1
|
Knopp-Sihota JA, MacGregor T, Nuspl M, Reeves J, Kennedy M. Healthcare aide-focused interventions to improve pain management in long-term care homes: A systematic review. Arch Gerontol Geriatr 2023; 104:104808. [PMID: 36137462 DOI: 10.1016/j.archger.2022.104808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 08/19/2022] [Accepted: 09/04/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Pain is common in long-term care residents. We examined the effectiveness of interventions involving healthcare aides that aim to manage pain for these residents. DESIGN A systematic review which follows PRISMA reporting guidelines. SETTING AND PARTICIPANTS We examined controlled trials and intervention studies that included long-term care residents aged ≥60 years who received interventions to reduce chronic pain. Interventions were either delivered by healthcare aides at the resident level or were directed at healthcare aides to improve their pain management practices for residents. METHODS We searched 7 databases to identify relevant studies. After screening 400 articles, we reviewed 131 full-text articles and included them if they reported a pain management intervention and measured pain with a standardized pain scale. Data were synthesized narratively. Risk of bias was assessed using the Mixed Methods Assessment Tool. RESULTS In total, 9 studies were examined in the narrative review. Six studies described pain interventions involving education, new pain protocols and/or new assessment tools delivered to healthcare aides. Three studies described pain interventions delivered by healthcare aides to residents, which included a new incontinence care routine, light touch massage, and a bathing intervention. CONCLUSIONS AND IMPLICATIONS Interventions involving healthcare aides may be beneficial to pain management for long-term care residents as they have the potential to reduce residents' pain and improve both pain assessment and reporting practices. Further research is warranted on specific elements that contribute to an improvement in residents' pain and to the overall role of healthcare aides care of residents.
Collapse
Affiliation(s)
- Jennifer A Knopp-Sihota
- Faculty of Health Disciplines, Athabasca University, Translating Research in Elder Care (TREC) Program, Faculty of Nursing, University of Alberta, 1 University Drive, Edmonton, AB, Canada.
| | - Tara MacGregor
- Translating Research in Elder Care (TREC) Program, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Megan Nuspl
- Translating Research in Elder Care (TREC) Program, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Jennifer Reeves
- Research in Elder Care (TREC) Program, Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Megan Kennedy
- Public Services Librarian, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
2
|
Knopp-Sihota J, Nuspl M, MacGregor T, Reeves J, Saleem A. HEALTHCARE AIDE-FOCUSED INTERVENTIONS TO IMPROVE PAIN MANAGEMENT IN LONG-TERM CARE. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.2035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Pain is endemic for residents of long-term care homes, with many residents experiencing pain daily. Given that healthcare aides provide most daily care for residents, they are ideally situated to deliver timely assessment and non-drug interventions for managing resident pain. In this Cochrane-style systematic review, we searched 7 databases to identify intervention studies that included long-term care residents aged ≥60 years who received interventions to reduce chronic pain. Interventions were either delivered by healthcare aides at the resident level or were directed at healthcare aides to improve their pain management practices. We screened 400 titles/abstracts and 152 full-text articles. Nine studies met inclusion criteria and were included in a narrative review. Due to the limited number of studies and variety of study designs, data were insufficient to perform meta-analyses or thematic analysis. Three studies described pain interventions delivered by healthcare aides at the resident level reporting significant improvement of pain. Six studies described pain interventions delivered to healthcare aides. Results of these interventions were inconsistent; 2 reported significant improvements in pain-related outcomes (e.g., resident pain, monitoring of pain), 3 reported insignificant changes, and 1 reported a positive correlation between measured pain and pain medication use. We concluded that despite the paucity of research in this area, this systematic review provides preliminary support for pain interventions by healthcare aides for long-term care residents. Future research exploring interventions for healthcare aides to take greater roles in pain management could unlock further improvements in resident care.
