments of comprehensive gerontological assessment (CGA). Post intervention, participants (83.70% average attendance) significantly improved scores in QoL, biological and biopsychosocial frailty, sarcopenia, functionality in basic, instrumental, and advanced activities of daily living, dynamic balance, cognitive status and mood, systolic and diastolic blood pressure, weight, body mass index, strength and flexibility clinical tests of lower and upper extremity, aerobic capacity, agility, and tandem balance. The indication and prescription of structured multicomponent PE based on FITT-VP principles, as evaluated with the CGA, improved the QoL and biopsychosocial health of older adults. This intervention could serve as a pilot for RCTs or to improve PE programs or services for older adults under the auspices of existing public policy.
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Affiliation(s)
- Rafael Pizarro-Mena
- Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Sede Los Leones, Santiago 7500000, Chile
| | - Samuel Duran-Aguero
- Facultad de Ciencias para el Cuidado de la Salud, Universidad San Sebastián, Sede Los Leones, Santiago 7500000, Chile
| | - Solange Parra-Soto
- Departamento de Nutrición y Salud Pública, Universidad del Bío-Bío, Chillan 3780000, Chile
| | - Francisco Vargas-Silva
- Facultad de Odontología y Ciencias de la Rehabilitación, Universidad San Sebastián, Sede Los Leones, Santiago 7500000, Chile
| | - Sebastian Bello-Lepe
- Escuela de Fonoaudiología, Universidad de Valparaíso, Viña del Mar 2520000, Chile
- Centro de Investigación del Desarrollo en Cognición y Lenguaje (CIDCL), Universidad de Valparaíso, Viña del Mar 2520000, Chile
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Effectiveness of Interventions to Improve the Anticholinergic Prescribing Practice in Older Adults: A Systematic Review. J Clin Med 2022; 11:jcm11030714. [PMID: 35160166 PMCID: PMC8836376 DOI: 10.3390/jcm11030714] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Pharmacotherapy in older adults is one of the most challenging aspects of patient care. Older people are prone to drug-related problems such as adverse effects, ineffectiveness, underdosage, overdosage, and drug interactions. Anticholinergic medications are associated with poor outcomes in older patients, and there is no specific intervention strategy for reducing drug burden from anticholinergic activity medications. Little is known about the effectiveness of current interventions that may likely improve the anticholinergic prescribing practice in older adults. AIMS This review seeks to document all types of interventions aiming to reduce anticholinergic prescribing among older adults and assess the current evidence and quality of existing single and combined interventions. METHODS We systematically searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO from January 1990 to August 2021. Only studies that examined the effect of interventions in older people focused on improving compliance with anticholinergic prescribing guidelines with quantifiable data were included. The primary outcome of interest was to find the effectiveness of interventions that enhance the anticholinergic prescribing practice in older adults. RESULTS We screened 3168 records and ended up in 23 studies that met the inclusion criteria. We found only single-component interventions to reduce anticholinergic prescribing errors in older people. Pharmacists implemented interventions without collaboration in nearly half of the studies (n = 11). Medication review (43%) and education provision (26%) to healthcare practitioners were the most common interventions. Sixteen studies (70%) reported significant reductions in anticholinergic prescribing errors, whereas seven studies (30%) showed no significant effect. CONCLUSION This systematic review suggests that healthcare practitioner-oriented interventions have the potential to reduce the occurrence of anticholinergic prescribing errors in older people. Interventions were primarily effective in reducing the burden of anticholinergic medications and assisting with deprescribing anticholinergic medications in older adults.
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Woodcock EW. Barriers to and Facilitators of Automated Patient Self-scheduling for Health Care Organizations: Scoping Review. J Med Internet Res 2022; 24:e28323. [PMID: 35014968 PMCID: PMC8790681 DOI: 10.2196/28323] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/25/2021] [Accepted: 11/26/2021] [Indexed: 01/26/2023] Open
Abstract
Background Appointment management in the outpatient setting is important for health care organizations, as waits and delays lead to poor outcomes. Automated patient self-scheduling of outpatient appointments has demonstrable advantages in the form of patients’ arrival rates, labor savings, patient satisfaction, and more. Despite evidence of the potential benefits of self-scheduling, the organizational uptake of self-scheduling in health care has been limited. Objective The objective of this scoping review is to identify and to catalog existing evidence of the barriers to and facilitators of self-scheduling for health care organizations. Methods A scoping review was conducted by searching 4 databases (PubMed, CINAHL, Business Source Ultimate, and Scopus) and systematically reviewing peer-reviewed studies. The Consolidated Framework for Implementation Research was used to catalog the studies. Results In total, 30 full-text articles were included in this review. The results demonstrated that self-scheduling initiatives have increased over time, indicating the broadening appeal of self-scheduling. The body of literature regarding intervention characteristics is appreciable. Outer setting factors, including national policy, competition, and the response to patients’ needs and technology access, have played an increasing role in influencing implementation over time. Self-scheduling, compared with using the telephone to schedule an appointment, was most often cited as a relative advantage. Scholarly pursuit lacked recommendations related to the framework’s inner setting, characteristics of individuals, and processes as determinants of implementation. Future discoveries regarding these Consolidated Framework for Implementation Research domains may help detect, categorize, and appreciate organizational-level barriers to and facilitators of self-scheduling to advance knowledge regarding this solution. Conclusions This scoping review cataloged evidence of the existence, advantages, and intervention characteristics of patient self-scheduling. Automated self-scheduling may offer a solution to health care organizations striving to positively affect access. Gaps in knowledge regarding the uptake of self-scheduling by health care organizations were identified to inform future research.
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Affiliation(s)
- Elizabeth W Woodcock
- Department of Health Policy & Management, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Veazie S, Peterson K, Bourne D, Anderson J, Damschroder L, Gunnar W. Implementing High-Reliability Organization Principles Into Practice: A Rapid Evidence Review. J Patient Saf 2022; 18:e320-e328. [PMID: 32910041 DOI: 10.1097/pts.0000000000000768] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To promote a safety culture and reduce harm, health care systems are adopting high-reliability organization (HRO) principles. This rapid review synthesizes HRO frameworks, metrics, and implementation effects to help inform health systems' efforts toward becoming HROs. METHODS Bibliographic databases were searched from 2010 to 2019. One reviewer used prespecified criteria to assess articles for inclusion, evaluate study quality, extract data, and grade strength of evidence with second reviewer checking. RESULTS Twenty-three articles were identified: 8 described frameworks, 9 examined metrics, and 9 evaluated implementation outcomes. Five common strategies for HRO implementation emerged (developing leadership, supporting a culture of safety, providing training and learning, building data systems, and implementing quality improvement interventions). The Joint Commission's and Institute for Healthcare Improvement's frameworks emerged as the most comprehensive and widely applicable. The Joint Commission's Oro 2.0 metric for evaluating HRO progress similarly stood out as it was developed through broad stakeholder input and was validated by external researchers. Multicomponent HRO interventions delivered for at least 2 years were associated with improved process and patient safety outcomes. Because each HRO intervention was only supported by a single poor or fair-quality study-none of which contained a concurrent control group-a causal relationship between any HRO initiative and outcomes could not be established. CONCLUSIONS Health care system adoption of HRO principles is associated with improved safety outcomes, yet the level of evidence is low. Priorities for future HRO studies include use of concurrent control groups and examination of specific outcomes measurements.
