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Scheibe S, Timpel P, Mäder M, Heinrich R, Kugler J, Schönfelder T. [The effectiveness of digital care applications in people with need of home care: A systematic review]. Pflege 2024. [PMID: 38411152 DOI: 10.1024/1012-5302/a000983] [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] [Indexed: 02/28/2024]
Abstract
The effectiveness of digital care applications in people with need of home care: A systematic review Abstract: Background: The growing need for long-term care poses challenges for healthcare systems. In June 2021, digital care applications (DiPA) were introduced as a new service in the statutory long-term care insurance in Germany. Their aim is to counteract the increased care need and/or support independence in the home. Aim: This project systematically identified and reported on national and international evidence on DiPA effectiveness, as described by the Federal Institute for Drugs and Medical Devices (BfArM). Methods: The systematic review was conducted in accordance with the PRISMA statement by means of systematic searches in the databases Medline and Cinahl, and supplemented by an extensive manual search (08/2022). Study quality was assessed using the Risk of Bias Tool (RoB2). The results were synthesized narratively. Results: Eight randomized controlled studies were included; improvements in cognition, activities of daily living, and mobility in home care patients, were reported. Study quality was low to moderate, due to mostly unblinded study designs and low case numbers. Conclusions: The currently available evidence fails to provide a reliable basis for assessing the benefits of DiPA, to neither DiPA manufacturers, nor to responsible parties in the healthcare system. Further research on DiPA effectiveness, particularly with high-quality studies, are necessary to assess its potential in the German care sector.
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Affiliation(s)
- Sandy Scheibe
- WIG2 GmbH, Wissenschaftliches Institut für Gesundheitsökonomie und Gesundheitssystemforschung, Leipzig, Deutschland
- Lehrstuhl Gesundheitswissenschaften/Public Health, Technische Universität Dresden, Deutschland
| | - Patrick Timpel
- WIG2 GmbH, Wissenschaftliches Institut für Gesundheitsökonomie und Gesundheitssystemforschung, Leipzig, Deutschland
| | - Melanie Mäder
- WIG2 GmbH, Wissenschaftliches Institut für Gesundheitsökonomie und Gesundheitssystemforschung, Leipzig, Deutschland
- Lehrstuhl Health Economics and Management, Wirtschaftswissenschaftliche Fakultät, Universität Leipzig, Deutschland
| | - Ria Heinrich
- WIG2 GmbH, Wissenschaftliches Institut für Gesundheitsökonomie und Gesundheitssystemforschung, Leipzig, Deutschland
| | - Joachim Kugler
- Lehrstuhl Gesundheitswissenschaften/Public Health, Technische Universität Dresden, Deutschland
| | - Tonio Schönfelder
- WIG2 GmbH, Wissenschaftliches Institut für Gesundheitsökonomie und Gesundheitssystemforschung, Leipzig, Deutschland
- Lehrstuhl Gesundheitswissenschaften/Public Health, Technische Universität Dresden, Deutschland
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Yang L, Li Y, Zhang S, Qian H, Xu W, Yu J. Efficacy of Acupuncture Combined with Traditional Chinese Medicine Fumigation Therapy in Sequelae of Pelvic Inflammatory Disease: A Systematic Review and Meta-Analysis. Complement Med Res 2024; 31:175-186. [PMID: 38330934 DOI: 10.1159/000536101] [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: 06/14/2023] [Accepted: 01/02/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND AND OBJECTIVE Acupuncture combined with traditional Chinese medicine fumigation is increasingly being used in treating sequelae of pelvic inflammatory disease (SPID). However, there is a lack of meta-analysis on the effectiveness of acupuncture combined with traditional Chinese medicine fumigation in treating SPID. The aim of this study was to assess the feasibility of combining acupuncture with traditional Chinese medicine fumigation in the treatment of SPID. METHODS We searched eight databases for studies on acupuncture combined with traditional Chinese medicine fumigation for the treatment of SPID from the date of establishment to October 29, 2022. We assessed the quality of included studies by using the Cochrane bias risk tool. Pooled results were expressed as risk ratios (RRs), with a 95% confidence interval (CI). In addition, we identified sources of heterogeneity by sensitivity analysis, assessed publication bias by Egger's test, and assessed the quality of the evidence by Grades of Recommendation, Assessment, Development, and Evaluation (GRADE). All statistical analyses were performed by Review Manager 5.3 and Stata 14. RESULTS Finally, seven studies with a total of 663 participants were included. We found a significant difference in the total effective rate in the acupuncture combined with the fumigation group compared with the acupuncture group in the treatment of SPID (RR = 1.17, 95% CI [1.09, 1.25], p = 0.0001 < 0.05; I2 = 0%; 6 trials), and a significant difference in the total effective rate in the acupuncture combined with fumigation group compared with the fumigation group in the treatment of SPID (RR = 1.42, 95% CI [1.21, 1.66], p = 0.0001 < 0.05; 5 trials). CONCLUSION The clinical efficacy of acupuncture combined with herbal fumigation in the treatment of SPID is relatively good. Larger scale studies are needed in the future. Hintergrund und Ziel Akupunktur in Kombination mit Fumigation, einem Verfahren der Traditionellen Chinesischen Medizin, wird zunehmend in der Behandlung von Folgeerscheinungen von Beckenentzündungen (SPID; sequelae of pelvic inflammatory disease) eingesetzt. Es mangelt jedoch an Metaanalysen zur Wirksamkeit der Akupunktur in Kombination mit Fumigation gemäß der Traditionellen Chinesischen Medizin in der Behandlung