Collapse
Affiliation(s)
| | - Megan Nuspl
- University of Alberta , Edmonton, Alberta , Canada
| | | | | | - Ahsan Saleem
- University of Alberta , Edmonton, Alberta , Canada
| |
Collapse
|
3
|
Knopp-Sihota JA, MacGregor T, Reeves JTH, Kennedy M, Saleem A. Management of Chronic Pain in Long-Term Care: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc 2022; 23:1507-1516.e0. [PMID: 35594944 DOI: 10.1016/j.jamda.2022.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/07/2022] [Accepted: 04/11/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Pain, a complex subjective experience, is common in care home residents. Despite advances in pain management, optimal pain control remains a challenge. In this updated systematic review, we examined effectiveness of interventions for treating chronic pain in care home residents. DESIGN A Cochrane-style systematic review and meta-analysis using PRISMA guidelines. SETTING AND PARTICIPANTS Randomized and nonrandomized controlled trials and intervention studies included care home residents aged ≥60 years receiving interventions to reduce chronic pain. METHODS Six databases were searched to identify relevant studies. After duplicate removal, articles were screened by title and abstract. Full-text articles were reviewed and included if they implemented a pain management intervention and measured pain with a standardized quantitative pain scale. Meta-analyses calculated standardized mean differences (SMDs) using random-effect models. Risk of bias was assessed using the Cochrane Risk-of-Bias Tool 2.0. RESULTS We included 42 trials in the meta-analysis and described 13 more studies narratively. Studies included 26 nondrug alternative treatments, 8 education interventions, 7 system modifications, 3 nonanalgesic drug treatments, 2 analgesic treatments, and 9 combined interventions. Pooled results at trial completion revealed that, except for nonanalgesic drugs and health system modification interventions, all interventions were at least moderately effective in reducing pain. Analgesic treatments (SMD -0.80; 95% CI -1.47 to -0.12; P = .02) showed the greatest treatment effect, followed by nondrug alternative treatments (SMD -0.70; 95% CI -0.95 to -0.45; P < .001), combined interventions (SMD -0.37; 95% CI -0.60 to -0.13; P = .002), and education interventions (SMD -0.31; 95% CI -0.48 to -0.15; P < .001). CONCLUSIONS AND IMPLICATIONS Our findings suggest that analgesic drugs and nondrug alternative pain management strategies are the most effective in reducing pain among care home residents. Clinicians should also consider implementing nondrug alternative therapies in care homes, rather than relying solely on analgesic drug options.
Collapse
Affiliation(s)
- Jennifer A Knopp-Sihota
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada; Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | - Tara MacGregor
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Megan Kennedy
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Ahsan Saleem
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
4
|
Pillay J, Wingert A, MacGregor T, Gates M, Vandermeer B, Hartling L. Screening for chlamydia and/or gonorrhea in primary health care: systematic reviews on effectiveness and patient preferences. Syst Rev 2021; 10:118. [PMID: 33879251 PMCID: PMC8056106 DOI: 10.1186/s13643-021-01658-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We conducted systematic reviews on the benefits and harms of screening compared with no screening or alternative screening approaches for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in non-pregnant sexually active individuals, and on the relative importance patients' place on the relevant outcomes. Findings will inform recommendations by the Canadian Task Force on Preventive Health Care. METHODS We searched five databases (to January 24, 2020), trial registries, conference proceedings, and reference lists for English and French literature published since 1996. Screening, study selection, and risk of bias assessments were independently undertaken by two reviewers, with consensus for final decisions. Data extraction was conducted by one reviewer and checked by another for accuracy and completeness. Meta-analysis was conducted where appropriate. We used the GRADE approach to rate the certainty of the evidence. The Task Force and content experts provided input on determining thresholds for important effect sizes and on interpretation of findings. RESULTS Of 41 included studies, 17 and 11 reported on benefits and harms of screening, respectively, and 14 reported on patient preferences. Universal screening for CT in general populations 16 to 29 years of age, using population-based or opportunistic approaches achieving low screening rates, may make little-to-no difference for a female's risk of pelvic inflammatory disease (PID) (2 RCTs, n=141,362; 0.3 more in 1000 [7.6 fewer to 11 more]) or ectopic pregnancy (1 RCT, n=15,459; 0.20 more per 1000 [2.2 fewer to 3.9 more]). It may also not make a difference for CT transmission (3 RCTs, n=41,709; 3 fewer per 1000 [11.5 fewer to 6.9 more]). However, benefits may be achieved for reducing PID if screening rates are increased (2 trials, n=30,652; 5.7 fewer per 1000 [10.8 fewer to 1.1 more]), and for reducing CT and NG transmission when intensely screening