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Affiliation(s)
- Stephanie Veazie
- From the VA Evidence Synthesis Program Coordinating Center, Portland, OR
| | - Kim Peterson
- From the VA Evidence Synthesis Program Coordinating Center, Portland, OR
| | - Donald Bourne
- From the VA Evidence Synthesis Program Coordinating Center, Portland, OR
| | - Johanna Anderson
- From the VA Evidence Synthesis Program Coordinating Center, Portland, OR
| | | | - William Gunnar
- VHA National Center for Patient Safety, University of Michigan, Ann Arbor, MI
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11
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Represas-Carrera F, Couso-Viana S, Méndez-López F, Masluk B, Magallón-Botaya R, Recio-Rodríguez JI, Pombo H, Leiva-Rus A, Gil-Girbau M, Motrico E, Martí-Lluch R, Gude F, Clavería A. Effectiveness of a Multicomponent Intervention in Primary Care That Addresses Patients with Diabetes Mellitus with Two or More Unhealthy Habits, Such as Diet, Physical Activity or Smoking: Multicenter Randomized Cluster Trial (EIRA Study). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5788. [PMID: 34071171 PMCID: PMC8198299 DOI: 10.3390/ijerph18115788] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 05/14/2021] [Accepted: 05/24/2021] [Indexed: 12/23/2022]
Abstract
Introduction: We evaluated the effectiveness of an individual, group and community intervention to improve the glycemic control of patients with diabetes mellitus aged 45-75 years with two or three unhealthy life habits. As secondary endpoints, we evaluated the inverventions' effectiveness on adhering to Mediterranean diet, physical activity, sedentary lifestyle, smoking and quality of life. Method: A randomized clinical cluster (health centers) trial with two parallel groups in Spain from January 2016 to December 2019 was used. Patients with diabetes mellitus aged 45-75 years with two unhealthy life habits or more (smoking, not adhering to Mediterranean diet or little physical activity) participated. Centers were randomly assigned. The sample size was estimated to be 420 people for the main outcome variable. Educational intervention was done to improve adherence to Mediterranean diet, physical activity and smoking cessation by individual, group and community interventions for 12 months. Controls received the usual health care. The outcome variables were: HbA1c (main), the Mediterranean diet adherence score (MEDAS), the international diet quality index (DQI-I), the international physical activity questionnaire (IPAQ), sedentary lifestyle, smoking ≥1 cigarette/day and the EuroQuol questionnaire (EVA-EuroQol5D5L). Results: In total, 13 control centers (n = 356) and 12 intervention centers (n = 338) were included with similar baseline conditions. An analysis for intention-to-treat was done by applying multilevel mixed models fitted by basal values and the health center: the HbA1c adjusted mean difference = -0.09 (95% CI: -0.29-0.10), the DQI-I adjusted mean difference = 0.25 (95% CI: -0.32-0.82), the MEDAS adjusted mean difference = 0.45 (95% CI: 0.01-0.89), moderate/high physical activity OR = 1.09 (95% CI: 0.64-1.86), not living a sedentary lifestyle OR = 0.97 (95% CI: 0.55-1.73), no smoking OR = 0.61 (95% CI: 0.54-1.06), EVA adjusted mean difference = -1.26 (95% CI: -4.98-2.45). Conclusions: No statistically significant changes were found for either glycemic control or physical activity, sedentary lifestyle, smoking and quality of life. The multicomponent individual, group and community interventions only showed a statistically significant improvement in adhering to Mediterranean diet. Such innovative interventions need further research to demonstrate their effectiveness in patients with poor glycemic control.
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Affiliation(s)
- Francisco Represas-Carrera
- Galicia South Health Research Institute, Hospital Álvaro Cunqueiro, Technical Block, Floor 2, Roal Clara Campoamor nº 341, 36213 Vigo, Spain; (S.C.-V.); (A.C.)
| | - Sabela Couso-Viana
- Galicia South Health Research Institute, Hospital Álvaro Cunqueiro, Technical Block, Floor 2, Roal Clara Campoamor nº 341, 36213 Vigo, Spain; (S.C.-V.); (A.C.)
| | - Fátima Méndez-López
- Aragonese Research Group in Primary Care (GAIAP), Institute of Health Research, Avenue San Juan Bosco, 13, 50009 Zaragoza, Spain; (F.M.-L.); (B.M.); (R.M.-B.)
| | - Bárbara Masluk
- Aragonese Research Group in Primary Care (GAIAP), Institute of Health Research, Avenue San Juan Bosco, 13, 50009 Zaragoza, Spain; (F.M.-L.); (B.M.); (R.M.-B.)
| | - Rosa Magallón-Botaya
- Aragonese Research Group in Primary Care (GAIAP), Institute of Health Research, Avenue San Juan Bosco, 13, 50009 Zaragoza, Spain; (F.M.-L.); (B.M.); (R.M.-B.)
| | - Jose I. Recio-Rodríguez
- San Juan Health Centre, Salamanca Primary Care Research Unit (APISAL), Institute of Biomedical Research of Salamanca (IBSAL), Department of Nursing and Physiotherapy (University of Salamanca), Avenue Portugal 83, 2 Floor, 37005 Salamanca, Spain;
| | - Haizea Pombo
- Ezkerraldea-Enkarterri-Cruces Integrated Health Organisation, Biocruces Bizkaia Health Research Institute Innovation Unit, Plaza de Cruces s/n, 48903 Barakaldo, Spain;
| | - Alfonso Leiva-Rus
- Balearic Islands Health Research Institute (IdISBa), Highway Valldemosa 79, 07120 Palma, Spain;
| | - Montserrat Gil-Girbau
- Research Group in Health Technology Assessment in Primary Care and Mental Health (PRISMA), Research and Development Unit, Institut de Recerca Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Street Dr. Antoni Pujadas, 42, 08830 Sant Boi de Llobregat, Spain;
| | - Emma Motrico
- Psychology Department, Universidad Loyola Andalucía, Avenue of the Universities, s/n, 41704 Dos Hermanas, Spain;
| | - Ruth Martí-Lluch
- Girona Research Support Unit, Jordi Gol i Gurina University Institute for Research in Primary Health Care Foundation (IDIAPJGol), Street Maluquer Salvador 11, 17002 Girona, Spain;
| | - Francisco Gude
- Clinical Epidemiology Unit, Research Methods Group, Santiago Institute of Sanitary Research (IDIS), Complejo Hospitalario Universitario de Santiago, Travesía da Choupana, s/n, 157056 Santiago de Compostela, Spain;
| | - Ana Clavería
- Galicia South Health Research Institute, Hospital Álvaro Cunqueiro, Technical Block, Floor 2, Roal Clara Campoamor nº 341, 36213 Vigo, Spain; (S.C.-V.); (A.C.)
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12
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Fortune N, Madden R, Riley T, Short S. The International Classification of Health Interventions: an 'epistemic hub' for use in public health. Health Promot Int 2021; 36:1753-1764. [PMID: 33585880 DOI: 10.1093/heapro/daab011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The current lack of a common basis for collecting data on population-level prevention and health promotion interventions causes public health to be relatively invisible within broader health systems, making it vulnerable to funding cuts when there is pressure to reduce spending. Further, the inconsistent use of terms for describing interventions hinders knowledge translation and building an evidence base for public health practice and policy. The International Classification of Health Interventions (ICHI), being developed by the World Health Organization, is a standard statistical classification for interventions across the full scope of health systems. ICHI has potential to meet the need for a common language and structure for describing and capturing information about prevention and health promotion interventions. We report on a developmental appraisal conducted to examine the strengths and limitations of ICHI for coding interventions delivered for public health purposes. Our findings highlight classification challenges in relation to: consistently identifying separate components within multi-component interventions; operationalizing the ICHI concept of intervention target when there are intermediary targets as well as an ultimate target; coding an intervention component that involves more than one ICHI target or action; and standardising what is being counted. We propose that, alongside its purpose as a statistical classification, ICHI can play a valuable role as an 'epistemic hub', to be used flexibly by public health actors to meet a range of information needs, and as a basis for improved communication and exchange.
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Affiliation(s)
- Nicola Fortune
- Faculty of Medicine and Health, The University of Sydney, NSW, 2006, Australia
| | - Richard Madden
- Faculty of Medicine and Health, The University of Sydney, NSW, 2006, Australia
| | - Therese Riley
- Therese Riley Consulting, Sandringham, VIC, 3191, Australia
| | - Stephanie Short
- Faculty of Medicine and Health, The University of Sydney, NSW, 2006, Australia
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13
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Smit LC, Dikken J, Schuurmans MJ, de Wit NJ, Bleijenberg N. Value of social network analysis for developing and evaluating complex healthcare interventions: a scoping review. BMJ Open 2020; 10:e039681. [PMID: 33203632 PMCID: PMC7674094 DOI: 10.1136/bmjopen-2020-039681] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Most complex healthcare interventions target a network of healthcare professionals. Social network analysis (SNA) is a powerful technique to study how social relationships within a network are established and evolve. We identified in which phases of complex healthcare intervention research SNA is used and the value of SNA for developing and evaluating complex healthcare interventions. METHODS A scoping review was conducted using the Arksey and O'Malley methodological framework. We included complex healthcare intervention studies using SNA to identify the study characteristics, level of complexity of the healthcare interventions, reported strengths and limitations, and reported implications of SNA. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews 2018 was used to guide the reporting. RESULTS Among 2466 identified studies, 40 studies were selected for analysis. At first, the results showed that SNA seems underused in evaluating complex intervention research. Second, SNA was not used in the development phase of the included studies. Third, the reported implications in the evaluation and implementation phase reflect the value of SNA in addressing the implementation and population complexity. Fourth, pathway complexity and contextual complexity of the included interventions were unclear or unable to access. Fifth, the use of a mixed methods approach was reported as a strength, as the combination and integration of a quantitative and qualitative method clearly establishes the results. CONCLUSION SNA is a widely applicable method that can be used in different phases of complex intervention research. SNA can be of value to disentangle and address the level of complexity of complex healthcare interventions. Furthermore, the routine use of SNA within a mixed method approach could yield actionable insights that would be useful in the transactional context of complex interventions.
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Affiliation(s)
- Linda C Smit
- Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Jeroen Dikken
- Faculty of Health, Nutrition & Sport, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - Marieke J Schuurmans
- Education Center, UMC Utrecht Academy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Niek J de Wit
- Department of General Practice, Division Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nienke Bleijenberg
- Research Centre for Healthy and Sustainable Living, University of Applied Sciences Utrecht, Utrecht, The Netherlands
- Department of Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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14
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Martínez C, Feliu A, Castellano Y, Fu M, Fernández P, Cabrera-Jaime S, Puig-Llobet M, Galimany J, Guydish J, Fernández E. Factors associated with receipt of the 5As model of brief intervention for smoking cessation among hospitalized patients. Addiction 2020; 115:2098-2112. [PMID: 32297373 DOI: 10.1111/add.15076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/18/2019] [Accepted: 04/01/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Guidelines recommend the 5As model of brief intervention for providing smoking cessation support in clinical settings. This study assessed patient and hospital characteristics associated with self-reported receipt of the 5As (ask, advise, assess, assist and arrange). DESIGN Multi-center cross-sectional study. SETTING AND PARTICIPANTS Adult inpatients (n = 1047) were randomly selected from 13 hospitals in the Barcelona province of Spain in 2014-2015. MEASUREMENTS We explored participants' receipt of the 5As through a questionnaire. Given the progressiveness of the 5As, we recoded the fulfillment of the intervention as: A0 : no intervention; A1 : ask; A2 : ask and advise; A3 : A2 and assess; A4 : A3 and assist; and A5 : A4 and arrange a follow-up. We explored patient (e.g. age, sex, comorbidities) and hospital (e.g. type of hospital, unit) characteristics. We adjusted multi-level robust Poisson regression models to estimate the adjusted prevalence ratios (aPR) of the association between the recoded 5As intervention received. FINDINGS A total of 60.4% (n = 624) of patients had been asked (A1 ) about their smoking status. Among smokers, 46.5% (n = 90) were advised (A2 ), 26.6% (n = 48) assessed (A3 ) and 4.6% (n = 10) received all the components of the 5As (A5 ). Middle-aged smokers [aPR = 3.63; 95% confidence interval (CI) = 1.69-7.79] with a respiratory disease (aPR = 2.19; 95% CI = 1.11-4.34) were most likely to have been asked, advised and assessed (A3 ). The cessation intervention was most frequently performed by physicians. CONCLUSIONS In the Barcelona province of Spain, it appears that fewer than half of hospitalized patients who smoke were advised to quit and few received the full 'five As' brief intervention for smoking cessation.
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Affiliation(s)
- Cristina Martínez
- Tobacco Control Unit, Institut Català d'Oncologia (ICO), L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Sciences, Campus of Bellvitge. University of Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain.,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Ariadna Feliu
- Tobacco Control Unit, Institut Català d'Oncologia (ICO), L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Sciences, Campus of Bellvitge. University of Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Yolanda Castellano
- Tobacco Control Unit, Institut Català d'Oncologia (ICO), L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Sciences, Campus of Bellvitge. University of Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Marcela Fu
- Tobacco Control Unit, Institut Català d'Oncologia (ICO), L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Sciences, Campus of Bellvitge. University of Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Paz Fernández
- School of Medicine and Health Sciences, Campus of Bellvitge. University of Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain.,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Sandra Cabrera-Jaime
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Montse Puig-Llobet
- School of Medicine and Health Sciences, Campus of Bellvitge. University of Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Jordi Galimany
- School of Medicine and Health Sciences, Campus of Bellvitge. University of Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain
| | - Joseph Guydish
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA
| | - Esteve Fernández
- Tobacco Control Unit, Institut Català d'Oncologia (ICO), L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,School of Medicine and Health Sciences, Campus of Bellvitge. University of Barcelona, L'Hospitalet del Llobregat, Barcelona, Spain.,Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
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15
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Chang F, Eriksson A, Östlund B. Discrepancies between Expected and Actual Implementation: The Process Evaluation of PERS Integration in Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4245. [PMID: 32545871 PMCID: PMC7344572 DOI: 10.3390/ijerph17124245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 11/17/2022]
Abstract
Recent studies prove that when implementing new technology technology-driven and one-size-fits-all approaches are problematic. This study focuses on the process of implementing personal emergency response system (PERS) at nursing homes. The aim is to understand why the implementation of PERS has not met initial expectations. Multiple methods were used in two Swedish nursing homes, including document analysis, questionnaires (n = 42), participant observation (67 h), and individual interviews (n = 12). A logic model was used to ascertain the discrepancies that emerged between expected and actual implementation, and the domestication theory was used to discuss the underlying meanings of the discrepancies. The discrepancies primarily focused on staff competence, system readiness, work routines, and implementation duration. Corresponding reasons were largely relevant to management issues regarding training, the procurement systems, individual and collective responsibilities as well as invisible work. The uptake of technology in daily practice is far more nuanced than a technology implementation plan might imply. We point out the importance of preparing for implementation, adjusting to new practices, and leaving space and time for facilitating implementation. The findings will be of use to implementers, service providers, and organizational managers to evaluate various measures in the implementation process, enabling them to perform technology implementation faster and more efficiently.
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Affiliation(s)
- Fangyuan Chang
- Department of Biomedical Engineering and Health Systems, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, SE-142 58 Stockholm, Sweden; (A.E.); (B.Ö.)
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16
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Assessing the Effectiveness of Complex Interventions to Meet the Needs of VA Stakeholders: Experience of the Department of Veterans Affairs Evidence Synthesis Program. Med Care 2020; 57 Suppl 10 Suppl 3:S278-S285. [PMID: 31517800 PMCID: PMC6750156 DOI: 10.1097/mlr.0000000000001158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Complex health care interventions involve multiple distinct elements that contribute to their functioning. Conducting systematic reviews of complex interventions has substantial challenges. Although methodological guidance exists, less is known about the practical strategies and approaches undertaken by systematic review groups to navigate common challenges and enhance impacts of systematic review findings.
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17
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Ji X, Leng XY, Dong Y, Ma YH, Xu W, Cao XP, Hou XH, Dong Q, Tan L, Yu JT. Modifiable risk factors for carotid atherosclerosis: a meta-analysis and systematic review. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:632. [PMID: 31930033 DOI: 10.21037/atm.2019.10.115] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Carotid atherosclerosis is a major cause of stroke, but the conclusion about risk factors for carotid atherosclerosis is still controversial. The aim of our present meta-analysis and systematic review was to explore the modifiable risk factors for carotid atherosclerosis. Methods We searched PubMed from January 1962 to October 2018 to include longitudinal and cross-sectional studies. The results were pooled using random effects model. Heterogeneity was measured by I2 statistic and publication bias was assessed by funnel plots. Results A total of 14,700 articles were screened, of which 76 with 27 factors were eligible. Our meta-analysis of cross-sectional studies indicated nine factors (hyperlipidemia, hyperhomocysteinemia, hypertension, hyperuricemia, smoking, metabolic syndrome, hypertriglyceridemia, diabetes, and higher low density lipoprotein) were significantly associated with the presence of carotid plaque, among which four (hyperlipidemia, hyperhomocysteinemia, hypertension, and hyperuricemia) could elevate the risk of atherosclerosis by at least 50%; and one factor (hypertension) was associated with increased carotid intima-media thickness. In the systematic review, another five factors [negative emotion, socioeconomic strain, alcohol, air pollution, and obstructive sleep apnea syndrome (OSAS)] were also related to the presence of atherosclerosis. The cross-sectional associations with most of the above 14 factors were further confirmed by longitudinal studies. Among them, the managements of 4 factors (hypertension, hyperlipidemia, diabetes and OSAS) were indicated to prevent carotid atherosclerosis by cohort studies. Conclusions Effective interventions targeting pre-existing disease, negative emotion, lifestyle and diet may reduce the risk of carotid atherosclerosis. Further good-quality prospective studies are needed to confirm these findings.
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Affiliation(s)
- Xi Ji
- Department of Neurology, Qingdao Municipal Hospital, Dalian Medical University, Dalian 116044, China.,Department of Neurology, Xuchang People's Hospital, Xuchang 461000, China
| | - Xin-Yi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Yi Dong
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Ya-Hui Ma
- Department of Neurology, Qingdao Municipal Hospital, Dalian Medical University, Dalian 116044, China
| | - Wei Xu
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao 266071, China
| | - Xi-Peng Cao
- Clinical Research Center, Qingdao Municipal Hospital, Qingdao University, Qingdao 266071, China
| | - Xiao-He Hou
- Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao 266071, China
| | - Qiang Dong
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
| | - Lan Tan
- Department of Neurology, Qingdao Municipal Hospital, Dalian Medical University, Dalian 116044, China.,Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao 266071, China
| | - Jin-Tai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, China
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18
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Montgomery P, Movsisyan A, Grant SP, Macdonald G, Rehfuess EA. Considerations of complexity in rating certainty of evidence in systematic reviews: a primer on using the GRADE approach in global health. BMJ Glob Health 2019; 4:e000848. [PMID: 30775013 PMCID: PMC6350753 DOI: 10.1136/bmjgh-2018-000848] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/04/2018] [Accepted: 07/06/2018] [Indexed: 12/31/2022] Open
Abstract
Public health interventions and health technologies are commonly described as 'complex', as they involve multiple interacting components and outcomes, and their effects are largely influenced by contextual interactions and system-level processes. Systematic reviewers and guideline developers evaluating the effects of these complex interventions and technologies report difficulties in using existing methods and frameworks, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE). As part of a special series of papers on implications of complexity in the WHO guideline development, this paper serves as a primer on how to consider sources of complexity when using the GRADE approach to rate certainty of evidence. Relevant sources of complexity in systematic reviews, health technology assessments and guidelines of public health are outlined and mapped onto the reported difficulties in rating the estimates of the effect of these interventions. Recommendations on how to address these difficulties are further outlined, and the need for an integrated use of GRADE from the beginning of the review or guideline development is emphasised. The content of this paper is informed by the existing GRADE guidance, an ongoing research project on considering sources of complexity when applying the GRADE approach to rate certainty of evidence in systematic reviews and the review authors' own experiences with using GRADE.