high-prevalence female populations (2 trials, n=6127; 34.3 fewer per 1000 [4 to 58 fewer]; NNS 29 [17 to 250]). Evidence on infertility in females from CT screening and on transmission of NG in males and both sexes from screening for CT and NG is very uncertain. No evidence was found for cervicitis, chronic pelvic pain, or infertility in males from CT screening, or on any clinical outcomes from NG screening. Undergoing screening, or having a diagnosis of CT, may cause a small-to-moderate number of people to experience some degree of harm, mainly due to feelings of stigmatization and anxiety about future infertility risk. The number of individuals affected in the entire screening-eligible population is likely smaller. Screening may make little-to-no difference for general anxiety, self-esteem, or relationship break-up. Evidence on transmission from studies comparing home versus clinic screening is very uncertain. Four studies on patient preferences found that although utility values for the different consequences of CT and NG infections are probably quite similar, when considering the duration of the health state experiences, infertility and chronic pelvic pain are probably valued much more than PID, ectopic pregnancy, and cervicitis. How patients weigh the potential benefits versus harms of screening is very uncertain (1 survey, 10 qualitative studies); risks to reproductive health and transmission appear to be more important than the (often transient) psychosocial harms. DISCUSSION Most of the evidence on screening for CT and/or NG offers low or very low certainty about the benefits and harms. Indirectness from use of comparison groups receiving some screening, incomplete outcome ascertainment, and use of outreach settings was a major contributor to uncertainty. Patient preferences indicate that the potential benefits from screening appear to outweigh the possible harms. Direct evidence about which screening strategies and intervals to use, which age to start and stop screening, and whether screening males in addition to females is necessary to prevent clinical outcomes is scarce, and further research in these areas would be informative. Apart from the evidence in this review, information on factors related to equity, acceptability, implementation, cost/resources, and feasibility will support recommendations made by the Task Force. SYSTEMATIC REVIEW REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42018100733 .
Collapse
Affiliation(s)
- Jennifer Pillay
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - Aireen Wingert
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Tara MacGregor
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Michelle Gates
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Ben Vandermeer
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, Faculty of Medicine and Dentistry, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| |
Collapse
|
5
|
Gates M, Hartling L, Shulhan-Kilroy J, MacGregor T, Guitard S, Wingert A, Featherstone R, Vandermeer B, Poonai N, Kircher J, Perry S, Graham TAD, Scott SD, Ali S. Digital Technology Distraction for Acute Pain in Children: A Meta-analysis. Pediatrics 2020; 145:peds.2019-1139. [PMID: 31969473 DOI: 10.1542/peds.2019-1139] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2019] [Indexed: 12/14/2022] Open
Abstract
CONTEXT Digital distraction is being integrated into pediatric pain care, but its efficacy is currently unknown. OBJECTIVE To determine the effect of digital technology distraction on pain and distress in children experiencing acutely painful conditions or procedures. DATA SOURCES Medline, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Institute of Electrical and Electronics Engineers Xplore, Ei Compendex, Web of Science, and gray literature sources. STUDY SELECTION Quantitative studies of digital technology distraction for acutely painful conditions or procedures in children. DATA EXTRACTION Performed by 1 reviewer with verification. Outcomes were child pain and distress. RESULTS There were 106 studies (n = 7820) that reported on digital technology distractors (eg, virtual reality and video games) used during common procedures (eg, venipuncture, dental, and burn treatments). No studies reported on painful conditions. For painful procedures, digital distraction resulted in a modest but clinically important reduction in self-reported pain (standardized mean difference [SMD] -0.48; 95% confidence interval [CI] -0.66 to -0.29; 46 randomized controlled trials [RCTs]; n = 3200), observer-reported pain (SMD -0.68; 95% CI -0.91 to -0.45; 17 RCTs; n = 1199), behavioral pain (SMD -0.57; 95% CI -0.94 to -0.19; 19 RCTs; n = 1173), self-reported distress (SMD -0.49; 95% CI -0.70 to -0.27; 19 RCTs; n = 1818), observer-reported distress (SMD -0.47; 95% CI -0.77 to -0.17; 10 RCTs; n = 826), and behavioral distress (SMD -0.35; 95% CI -0.59 to -0.12; 17 RCTs; n = 1264) compared with usual care. LIMITATIONS Few studies directly compared different distractors or provided subgroup data to inform applicability. CONCLUSIONS Digital distraction provides modest pain and distress reduction for children undergoing painful procedures; its superiority over nondigital distractors is not established. Context, preferences, and availability should inform the choice of distractor.