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Affiliation(s)
- Paul Montgomery
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Ani Movsisyan
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Sean P Grant
- Pardee RAND Graduate School, RAND Corporation, Santa Monica, California, USA
| | | | - Eva Annette Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, Ludwig Maximilian University, Munich, Germany
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19
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Higgins JPT, López-López JA, Becker BJ, Davies SR, Dawson S, Grimshaw JM, McGuinness LA, Moore THM, Rehfuess EA, Thomas J, Caldwell DM. Synthesising quantitative evidence in systematic reviews of complex health interventions. BMJ Glob Health 2019; 4:e000858. [PMID: 30775014 PMCID: PMC6350707 DOI: 10.1136/bmjgh-2018-000858] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/13/2018] [Accepted: 08/14/2018] [Indexed: 12/29/2022] Open
Abstract
Public health and health service interventions are typically complex: they are multifaceted, with impacts at multiple levels and on multiple stakeholders. Systematic reviews evaluating the effects of complex health interventions can be challenging to conduct. This paper is part of a special series of papers considering these challenges particularly in the context of WHO guideline development. We outline established and innovative methods for synthesising quantitative evidence within a systematic review of a complex intervention, including considerations of the complexity of the system into which the intervention is introduced. We describe methods in three broad areas: non-quantitative approaches, including tabulation, narrative and graphical approaches; standard meta-analysis methods, including meta-regression to investigate study-level moderators of effect; and advanced synthesis methods, in which models allow exploration of intervention components, investigation of both moderators and mediators, examination of mechanisms, and exploration of complexities of the system. We offer guidance on the choice of approach that might be taken by people collating evidence in support of guideline development, and emphasise that the appropriate methods will depend on the purpose of the synthesis, the similarity of the studies included in the review, the level of detail available from the studies, the nature of the results reported in the studies, the expertise of the synthesis team and the resources available.
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Affiliation(s)
- Julian P T Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - José A López-López
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Betsy J Becker
- Department of Educational Psychology and Learning Systems, College of Education, Florida State University, Tallahassee, Florida, USA
| | - Sarah R Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Dawson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Luke A McGuinness
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Theresa H M Moore
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Collaboration for Leadership in Applied Health Care (CLAHRC) West, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Eva A Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany
| | - James Thomas
- EPPI-Centre, Department of Social Science, University College London, London, UK
| | - Deborah M Caldwell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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20
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Node-making process in network meta-analysis of nonpharmacological treatment are poorly reported. J Clin Epidemiol 2018; 97:95-102. [DOI: 10.1016/j.jclinepi.2017.11.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 11/15/2017] [Accepted: 11/22/2017] [Indexed: 12/14/2022]
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21
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Peterson K, Anderson J, Bourne D, Mackey K, Helfand M. Effectiveness of Models Used to Deliver Multimodal Care for Chronic Musculoskeletal Pain: a Rapid Evidence Review. J Gen Intern Med 2018; 33:71-81. [PMID: 29633140 PMCID: PMC5902347 DOI: 10.1007/s11606-018-4328-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Primary care providers (PCPs) face many system- and patient-level challenges in providing multimodal care for patients with complex chronic pain as recommended in some pain management guidelines. Several models have been developed to improve the delivery of multimodal chronic pain care. These models vary in their key components, and work is needed to identify which have the strongest evidence of clinically-important improvements in pain and function. Our objective was to determine which primary care-based multimodal chronic pain care models provide clinically relevant benefits, define key elements of these models, and identify patients who are most likely to benefit. METHODS To identify studies, we searched MEDLINE® (1996 to October 2016), CINAHL, reference lists, and numerous other sources and consulted with experts. We used predefined criteria for study selection, data abstraction, internal validity assessment, and strength of evidence grading. RESULTS We identified nine models, evaluated in mostly randomized controlled trials (RCTs). The RCTs included 3816 individuals primarily from the USA. The most common pain location was the back. Five models primarily coupling a decision-support component-most commonly algorithm-guided treatment and/or stepped care-with proactive ongoing treatment monitoring have the best evidence of providing clinically relevant improvement in pain intensity and pain-related function over 9 to 12 months (NNT range, 4 to 13) and variable improvement in quality of life, depression, anxiety, and sleep. The strength of the evidence was generally low, as each model was only supported by a single RCT with imprecise findings. DISCUSSION Multimodal chronic pain care delivery models coupling decision support with proactive treatment monitoring consistently provide clinically relevant improvement in pain and function. Wider implementation of these models should be accompanied by further evaluation of clinical and implementation effectiveness.
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Affiliation(s)
- Kim Peterson
- Department of Veterans Affairs, VA Portland Health Care System, Evidence-based Synthesis Program (ESP) Coordinating Center, Portland, OR, USA.
| | - Johanna Anderson
- Department of Veterans Affairs, VA Portland Health Care System, Evidence-based Synthesis Program (ESP) Coordinating Center, Portland, OR, USA
| | - Donald Bourne
- Department of Veterans Affairs, VA Portland Health Care System, Evidence-based Synthesis Program (ESP) Coordinating Center, Portland, OR, USA
| | - Katherine Mackey
- Department of Veterans Affairs, VA Portland Health Care System, Evidence-based Synthesis Program (ESP) Coordinating Center, Portland, OR, USA
| | - Mark Helfand
- Department of Veterans Affairs, VA Portland Health Care System, Evidence-based Synthesis Program (ESP) Coordinating Center, Portland, OR, USA
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Abstract
Meta-analysis is a prominent method for estimating the effects of public health interventions, yet these interventions are often complex in ways that pose challenges to using conventional meta-analytic methods. This article discusses meta-analytic techniques that can be used in research syntheses on the effects of complex public health interventions. We first introduce the use of complexity frameworks to conceptualize public health interventions. We then present a menu of meta-analytic procedures for addressing various sources of complexity when answering questions about the effects of public health interventions in research syntheses. We conclude with a review of important practices and key resources for conducting meta-analyses on complex interventions, as well as future directions for research synthesis more generally. Overall, we argue that it is possible to conduct meaningful quantitative syntheses of research on the effects of public health interventions, though these meta-analyses may require the use of advanced techniques to properly consider and attend to issues of complexity.
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Affiliation(s)
- Emily E Tanner-Smith
- Peabody Research Institute, Vanderbilt University, Nashville, Tennessee 37203, USA.,Current affiliation: Department of Counseling Psychology and Human Services, University of Oregon, Eugene, Oregon 97403-1215, USA;
| | - Sean Grant
- RAND Corporation, Santa Monica, California 90407-2138, USA;
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23
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Davis MM, Freeman M, Shannon J, Coronado GD, Stange KC, Guise JM, Wheeler SB, Buckley DI. A systematic review of clinic and community intervention to increase fecal testing for colorectal cancer in rural and low-income populations in the United States - How, what and when? BMC Cancer 2018; 18:40. [PMID: 29304835 PMCID: PMC5756384 DOI: 10.1186/s12885-017-3813-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 11/21/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Interventions to improve fecal testing for colorectal cancer (CRC) exist, but are not yet routine practice. We conducted this systematic review to determine how implementation strategies and contextual factors influenced the uptake of interventions to increase Fecal Immunochemical Tests (FIT) and Fecal Occult Blood Testing (FOBT) for CRC in rural and low-income populations in the United States. METHODS We searched Medline and the Cochrane Library from January 1998 through July 2016, and Scopus and clinicaltrials.gov through March 2015, for original articles of interventions to increase fecal testing for CRC. Two reviewers independently screened abstracts, reviewed full-text articles, extracted data and performed quality assessments. A qualitative synthesis described the relationship between changes in fecal testing rates for CRC, intervention components, implementation strategies, and contextual factors. A technical expert panel of primary care professionals, health system leaders, and academicians guided this work. RESULTS Of 4218 citations initially identified, 27 unique studies reported in 29 publications met inclusion criteria. Studies were conducted in primary care (n = 20, 74.1%), community (n = 5, 18.5%), or both (n = 2, 7.4%) settings. All studies (n = 27, 100.0%) described multicomponent interventions. In clinic based studies, components that occurred most frequently among the highly effective/effective study arms were provision of kits by direct mail, use of a pre-addressed stamped envelope, client reminders, and provider ordered in-clinic distribution. Interventions were delivered by clinic staff/community members (n = 10, 37.0%), research staff (n = 6, 22.2%), both (n = 10, 37.0%), or it was unclear (n = 1, 3.7%). Over half of the studies lacked information on training or monitoring intervention fidelity (n = 15, 55.6%). CONCLUSIONS Studies to improve FIT/FOBT in rural and low-income populations utilized multicomponent interventions. The provision of kits through the mail, use of pre-addressed stamped envelopes, client reminders and in-clinic distribution appeared most frequently in the highly effective/effective clinic-based study arms. Few studies described contextual factors or implementation strategies. More robust application of guidelines to support reporting on methods to select, adapt and implement interventions can help end users determine not just which interventions work to improve CRC screening, but which interventions would work best in their setting given specific patient populations, clinical settings, and community characteristics. TRIAL REGISTRATION In accordance with PRISMA guidelines, our systematic review protocol was registered with PROSPERO, the international prospective register of systematic reviews, on April 16, 2015 (registration number CRD42015019557 ).