Collapse
Affiliation(s)
- Michelle Gates
- Department of Pediatrics and.,Alberta Research Centre for Health Evidence, and
| | - Lisa Hartling
- Department of Pediatrics and .,Alberta Research Centre for Health Evidence, and
| | | | - Tara MacGregor
- Department of Pediatrics and.,Alberta Research Centre for Health Evidence, and
| | - Samantha Guitard
- Department of Pediatrics and.,Alberta Research Centre for Health Evidence, and
| | - Aireen Wingert
- Department of Pediatrics and.,Alberta Research Centre for Health Evidence, and
| | - Robin Featherstone
- Department of Pediatrics and.,Alberta Research Centre for Health Evidence, and
| | - Ben Vandermeer
- Department of Pediatrics and.,Alberta Research Centre for Health Evidence, and
| | - Naveen Poonai
- Department of Pediatrics and Internal Medicine, Schulieh School of Medicine and Dentistry, Western University, London, Canada
| | - Janeva Kircher
- Department of Pediatrics and.,Emergency Medicine, Faculty of Medicine and Dentistry
| | - Shirley Perry
- Women and Children's Health Research Institute, University of Albert, Edmonton, Canada
| | - Timothy A D Graham
- Emergency Medicine, Faculty of Medicine and Dentistry.,Alberta Health Services Edmonton Zone, Edmonton, Canada; and
| | | | - Samina Ali
- Department of Pediatrics and.,Emergency Medicine, Faculty of Medicine and Dentistry.,Women and Children's Health Research Institute, University of Albert, Edmonton, Canada
| |
Collapse
|
6
|
Gates M, Shulhan-Kilroy J, Featherstone R, MacGregor T, Scott SD, Hartling L. Parent experiences and information needs related to bronchiolitis: A mixed studies systematic review. Patient Educ Couns 2019; 102:864-878. [PMID: 30573297 DOI: 10.1016/j.pec.2018.12.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To inform evidence-based knowledge products (i.e., infographics, videos, eBooks) of relevance to parents, we systematically reviewed evidence on parent experiences and information needs related to bronchiolitis. METHODS We searched Medline, CINAHL, PsycINFO, and ProQuest Dissertations & Theses Global, and scanned reference lists for studies published post-2000. We appraised quality in duplicate using the Mixed Methods Appraisal Tool (MMAT) and synthesized findings narratively. RESULTS We retrieved 797 records and included 29; 14 (48%) met >50% of MMAT criteria. Studies predominantly enrolled mothers. Most reported quantitatively on hospitalization experiences (n = 9, 31%), treatments (n = 5, 17%), or respiratory syncytial virus (RSV) prophylaxis (n = 9, 31%). Ten (34%) studies reported on information needs; 3 contributed qualitative data. Parents could not always identify bronchiolitis symptoms. During hospitalization, parents endured guilt and anxiety. Mothers wanted to take an active role in their child's care but often felt uninvolved. Barriers to RSV prophylaxis included transportation, scheduling, and insurance issues. CONCLUSIONS Evidence focused primarily on hospitalization, which parents found frightening. More information is needed on home care experiences and information preferences. PRACTICE IMPLICATIONS Timely education and support from healthcare providers may help to alleviate parents' fears and enhance involvement in their child's care.
Collapse
Affiliation(s)
- Michelle Gates
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Canada.
| | - Jocelyn Shulhan-Kilroy
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Canada.
| | - Robin Featherstone
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Canada.
| | - Tara MacGregor
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Canada.
| | - Shannon D Scott
- Evidence in Child Health to Advance Outcomes (ECHO), Faculty of Nursing, University of Alberta, Canada.
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence (ARCHE), Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Canada.
| |
Collapse
|
7
|
Pillay J, Moore A, Rahman P, Lewin G, Reynolds D, Riva J, Thériault G, Thombs B, Wilson B, Robinson J, Ramdyal A, Cadieux G, Featherstone R, Burchell AN, Dillon JA, Singh A, Wong T, Doull M, Traversy G, Courage S, MacGregor T, Johnson C, Vandermeer B, Hartling L. Screening for chlamydia and/or gonorrhea in primary health care: protocol for systematic review. Syst Rev 2018; 7:248. [PMID: 30587234 PMCID: PMC6307186 DOI: 10.1186/s13643-018-0904-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 12/05/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Chlamydia trachomatis and Neisseria gonorrhoeae are the most commonly reported sexually transmitted infections in Canada. Existing national guidance on screening for these infections was not based on a systematic review, and recommendations as well as implementation considerations (e.g., population groups, testing and case management) should be explicit and reflect the quality of evidence. The aim of this systematic review is to synthesize research on screening for these infections in sexually active individuals within primary care. We will also review evidence on how people weigh the relative importance of the potential outcomes from screening, rated as most important by the Canadian Task Force on Preventive Health Care (CTFPHC) with input from patients and stakeholders. METHODS We have developed a peer-reviewed strategy to comprehensively search MEDLINE, Embase, Cochrane Library, CINAHL, and PsycINFO for English and French literature published 1996 onwards. We will also search trial registries and conference proceedings, and mine references lists. Screening, study selection, risk of bias assessments, and quality of findings across studies (for each outcome) will be independently undertaken by two reviewers with consensus for final decisions. Data extraction will be conducted by one reviewer and checked by another for accuracy and completeness. The CTFPHC and content experts will provide input for decisions on study design (i.e., when and whether to include uncontrolled studies for screening effectiveness) and for interpretation of the findings. DISCUSSION The results section of the review will include a description of all studies, results of all analyses, including planned subgroup and sensitivity analyses, and evidence profiles and summary of findings tables incorporating assessment based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods to communicate our confidence in the estimates of effect. We will compare our findings to others and discuss limitations of the review and available literature. The findings will be used by the CTFPHC-supplemented by consultations with patients and stakeholders and from other sources on issues of feasibility, acceptability, costs/resources, and equity-to inform recommendations on screening to support primary health care providers in delivering preventive care. SYSTEMATIC REVIEW REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42018100733.
Collapse
Affiliation(s)
- Jennifer Pillay
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue, Edmonton, Alberta T6G 1C9 Canada
| | - Ainsley Moore
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Prinon Rahman
- Global Health and Guidelines Division, Public Health Agency of Canada, Edmonton, Canada
| | - Gabriel Lewin
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Donna Reynolds
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - John Riva
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | | | - Brett Thombs
- Faculty of Medicine, McGill University, Montreal, Canada
| | - Brenda Wilson
- Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Canada
| | - Joan Robinson
- Division of Infectious Diseases, Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Amanda Ramdyal
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | | | - Robin Featherstone
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue, Edmonton, Alberta T6G 1C9 Canada
| | - Anne N. Burchell
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jo-Anne Dillon