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Affiliation(s)
- Melinda M. Davis
- Oregon Rural Practice-based Research Network (ORPRN), Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail Code: L222, Portland, 97239 OR USA
- Department of Family Medicine & OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR USA
| | - Michele Freeman
- VA Evidence-based Synthesis Program, Portland VA Medical Center, Portland, OR USA
| | - Jackilen Shannon
- OHSU-PSU School of Public Health and Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland, OR USA
| | | | - Kurt C. Stange
- Center for Community Health Integration, Departments of Family Medicine & Community Health, Population & Quantitative Health Sciences, Sociology, and the Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH USA
| | - Jeanne-Marie Guise
- Departments of Obstetrics & Gynecology, Medical Informatics and Clinical Epidemiology, and Emergency Medicine and the OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR USA
| | - Stephanie B. Wheeler
- Department of Health Policy & Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC USA
| | - David I. Buckley
- Departments of Family Medicine, Medical Informatics and Clinical Epidemiology, Public Health & Preventive Medicine, Oregon Health & Science University, Portland, OR USA
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Edwards ST, Peterson K, Chan B, Anderson J, Helfand M. Effectiveness of Intensive Primary Care Interventions: A Systematic Review. J Gen Intern Med 2017; 32:1377-1386. [PMID: 28924747 PMCID: PMC5698228 DOI: 10.1007/s11606-017-4174-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/28/2017] [Accepted: 08/18/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Multicomponent, interdisciplinary intensive primary care programs target complex patients with the goal of preventing hospitalizations, but programs vary, and their effectiveness is not clear. In this study, we systematically reviewed the impact of intensive primary care programs on all-cause mortality, hospitalization, and emergency department use. METHODS We searched PubMed, CINAHL, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Reviews of Effects from inception to March 2017. Additional studies were identified from reference lists, hand searching, and consultation with content experts. We included systematic reviews, randomized controlled trials (RCTs), and observational studies of multicomponent, interdisciplinary intensive primary care programs targeting complex patients at high risk of hospitalization or death, with a comparison to usual primary care. Two investigators identified studies and abstracted data using a predefined protocol. Study quality was assessed using the Cochrane risk of bias tool. RESULTS A total of 18 studies (379,745 participants) were included. Three major intensive primary care program types were identified: primary care replacement (home-based; three RCTs, one observational study, N = 367,681), primary care replacement (clinic-based; three RCTs, two observational studies, N = 9561), and primary care augmentation, in which an interdisciplinary team was added to existing primary care (five RCTs, three observational studies, N = 2503). Most studies showed no impact of intensive primary care on mortality or emergency department use, and the effectiveness in reducing hospitalizations varied. There were no adverse effects reported. DISCUSSION Intensive primary care interventions demonstrated varying effectiveness in reducing hospitalizations, and there was limited evidence that these interventions were associated with changes in mortality. While interventions could be grouped into categories, there was still substantial overlap between intervention approaches. Further work is needed to identify program features that may be associated with improved outcomes.
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Affiliation(s)
- Samuel T Edwards
- Section of General Internal Medicine, VA Portland Health Care System, Portland, OR, USA. .,Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA. .,Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA. .,Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA.
| | - Kim Peterson
- Evidence-based Synthesis Program (ESP) Coordinating Center, VA Portland Health Care System, Portland, OR, USA
| | - Brian Chan
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - Johanna Anderson
- Evidence-based Synthesis Program (ESP) Coordinating Center, VA Portland Health Care System, Portland, OR, USA
| | - Mark Helfand
- Section of General Internal Medicine, VA Portland Health Care System, Portland, OR, USA.,Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.,Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA.,Evidence-based Synthesis Program (ESP) Coordinating Center, VA Portland Health Care System, Portland, OR, USA
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25
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Voruganti T, Grunfeld E, Makuwaza T, Bender JL. Web-Based Tools for Text-Based Patient-Provider Communication in Chronic Conditions: Scoping Review. J Med Internet Res 2017; 19:e366. [PMID: 29079552 PMCID: PMC5681721 DOI: 10.2196/jmir.7987] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/24/2017] [Indexed: 01/30/2023] Open
Abstract
Background Patients with chronic conditions require ongoing care which not only necessitates support from health care providers outside appointments but also self-management. Web-based tools for text-based patient-provider communication, such as secure messaging, allow for sharing of contextual information and personal narrative in a simple accessible medium, empowering patients and enabling their providers to address emerging care needs. Objective The objectives of this study were to (1) conduct a systematic search of the published literature and the Internet for Web-based tools for text-based communication between patients and providers; (2) map tool characteristics, their intended use, contexts in which they were used, and by whom; (3) describe the nature of their evaluation; and (4) understand the terminology used to describe the tools. Methods We conducted a scoping review using the MEDLINE (Medical Literature Analysis and Retrieval System Online) and EMBASE (Excerpta Medica Database) databases. We summarized information on the characteristics of the tools (structure, functions, and communication paradigm), intended use, context and users, evaluation (study design and outcomes), and terminology. We performed a parallel search of the Internet to compare with tools identified in the published literature. Results We identified 54 papers describing 47 unique tools from 13 countries studied in the context of 68 chronic health conditions. The majority of tools (77%, 36/47) had functions in addition to communication (eg, viewable care plan, symptom diary, or tracker). Eight tools (17%, 8/47) were described as allowing patients to communicate with the team or multiple health care providers. Most of the tools were intended to support communication regarding symptom reporting (49%, 23/47), and lifestyle or behavior modification (36%, 17/47). The type of health care providers who used tools to communicate with patients were predominantly allied health professionals of various disciplines (30%, 14/47), nurses (23%, 11/47), and physicians (19%, 9/47), among others. Over half (52%, 25/48) of the tools were evaluated in randomized controlled trials, and 23 tools (48%, 23/48) were evaluated in nonrandomized studies. Terminology of tools varied by intervention type and functionality and did not consistently reflect a theme of communication. The majority of tools found in the Internet search were patient portals from 6 developers; none were found among published articles. Conclusions Web-based tools for text-based patient-provider communication were identified from a wide variety of clinical contexts and with varied functionality. Tools were most prevalent in contexts where intended use was self-management. Few tools for team-based communication were found, but this may become increasingly important as chronic disease care becomes more interdisciplinary.
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Affiliation(s)
- Teja Voruganti
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Eva Grunfeld
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Tutsirai Makuwaza
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Jacqueline L Bender
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,ELLICSR Health, Wellness & Cancer Survivorship Centre, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON, Canada
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26
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Viswanathan M, McPheeters ML, Murad MH, Butler ME, Devine EEB, Dyson MP, Guise JM, Kahwati LC, Miles JNV, Morton SC. AHRQ series on complex intervention systematic reviews-paper 4: selecting analytic approaches. J Clin Epidemiol 2017; 90:28-36. [PMID: 28720515 PMCID: PMC10906111 DOI: 10.1016/j.jclinepi.2017.06.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 05/28/2017] [Accepted: 06/08/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Systematic reviews of complex interventions can vary widely in purpose, data availability and heterogeneity, and stakeholder expectations. RATIONALE This article addresses the uncertainty that systematic reviewers face in selecting methods for reviews of complex interventions. Specifically, it lays out parameters for systematic reviewers to consider when selecting analytic approaches that best answer the questions at hand and suggests analytic techniques that may be appropriate in different circumstances. DISCUSSION Systematic reviews of complex interventions comprising multiple questions may use multiple analytic approaches. Parameters to consider when choosing analytic methods for complex interventions include nature and timing of the decision (clinical practice guideline, policy, or other); purpose of the review; extent of existing evidence; logistic factors such as the timeline, process, and resources for deciding the scope of the review; and value of information to be obtained from choosing specific systematic review methods. Reviewers may elect to revise their analytic approach based on new or changing considerations during the course of the review but should guard against bias through transparency of reporting.