- Department of Microbiology and Immunology, University of Saskatchewan, Saskatoon, Canada
| | - Ameeta Singh
- Division of Infectious Diseases, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Tom Wong
- Public Health Agency of Canada, Edmonton, Canada
| | - Marion Doull
- Global Health and Guidelines Division, Public Health Agency of Canada, Edmonton, Canada
| | - Greg Traversy
- Global Health and Guidelines Division, Public Health Agency of Canada, Edmonton, Canada
| | - Susan Courage
- Global Health and Guidelines Division, Public Health Agency of Canada, Edmonton, Canada
| | - Tara MacGregor
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue, Edmonton, Alberta T6G 1C9 Canada
| | - Cydney Johnson
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue, Edmonton, Alberta T6G 1C9 Canada
| | - Ben Vandermeer
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue, Edmonton, Alberta T6G 1C9 Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, University of Alberta, 11405 87 Avenue, Edmonton, Alberta T6G 1C9 Canada
| |
Collapse
|
8
|
Pillay J, Boylan K, Newton A, Hartling L, Vandermeer B, Nuspl M, MacGregor T, Featherstone R, Carrey N. Harms of Antipsychotics in Children and Young Adults: A Systematic Review Update. Can J Psychiatry 2018; 63:661-678. [PMID: 29865900 PMCID: PMC6187435 DOI: 10.1177/0706743718779950] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To update and extend our previous systematic review on first- (FGAs) and second-generation antipsychotics (SGAs) for treatment of psychiatric and behavioral conditions in children, adolescents, and young adults (aged ≤24 years). This article focuses on the evidence for harms. METHOD We searched (to April 2016) 8 databases, gray literature, trial registries, Food and Drug Administration reports, and reference lists. Two reviewers conducted study screening and selection independently, with consensus for selection. One reviewer extracted and another verified all data; 2 reviewers independently assessed risk of bias. We conducted meta-analyses when appropriate and network meta-analysis across conditions for changes in body composition. Two reviewers reached consensus for ratings on the strength of evidence for prespecified outcomes. RESULTS A total of 135 studies (95 trials and 40 observational) were included, and 126 reported on harms. FGAs caused slightly less weight gain and more extrapyramidal symptoms than SGAs. SGAs as a class caused adverse effects, including weight gain, high triglyceride levels, extrapyramidal symptoms, sedation, and somnolence. They appeared to increase the risk for high cholesterol levels and type 2 diabetes. Many outcomes for individual drug comparisons were of low or insufficient strength of evidence. Olanzapine caused more short-term gains in weight and body mass index than several other SGAs. The dose of SGAs may not make a difference over the short term for some outcomes. CONCLUSIONS Clinicians need to weigh carefully the benefit-to-harm ratio when using antipsychotics, especially when treatment alternatives exist. More evidence is needed on the comparative harms between antipsychotics over the longer term.
Collapse
Affiliation(s)
- Jennifer Pillay
- 1 University of Alberta Evidence-based Practice Center, Edmonton, Alberta, Canada
| | - Khrista Boylan
- 2 Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Amanda Newton
- 1 University of Alberta Evidence-based Practice Center, Edmonton, Alberta, Canada.,3 Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Hartling
- 1 University of Alberta Evidence-based Practice Center, Edmonton, Alberta, Canada.,3 Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Ben Vandermeer
- 1 University of Alberta Evidence-based Practice Center, Edmonton, Alberta, Canada
| | - Megan Nuspl
- 1 University of Alberta Evidence-based Practice Center, Edmonton, Alberta, Canada
| | - Tara MacGregor
- 1 University of Alberta Evidence-based Practice Center, Edmonton, Alberta, Canada
| | - Robin Featherstone
- 1 University of Alberta Evidence-based Practice Center, Edmonton, Alberta, Canada
| | - Normand Carrey
- 4 Douglas Research Institute and IWK Health Centre, Halifax, Nova Scotia, Canada.,5 Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
9
|
Ali MA, Penfold RS, Patel I, MacGregor T, Cahill TJ, Alie AM, Shankar S, Nguyen M, Finlayson AET, Mahmud I. The Palestinian territories: barriers to healthcare and medical education and the strategic role of distance-learning partnerships in education systems strengthening. Med Confl Surviv 2014; 30:11-8. [PMID: 24684019 DOI: 10.1080/13623699.2014.873644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
10
|
Cummings GG, MacGregor T, Davey M, Lee H, Wong CA, Lo E, Muise M, Stafford E. Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. Int J Nurs Stud 2010; 47:363-85. [DOI: 10.1016/j.ijnurstu.2009.08.006] [Citation(s) in RCA: 413] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Revised: 08/04/2009] [Accepted: 08/11/2009] [Indexed: 10/20/2022]
|
11
|
Abstract
BACKGROUND Laboratory and epidemiological studies have implicated vitamin D deficiency in the pathogenesis of breast cancer. 1,25-Dihydroxyvitamin D (1,25(OH)(2)D) promotes differentiation and apoptosis, and potently inhibits proliferation of malignant breast epithelial cells in culture. Serum levels of 1,25(OH)(2)D are higher in normal women than in patients with primary breast cancer. AIM To clarify the role of vitamin D in breast cancer progression by comparing the levels of serum vitamin D in patients with early and in those with advanced breast cancer. METHODS Circulating levels of 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH) and calcium were measured prospectively in 279 Caucasian women with invasive breast cancer, 204 women with early-stage disease and 75 women with locally advanced or metastatic disease. RESULTS Patients with early-stage breast cancer had significantly higher circulating levels of 25(OH)D (p<0.005) and significantly lower PTH (p<0.001) levels than those with advanced disease. Calcium levels did not differ significantly (p = 0.74). CONCLUSION Serum levels of 25(OH)D are significantly higher in patients with early-stage breast cancer than in those with locally advanced or metastatic disease.
Collapse
Affiliation(s)
- C Palmieri
- Cancer Research UK Laboratories, Department of Cancer Medicine, Faculty of Medicine, Imperial College, Hammersmith Hospital, London, UK.
| | | | | | | |
Collapse
|
12
|
Riska P, Lamson M, MacGregor T, Sabo J, Hattox S, Pav J, Keirns J. Disposition and biotransformation of the antiretroviral drug nevirapine in humans. Drug Metab Dispos 1999; 27:895-901. [PMID: 10421616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
The pharmacokinetics and biotransformation of the antiretroviral agent nevirapine (NVP) after autoinduction were characterized in eight healthy male volunteers. Subjects received 200-mg NVP tablets once daily for 2 weeks, followed by 200 mg twice daily for 2 weeks. Then they received a single oral dose (solution) of 50 mg containing 100 microCi of [(14)C]NVP. Biological fluids were analyzed for total radioactivity, parent compound (HPLC/UV), and metabolites (electrospray liquid chromatography/mass spectroscopy and liquid chromatography/tandem mass spectroscopy). Mean recovery of radioactivity was 91.4%, with 81.3% excreted in urine and 10.1% recovered in the feces over a period of 10 days. Circulating radioactivity was evenly distributed between whole blood and plasma. At maximum plasma concentration, parent compound accounted for approximately 75% of the circulating radioactivity. Mean plasma elimination half-lives for total radioactivity and NVP were 21.3 and 20.0 h, respectively. Several metabolites were identified in urine including 2-hydroxynevirapine glucuronide (18.6%), 3-hydroxynevirapine glucuronide (25.7%), 12-hydroxynevirapine glucuronide (23.7%), 8-hydroxynevirapine glucuronide (1.3%), 3-hydroxynevirapine (1.2%), 12-hydroxynevirapine (0.6%), and 4-carboxynevirapine (2.4%). Greater than 80% of the radioactivity in urine was made up of glucuronidated conjugates of hydroxylated metabolites of NVP. Thus, cytochrome P-450 metabolism, glucuronide conjugation, and urinary excretion of glucuronidated metabolites represent the primary route of NVP biotransformation and elimination in humans. Only a small fraction of the dose (2.7%) was excreted in urine as parent compound.
Collapse
Affiliation(s)
- P Riska
- Department of Drug Metabolism and Pharmacokinetics, Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Connecticut 06877, USA.
| | | | | | | | | | | | | |
Collapse
|
13
|
Abstract
The in vivo absorption potential of ipratropium bromide nasal spray was evaluated in studies involving healthy volunteers (0.03%, 0.06%, and 0.12% dosage strengths) and patients with perennial rhinitis (0.03% and 0.06%) and the common cold (0.06%). The dose used was two sprays per nostril, corresponding to a total dose of 84 micrograms, 168 micrograms, and 336 micrograms for the three dosage strengths. These studies indicate that 10% or less of active drug is absorbed systemically after nasal administration based on the amount of unchanged drug excreted in urine in a 24-hour interval. In most instances, the plasma drug concentrations were undetectable. In none of these studies did plasma ipratropium concentrations reach a level where systemic anticholinergic effects are known to occur.