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Affiliation(s)
- Meera Viswanathan
- RTI International, 3040 East Cornwallis Road, Durham, NC 27709, USA.
| | | | - M Hassan Murad
- Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Mary E Butler
- University of Minnesota School of Public Health, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Emily E Beth Devine
- Department of Pharmacy, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195-7630, USA
| | - Michele P Dyson
- Aberhart Centre, University of Alberta, 11402 University Avenue, Edmonton, AB T6G 2J3, USA
| | - Jeanne-Marie Guise
- Oregon Health & Science University-Portland State University School of Public Health, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Leila C Kahwati
- RTI International, 3040 East Cornwallis Road, Durham, NC 27709, USA
| | | | - Sally C Morton
- College of Science Office of the Dean, Virginia Polytechnic Institute and State University, 300 Turner Street NW, Blacksburg, VA 24061, USA
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27
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Guise JM, Butler ME, Chang C, Viswanathan M, Pigott T, Tugwell P. AHRQ series on complex intervention systematic reviews—paper 6: PRISMA-CI extension statement and checklist. J Clin Epidemiol 2017; 90:43-50. [DOI: 10.1016/j.jclinepi.2017.06.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 05/03/2017] [Accepted: 06/09/2017] [Indexed: 10/19/2022]
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28
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Allaouat S, Roustaei Z, Verbeek J, Ruotsalainen J. Five indicators were developed to assess the quality of reviews on preventive interventions. J Clin Epidemiol 2017; 92:89-98. [PMID: 28870872 DOI: 10.1016/j.jclinepi.2017.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 08/09/2017] [Accepted: 08/25/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The objective of the study was to develop quality indicators for preventive effectiveness and to evaluate their use with Cochrane Reviews of primary preventive interventions. STUDY DESIGN AND SETTING Based on the quality of care framework, we searched the literature to develop a set of quality indicators. Two authors applied the quality indicators independently to a sample of Cochrane systematic reviews of primary prevention. RESULTS Five quality indicators were developed: sample size, directness of evidence, adherence, harm, and costs. We applied the quality indicators to a random sample of 84 of a total of 264 Cochrane reviews of primary preventive interventions. Only 70% reviews (n = 59) complied with the indicator sample size, whereas 61% (n = 51) complied with directness of the outcome, 48% (n = 40) with adherence, 76% (n = 64) with harm, and 46% (n = 39) with the indicator cost. CONCLUSION Applying the five quality indicators is feasible. The quality of evidence in reviews of primary prevention can be substantially improved. Trialists and review authors should provide more information especially on adherence, costs, and indirectness of the outcome. Methodological research is needed on how to incorporate cost information in systematic reviews and how to better deal with indirectness.
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Affiliation(s)
- Sara Allaouat
- Cochrane Work, Finnish Institute of Occupational Health, PO Box 310, 70701 Kuopio, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO Box 1627 FI, Kuopio 70211, Finland.
| | - Zahra Roustaei
- Cochrane Work, Finnish Institute of Occupational Health, PO Box 310, 70701 Kuopio, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO Box 1627 FI, Kuopio 70211, Finland
| | - Jos Verbeek
- Cochrane Work, Finnish Institute of Occupational Health, PO Box 310, 70701 Kuopio, Finland
| | - Jani Ruotsalainen
- Cochrane Work, Finnish Institute of Occupational Health, PO Box 310, 70701 Kuopio, Finland
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Guise JM, Chang C, Butler M, Viswanathan M, Tugwell P. AHRQ series on complex intervention systematic reviews-paper 1: an introduction to a series of articles that provide guidance and tools for reviews of complex interventions. J Clin Epidemiol 2017; 90:6-10. [PMID: 28720511 DOI: 10.1016/j.jclinepi.2017.06.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 05/03/2017] [Accepted: 06/08/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Jeanne-Marie Guise
- Department of Obstetrics & Gynecology, Oregon Health & Science University School of Medicine, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Department of Medical Informatics & Outcomes Research School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Department of Emergency Medicine, Oregon Health & Science University School of Medicine, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Oregon Health & Science University, Portland State University School of Public Health, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Christine Chang
- Agency for Healthcare Research & Quality, 5600 Fishers Lane, Mailstop 06E53A, Rockville, MD 20857, USA
| | - Mary Butler
- University of Minnesota School of Public Health, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Meera Viswanathan
- RTI International, 3040 East Cornwallis Road, Research Triangle-Park, NC 27709, USA
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, 43 Bruyère Street, Annex E, Room 304, Ottawa, Ontario, Canada K1N 5C8
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30
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AHRQ series on complex intervention systematic reviews-paper 3: adapting frameworks to develop protocols. J Clin Epidemiol 2017; 90:19-27. [PMID: 28720510 DOI: 10.1016/j.jclinepi.2017.06.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 05/17/2017] [Accepted: 06/08/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Once a proposed topic has been identified for a systematic review and has undergone a question formulation stage, a protocol must be developed that specifies the scope and research questions in detail and outlines the methodology for conducting the systematic review. RATIONALE Framework modifications are often needed to accommodate increased complexity. We describe and give examples of adaptations and alternatives to traditional analytic frameworks. DISCUSSION This article identifies and describes elements of frameworks and how they can be adapted to inform the protocol and conduct of systematic reviews of complex interventions. Modifications may be needed to adapt the population, intervention, comparators, and outcomes normally used in protocol development to successfully describe complex interventions; in some instances, alternative frameworks may be better suited. Possible approaches to analytic frameworks for complex interventions that illustrate causal and associative linkages are outlined, including time elements, which systematic reviews of complex interventions may need to address. The need for and specifics of the accommodations vary with details of a specific systematic review. This in turn helps determine whether traditional frameworks are sufficient, can be refined, or if alternate frameworks must be adopted.
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31
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Guise JM, Butler M, Chang C, Viswanathan M, Pigott T, Tugwell P. AHRQ series on complex intervention systematic reviews-paper 7: PRISMA-CI elaboration and explanation. J Clin Epidemiol 2017; 90:51-58. [PMID: 28720513 DOI: 10.1016/j.jclinepi.2017.06.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 05/03/2017] [Accepted: 06/09/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Complex interventions are widely used in health care, public health, education, criminology, social work, business, and welfare. They have increasingly become the subject of systematic reviews and are challenging to effectively report. The Complex Interventions Methods Workgroup developed an extension to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Complex Interventions (PRISMA-CI). RATIONALE Following the EQUATOR Network guidance for Preferred Reporting Items for Systematic Reviews and Meta-Analysis extensions, this Explanation and Elaboration (EE) document accompanies the PRISMA-CI checklist to promote consistency in reporting of systematic reviews of complex interventions. DISCUSSIONS The EE document explains the meaning and rationale for each unique PRISMA-CI checklist item and provides examples to assist systematic review authors in operationalizing PRISMA-CI guidance. The Complex Interventions Workgroup developed PRISMA-CI as an important start toward increased consistency in reporting of systematic reviews of complex interventions. Because the field is rapidly expanding, the Complex Interventions Methods Workgroup plans to re-evaluate periodically for the need to add increasing specificity and examples as the field matures.
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Affiliation(s)
- Jeanne-Marie Guise
- Department of Obstetrics & Gynecology, Oregon Health & Science University School of Medicine, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Department of Medical Informatics & Outcomes Research School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Department of Emergency Medicine, Oregon Health & Science University School of Medicine, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Oregon Health & Science University-Portland State University School of Public Health, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Mary Butler
- University of Minnesota School of Public Health, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Christine Chang
- Agency for Healthcare Research & Quality, 5600 Fishers Lane, Mailstop 06E53A, Rockville, MD 20857, USA
| | - Meera Viswanathan
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Terri Pigott
- School of Education, Loyola University Chicago, 111 E. Pearson Avenue, Chicago, IL 60614, USA
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, 43 Bruyère Street, Annex E, Room 304, Ottawa, Ontario K1N 5C8 D, Canada
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Kelly MP, Noyes J, Kane RL, Chang C, Uhl S, Robinson KA, Springs S, Butler ME, Guise JM. AHRQ series on complex intervention systematic reviews-paper 2: defining complexity, formulating scope, and questions. J Clin Epidemiol 2017; 90:11-18. [PMID: 28720514 DOI: 10.1016/j.jclinepi.2017.06.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 05/10/2017] [Accepted: 06/08/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The early stages of a systematic review set the scope and expectations. This can be particularly challenging for complex interventions given their multidimensional and dynamic nature. RATIONALE This paper builds on concepts introduced in paper 1 of this series. It describes the methodological, practical, and philosophical challenges and potential approaches for formulating the questions and scope of systematic reviews of complex interventions. Furthermore, it discusses the use of theory to help organize reviews of complex interventions. DISCUSSION Many interventions in medicine, public health, education, social services, behavioral health, and community programs are complex, and they may not fit neatly within the established paradigm for reviews of straightforward interventions. This paper provides conceptual and operational guidance for these early stages of scope formulation to assist authors of systematic reviews of complex interventions.