Collapse
Affiliation(s)
- C C Wood
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, Conn. 06877-0368, USA
| | | | | | | | | |
Collapse
|
14
|
MacGregor T, Matzek K, Keirns J, Vinocur M, Chonko A. Oral pharmacokinetics of pirenzepine in patients with chronic renal insufficiency, failure, and maintenance haemodialysis. Eur J Clin Pharmacol 1990; 38:405-6. [PMID: 2344866 DOI: 10.1007/bf00315586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The pharmacokinetic properties of pirenzepine following administration of a single, 50 mg oral dose were evaluated in three groups of subjects: group I, end stage renal disease requiring maintenance haemodialysis (CLCR 0 to 10 ml.min-1); group II, moderate renal insufficiency (CLCR 10 to 30 ml.min-1); and group III, mild renal dysfunction (CLCR 30 to 70 ml.min-1). Additionally, subjects in group I received a 50 mg dose on a non-dialysis day and at least one week later, a 50 mg dose during haemodialysis. There was a linear relationship (r = 0.97) between pirenzepine renal clearance and renal function as measured by creatinine clearance. The harmonic mean terminal half-life for pirenzepine was 17.3 h in subjects with end stage renal disease, 18.0 h in subjects with moderate renal insufficiency and 14.7 h in subjects with mild renal dysfunction. Haemodialysis reduced the level of circulating pirenzepine by approximately 25%. The mean arterial to venous plasma pirenzepine ratio during hemodialysis was 1.29 (range 1.02-1.56). Based on subjective reporting of adverse experiences and clinical observation, pirenzepine appeared to have had a wide margin of safety in these patients. Dry mouth was the most frequently reported adverse experience attributable to pirenzepine administration. A reduction in dose or dosing frequency may be warranted only in end state renal disease (CLCR 0 to 10 ml.min-1).
Collapse
Affiliation(s)
- T MacGregor
- Boehringer Ingelheim Pharmaceuticals, inc., Ridgefield, Connecticut
| | | | | | | | | |
Collapse
|
15
|
Hatch F, McKellop K, Hansen G, MacGregor T. Relative bioavailability of metaproterenol in humans utilizing a single dose, stable isotope approach. J Pharm Sci 1986; 75:886-90. [PMID: 3783458 DOI: 10.1002/jps.2600750913] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The relative bioavailability of metaproterenol (3,5-dihydroxy-alpha-[(isopropylamino)methyl]benzyl alcohol) following a single dose (10-mg metaproterenol sulfate tablet) was studied in six normal male volunteers using coadministration of a solution of a deuterated analogue (metaproterenol-d7 sulfate). The bioavailability of the tablet formulation relative to that of the oral solution was 92 +/- 9%, with excellent power at the 5% significance level. Comparison of the coadministration of the labeled and unlabeled metaproterenol sulfate solutions in two subjects after a one-week washout demonstrated the absence of an isotope effect on either absorption or elimination. A GC-MS assay for metaproterenol was developed to measure plasma concentrations resulting from oral administration. The assay was linear over the range of 0.5-8 ng/mL, corresponding to typical plasma metaproterenol concentrations obtained after a single 10-mg oral dose. Accuracy and precision data were obtained at metaproterenol concentrations of 1.0 and 2.0 ng/mL plasma to demonstrate the applicability of the assay for bioavailability studies. Following oral administration, metaproterenol showed peak plasma concentrations of 2.2 to 13 ng/mL at 0.75 to 3.0 h, with a terminal harmonic mean half-life of 2.1 h over the plasma concentration range studied. The renal clearance of 133-158 mL/min for metaproterenol slightly exceeds the glomerular filtration rate in humans.
Collapse
|