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Affiliation(s)
- Michael P Kelly
- Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, Forvie Site, Cambridge, CB2 0SR, UK.
| | - Jane Noyes
- School of Social Sciences, Bangor University, Bangor, Gwynedd, LL57 2DG, UK
| | - Robert L Kane
- Minnesota Chair in Long-term Care and Aging, University of Minnesota School of Public Health. Minnesota Evidence-based Practice Center, D381 Mayo (MMC 197), 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Christine Chang
- AHRQ's Evidence-based Practice Center Program, 5600 Fishers Lane, Rockville, MD 20857, USA
| | - Stacey Uhl
- ECRI Institute, 5200 Butler Pike, Plymouth Meeting, PA 19462-1298, USA
| | - Karen A Robinson
- Johns Hopkins University Evidence-based Practice Center, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Stacey Springs
- Center for Evidence Synthesis in Health, Brown University, Box G-S121-8, School of Public Health, Providence, RI 02912, USA
| | - Mary E Butler
- University of Minnesota School of Public Health, Minnesota Evidence-based Practice Center, D381 Mayo (MMC 197), 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Jeanne-Marie Guise
- Scientific Resource Center for the AHRQ Effective Health Care Program, Department of Obstetrics & Gynecology, Oregon Health & Science University School of Medicine, Department of Medical Informatics & Outcomes Research School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239, USA; Department of Emergency Medicine, Oregon Health & Science University School of Medicine, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239, USA; Oregon Health & Science University-Portland State University School of Public Health, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239, USA
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Kane RL, Butler M, Ng W. Examining the quality of evidence to support the effectiveness of interventions: an analysis of systematic reviews. BMJ Open 2016; 6:e011051. [PMID: 27154482 PMCID: PMC4861106 DOI: 10.1136/bmjopen-2016-011051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This analysis examines the quality of evidence (QOE) for 1472 outcomes linked to interventions where the QOE was rated in 42 systematic reviews of randomised clinical trials and/or observational studies across different topics. SETTING Not applicable. PARTICIPANTS 76 systematic reviews. PRIMARY AND SECONDARY OUTCOME MEASURES Strength of evidence ratings by initial reviewers. RESULTS Among 76 systematic reviews, QOE ratings were available for only 42, netting 1472 comparisons. Of these, 57% included observational studies; 4% were rated as high and 12% as moderate; the rest were low or insufficient. The ratings varied by topic: 74% of the surgical study pairs were rated as low or insufficient, compared with 82% of pharmaceuticals and 86% of device studies, 88% of organisational, 91% of lifestyle studies, and 94% of psychosocial interventions. CONCLUSIONS We are some distance from being able to claim evidence-based practice. The press for individual-level data will make this challenge even harder.
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Affiliation(s)
- Robert L Kane
- Minnesota Evidence-based Practice Center, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Mary Butler
- Minnesota Evidence-based Practice Center, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Weiwen Ng
- Health Services Research, Policy, and Administration, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
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Kahwati L, Jacobs S, Kane H, Lewis M, Viswanathan M, Golin CE. Using qualitative comparative analysis in a systematic review of a complex intervention. Syst Rev 2016; 5:82. [PMID: 27209206 PMCID: PMC4875617 DOI: 10.1186/s13643-016-0256-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 04/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systematic reviews evaluating complex interventions often encounter substantial clinical heterogeneity in intervention components and implementation features making synthesis challenging. Qualitative comparative analysis (QCA) is a non-probabilistic method that uses mathematical set theory to study complex phenomena; it has been proposed as a potential method to complement traditional evidence synthesis in reviews of complex interventions to identify key intervention components or implementation features that might explain effectiveness or ineffectiveness. The objective of this study was to describe our approach in detail and examine the suitability of using QCA within the context of a systematic review. METHODS We used data from a completed systematic review of behavioral interventions to improve medication adherence to conduct two substantive analyses using QCA. The first analysis sought to identify combinations of nine behavior change techniques/components (BCTs) found among effective interventions, and the second analysis sought to identify combinations of five implementation features (e.g., agent, target, mode, time span, exposure) found among effective interventions. For each substantive analysis, we reframed the review's research questions to be designed for use with QCA, calibrated sets (i.e., transformed raw data into data used in analysis), and identified the necessary and/or sufficient combinations of BCTs and implementation features found in effective interventions. RESULTS Our application of QCA for each substantive analysis is described in detail. We extended the original review findings by identifying seven combinations of BCTs and four combinations of implementation features that were sufficient for improving adherence. We found reasonable alignment between several systematic review steps and processes used in QCA except that typical approaches to study abstraction for some intervention components and features did not support a robust calibration for QCA. CONCLUSIONS QCA was suitable for use within a systematic review of medication adherence interventions and offered insights beyond the single dimension stratifications used in the original completed review. Future prospective use of QCA during a review is needed to determine the optimal way to efficiently integrate QCA into existing approaches to evidence synthesis of complex interventions.
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Affiliation(s)
- Leila Kahwati
- RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709, USA.
| | - Sara Jacobs
- RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709, USA
| | - Heather Kane
- RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709, USA
| | - Megan Lewis
- RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709, USA
| | - Meera Viswanathan
- RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709, USA
| | - Carol E Golin
- Departments of Medicine and Health Behavior, University of North Carolina, Chapel Hill, NC, USA
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Movsisyan A, Melendez-Torres GJ, Montgomery P. Outcomes in systematic reviews of complex interventions never reached "high" GRADE ratings when compared with those of simple interventions. J Clin Epidemiol 2016; 78:22-33. [PMID: 27038850 DOI: 10.1016/j.jclinepi.2016.03.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 03/04/2016] [Accepted: 03/21/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate the application of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and the quality of evidence ratings in systematic reviews of complex interventions. STUDY DESIGN AND SETTING This study examined all 40 systematic reviews published in three Cochrane Review Groups from 2013 to May 2014: Cochrane Developmental, Psychosocial and Learning Problems Group (CDPLPG); Cochrane Public Health Group (CPHG); and Cochrane Depression, Anxiety, and Neurosis Group (CCDAN). The reviews were coded and classified into "complex" (n = 24) and "simple" (n = 16) intervention review groups based on the predefined complexity dimensions from the extant literature mapped into the PICOTS framework. All the data were analyzed in these two groups to help identify specific patterns of the GRADE ratings in the reviews of complex interventions. RESULTS Outcomes of complex intervention reviews had higher proportions of "very low" quality of evidence ratings compared with those of simple intervention reviews (37.5% vs. 9.1% for the primary benefit outcomes) and were more frequently downgraded for inconsistency, performance bias, and study design. None of the outcomes of complex intervention reviews (0%) were given "high" GRADE ratings. CONCLUSION Results suggest that the GRADE assessment may not adequately describe the evidence base of complex interventions.
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Affiliation(s)
- Ani Movsisyan
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford OX1 2ER, UK.
| | - G J Melendez-Torres
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford OX1 2ER, UK
| | - Paul Montgomery
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 Wellington Square, Oxford OX1 2ER, UK
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Caldwell DM, Welton NJ. Approaches for synthesising complex mental health interventions in meta-analysis. EVIDENCE-BASED MENTAL HEALTH 2016; 19:16-21. [PMID: 26792834 PMCID: PMC10699336 DOI: 10.1136/eb-2015-102275] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 11/16/2015] [Accepted: 11/19/2015] [Indexed: 12/17/2022]
Abstract
Clinical and statistical heterogeneity are commonplace in meta-analysis of mental health interventions. One possible source of this heterogeneity is the complexity of the intervention being evaluated. Complexity may relate to the intervention, or to the way in which it is implemented; however, the most common interpretation of a complex intervention is one which has multiple, potentially interacting components. In this article we outline different analytical strategies suggested for incorporating intervention complexity in a meta-analysis.
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Affiliation(s)
- Deborah M Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Nicky J Welton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Yue CY, Yang CZ, Liu CY, Yang Y. Meta-analysis of relationship between Helicobacter pylori infection and level of insulin resistance. Shijie Huaren Xiaohua Zazhi 2015; 23:5238-5249. [DOI: 10.11569/wcjd.v23.i32.5238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the association between Helicobacter pylori (H. pylori) infection and level of insulin resistance (IR).
METHODS: The articles on the association of H. pylori with IR level were retrieved by searching databases from the inception of each database to July 2015. Data extraction and quality assessment were completed by two authors. Meta-analysis was performed using RevMan 5.3 software.
RESULTS: Seven papers with nine studies were included for meta-analysis. A total of 3097 patients, including 1718 H. pylori (+) subjects, were involved. The results of Meta-analysis showed that there was a significant difference in insulin resistance levels between patients with H. pylori infection and those without in the overall population (WMD = 0.38, 95%CI: 0.13-0.64, P < 0.05). Subgroup analysis indicated that the significant difference in insulin resistance levels between patients with H. pylori infection and those without existed in patients aged < 45 years (WMD = 0.63, 95%CI: 0.40-0.86, P < 0.05), those who underwent endoscopic biopsy (WMD = 0.70, 95%CI: 0.46-0.94, P < 0.05), those who had a body mass index (BMI) < 25 kg/m2 (WMD = 0.72, 95%CI:0.49-0.96, P < 0.05), and Asian patients (WMD = 0.66, 95%CI: 0.44-0.87, P < 0.05), but not in patients aged ≥ 45 years, those who underwent serum H. pylori-IgG antibody testing, those who had a BMI ≥ 25 kg/m2, or American patients. The results of publication bias and sensitivity analysis confirmed the reliability and stability of this Meta-analysis.
CONCLUSION: H. pylori infection is associated with elevated insulin resistance.
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Bleich SN, Sherrod C, Chiang A, Boyd C, Wolff J, DuGoff E, Chang E, Salzberg C, Anderson K, Leff B, Anderson G. Systematic Review of Programs Treating High-Need and High-Cost People With Multiple Chronic Diseases or Disabilities in the United States, 2008-2014. Prev Chronic Dis 2015; 12:E197. [PMID: 26564013 PMCID: PMC4651160 DOI: 10.5888/pcd12.150275] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Finding ways to provide better and less expensive health care for people with multiple chronic conditions or disability is a pressing concern. The purpose of this systematic review was to evaluate different approaches for caring for this high-need and high-cost population. Methods We searched Medline for articles published from May 31, 2008, through June 10, 2014, for relevant studies. Articles were considered eligible for this review if they met the following criteria: included people with multiple chronic conditions (behavioral or mental health) or disabilities (2 or more); addressed 1 or more of clinical outcomes, health care use and spending, or patient satisfaction; and compared results from an intervention group with a comparison group or baseline measurements. We extracted information on program characteristics, participant characteristics, and significant (positive and negative) clinical findings, patient satisfaction, and health care use outcomes. For each outcome, the number of significant and positive results was tabulated. Results Twenty-seven studies were included across 5 models of care. Of the 3 studies reporting patient satisfaction outcomes, 2 reported significant improvements; both were randomized controlled trials (RCTs). Of the 14 studies reporting clinical outcomes, 12 reported improvements (8 were RCTs). Of the 13 studies reporting health care use and spending outcomes, 12 reported significant improvements (2 were RCTs). Two models of care — care and case management and disease management — reported improvements in all 3 outcomes. For care and case management models, most improvements were related to health care use. For the disease management models, most improvements were related to clinical outcomes. Conclusions Care and case management as well as disease management may be promising models of care for people with multiple chronic conditions or disabilities. More research and consistent methods are needed to understand the most appropriate care for these high-need and high-cost patients.
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Affiliation(s)
- Sara N Bleich
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Cheryl Sherrod
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Anne Chiang
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Cynthia Boyd
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer Wolff
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Eva Chang
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Claudia Salzberg
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Keely Anderson
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Bruce Leff
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gerard Anderson
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, Room 302, Baltimore, MD 21205.
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Han JH, Sullivan N, Leas BF, Pegues DA, Kaczmarek JL, Umscheid CA. Cleaning Hospital Room Surfaces to Prevent Health Care-Associated Infections: A Technical Brief. Ann Intern Med 2015; 163:598-607. [PMID: 26258903 PMCID: PMC4812669 DOI: 10.7326/m15-1192] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
The cleaning of hard surfaces in hospital rooms is critical for reducing health care-associated infections. This review describes the evidence examining current methods of cleaning, disinfecting, and monitoring cleanliness of patient rooms, as well as contextual factors that may affect implementation and effectiveness. Key informants were interviewed, and a systematic search for publications since 1990 was done with the use of several bibliographic and gray literature resources. Studies examining surface contamination, colonization, or infection with Clostridium difficile, methicillin-resistant Staphylococcus aureus, or vancomycin-resistant enterococci were included. Eighty studies were identified-76 primary studies and 4 systematic reviews. Forty-nine studies examined cleaning methods, 14 evaluated monitoring strategies, and 17 addressed challenges or facilitators to implementation. Only 5 studies were randomized, controlled trials, and surface contamination was the most commonly assessed outcome. Comparative effectiveness studies of disinfecting methods and monitoring strategies were uncommon. Future research should evaluate and compare newly emerging strategies, such as self-disinfecting coatings for disinfecting and adenosine triphosphate and ultraviolet/fluorescent surface markers for monitoring. Studies should also assess patient-centered outcomes, such as infection, when possible. Other challenges include identifying high-touch surfaces that confer the greatest risk for pathogen transmission; developing standard thresholds for defining cleanliness; and using methods to adjust for confounders, such as hand hygiene, when examining the effect of disinfecting methods.
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Affiliation(s)
- Jennifer H. Han
- From Perelman School of Medicine, University of Pennsylvania, and Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, and ECRI Institute–Penn Medicine Evidence-based Practice Center, Plymouth Meeting, Pennsylvania
| | - Nancy Sullivan
- From Perelman School of Medicine, University of Pennsylvania, and Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, and ECRI Institute–Penn Medicine Evidence-based Practice Center, Plymouth Meeting, Pennsylvania
| | - Brian F. Leas
- From Perelman School of Medicine, University of Pennsylvania, and Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, and ECRI Institute–Penn Medicine Evidence-based Practice Center, Plymouth Meeting, Pennsylvania
| | - David A. Pegues
- From Perelman School of Medicine, University of Pennsylvania, and Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, and ECRI Institute–Penn Medicine Evidence-based Practice Center, Plymouth Meeting, Pennsylvania
| | - Janice L. Kaczmarek
- From Perelman School of Medicine, University of Pennsylvania, and Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, and ECRI Institute–Penn Medicine Evidence-based Practice Center, Plymouth Meeting, Pennsylvania
| | - Craig A. Umscheid
- From Perelman School of Medicine, University of Pennsylvania, and Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia, and ECRI Institute–Penn Medicine Evidence-based Practice Center, Plymouth Meeting, Pennsylvania
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40
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Martinez C, Fernandez E. Commentary on Pardavila-Belio et al. (2015): Reporting on randomized control trials or giving details on how the cake was made--the list of ingredients and the implementation process. Addiction 2015; 110:1684-5. [PMID: 26350715 DOI: 10.1111/add.13046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/07/2015] [Indexed: 12/26/2022]
Affiliation(s)
- Cristina Martinez
- Tobacco Control Research Unit, Cancer Prevention and Control Department, Catalan Institute of Oncology-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Esteve Fernandez
- Tobacco Control Research Unit, Cancer Prevention and Control Department, Catalan Institute of Oncology-Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
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41
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Köhm M, Behrens F. [Pharmacotherapy of psoriatic arthritis. Treatment recommendations against the background of limited evidence]. Z Rheumatol 2015; 74:398-405. [PMID: 26085072 DOI: 10.1007/s00393-014-1530-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
International treatment recommendations for assisting the choice of pharmaceutical treatment of psoriatic arthritis are currently available in two different versions. While the group for research and assessment of psoriasis and psoriatic arthritis (GRAPPA) recommendations mainly focus on both the description of treatment options for the different phenotypes of psoriatic arthritis and the listing of evidence grades, the European League against Rheumatism (EULAR) recommendations try to implement the knowledge about drugs into an algorithm for the different treatment steps. However, the presentation of a treatment algorithm suggests comparable evidence levels for the individual treatment steps, which is at present not the case for psoriatic arthritis. This should be borne in mind for each individual treatment option and treatment step when using a predetermined therapy algorithm and in view of the heterogeneous study results (or no study results available). Both recommendations are currently being revised and will allow the latest evidence trends to be included in the updated version.
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Affiliation(s)
- M Köhm
- Abteilung Rheumatologie, Universitätsklinikum der Goethe-Universität Frankfurt/Main, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
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Möhler R, Köpke S, Meyer G. Criteria for Reporting the Development and Evaluation of Complex Interventions in healthcare: revised guideline (CReDECI 2). Trials 2015; 16:204. [PMID: 25935741 PMCID: PMC4461976 DOI: 10.1186/s13063-015-0709-y] [Citation(s) in RCA: 197] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 04/08/2015] [Indexed: 01/23/2023] Open
Abstract
Background Many healthcare interventions are of complex nature, consisting of several interacting components. Complex interventions are often described inadequately. A reporting guideline for complex interventions was published in 2012 (Criteria for Reporting the Development and Evaluation of Complex Interventions in healthcare, CReDECI) and was recently checked for its practicability. The reporting guideline was developed following the recommendations of the EQUATOR network but excluding a formal consensus process. Therefore, a consensus process was initiated, to revise the reporting guideline. Methods We used a three-phase consensus process consisting of (1) a web-based feedback survey on the published reporting guideline, (2) a face-to-face consensus conference, and (3) a final online review and feedback round to create the revised CReDECI. The consensus process was organized and conducted via the REFLECTION network. Results A total of 45 attendees from 16 European countries took part in the face-to-face consensus conference. The revised reporting guideline (CReDECI 2) comprises 13 items on three stages: development, feasibility and piloting, and evaluation of a complex intervention. Each item is illustrated by an explanation and an example. In contrast with most of the available reporting guidelines, CReDECI 2 does not focus on a specific study design, to reflect the use of different qualitative and quantitative designs and methods in the development and evaluation of complex interventions. Conclusions CReDECI 2 is a formally consented reporting guideline aiming to improve the reporting quality of the development and evaluation stages of complex interventions in healthcare. Since the guideline does not focus on a specific study design, design-specific reporting guidelines may additionally be used. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0709-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ralph Möhler
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Stockumer Straße 12, D-58453, Witten, Germany. .,Institute of Health and Nursing Science, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 8, D-06112, Halle (Saale), Germany.
| | - Sascha Köpke
- Nursing Research Unit, Institute of Social Medicine, University of Lübeck, Ratzeburger Allee 160, D-23538, Lübeck, Germany.
| | - Gabriele Meyer
- Institute of Health and Nursing Science, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Magdeburger Straße 8, D-06112, Halle (Saale), Germany.
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