von SPID. Das Ziel dieser Studie ist die Beurteilung der Machbarkeit der Kombination aus Akupunktur und Fumigation gemäß der Traditionellen Chinesischen Medizin in der Behandlung von SPID. Methoden Wir durchsuchten acht Datenbanken nach Studien zur Akupunktur in Kombination mit Fumigation gemäß der Traditionellen Chinesischen Medizin in der Behandlung von Folgeerscheinungen von SPID von der Einrichtung bis zum 29. Oktober 2022. Wir beurteilten die Qualität der eingeschlossenen Studien mit dem Cochrane-Tool zur Bewertung des Bias-Risikos. Die gepoolten Ergebnisse wurden als Risikoquotient (RR; risk ratio) mit 95%-Konfidenzintervall (KI) ausgedrückt. Zusätzlich identifizierten wir Quellen für Heterogenität mittels Sensitivitätsanalyse, beurteilten den Publikations-Bias mittels Egger-Test und bewerteten die Qualität der Evidenz nach Grad der Empfehlungsstärke, Beurteilung, Entwicklung und Evaluierung (GRADE). Alle statistischen Analysen erfolgten mit Review Manager 5.3 und Stata 14. Ergebnisse Im Endeffekt wurden 7 Studien mit insgesamt 663 Teilnehmern eingeschlossen. Wir fanden einen signifikanten Unterschied in der Gesamt-Effektivitätsrate bei der Gruppe, die zur Behandlung von SPID Akupunktur in Kombination mit Fumigation erhielt, im Vergleich zur reinen Akupunkturgruppe (RR = 1,17; 95%-KI [1,09; 1,25]; p = 0,0001 < 0,05; I2-Wert = 0%; 6 Studien), und einen signifikanten Unterschied in der Gesamt-Effektivitätsrate bei der Gruppe, die zur Behandlung von SPID Akupunktur in Kombination mit Fumigation erhielt, im Vergleich zur reinen Fumigationsgruppe (RR = 1,42; 95%-KI [1,21; 1,66]; p = 0,0001 < 0,05; 5 Studien). Schlussfolgerung Die klinische Wirksamkeit der Akupunktur in Kombination mit Kräuter-Fumigation zur Behandlung von SPID ist relativ gut. Zukünftig sind größere Studien erforderlich.
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Affiliation(s)
- Li Yang
- Department of Obstetrics and Gynaecology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China
| | - Yajun Li
- Department of Orthopedics, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China
| | - Shuang Zhang
- Department of Obstetrics and Gynaecology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China
| | - Haiqing Qian
- Department of Reproduction, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China
| | - Wenting Xu
- Department of Reproduction, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China
| | - Jinfen Yu
- Department of Obstetrics and Gynaecology, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, China
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Schmidt L, Sinyor M, Webb RT, Marshall C, Knipe D, Eyles EC, John A, Gunnell D, Higgins JPT. A narrative review of recent tools and innovations toward automating living systematic reviews and evidence syntheses. Z Evid Fortbild Qual Gesundhwes 2023; 181:65-75. [PMID: 37596160 DOI: 10.1016/j.zefq.2023.06.007] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/19/2023] [Accepted: 06/25/2023] [Indexed: 08/20/2023]
Abstract
Living reviews are an increasingly popular research paradigm. The purpose of a 'living' approach is to allow rapid collation, appraisal and synthesis of evolving evidence on an important research topic, enabling timely influence on patient care and public health policy. However, living reviews are time- and resource-intensive. The accumulation of new evidence and the possibility of developments within the review's research topic can introduce unique challenges into the living review workflow. To investigate the potential of software tools to support living systematic or rapid reviews, we present a narrative review informed by an examination of tools contained on the Systematic Review Toolbox website. We identified 11 tools with relevant functionalities and discuss the important features of these tools with respect to different steps of the living review workflow. Four tools (NestedKnowledge, SWIFT-ActiveScreener, DistillerSR, EPPI-Reviewer) covered multiple, successive steps of the review process, and the remaining tools addressed specific components of the workflow, including scoping and protocol formulation, reference retrieval, automated data extraction, write-up and dissemination of data. We identify several ways in which living reviews can be made more efficient and practical. Most of these focus on general workflow management, or automation through artificial intelligence and machine-learning, in the screening process. More sophisticated uses of automation mostly target living rapid reviews to increase the speed of production or evidence maps to broaden the scope of the map. We use a case study to highlight some of the barriers and challenges to incorporating tools into the living review workflow and processes. These include increased workload, the need for organisation, ensuring timely dissemination and challenges related to the development of bespoke automation tools to facilitate the review process. We describe how current end-user tools address these challenges, and which knowledge gaps remain that could be addressed by future tool development. Dedicated web presences for automatic dissemination of in-progress evidence updates, rather than solely relying on peer-reviewed journal publications, help to make the effort of a living evidence synthesis worthwhile. Despite offering basic living review functionalities, existing end-user tools could be further developed to be interoperable with other tools to support multiple workflow steps seamlessly, to address broader automatic evidence retrieval from a larger variety of sources, and to improve dissemination of evidence between review updates.
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Affiliation(s)
- Lena Schmidt
- National Institute for Health and Care Research Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle, UK; Sciome LLC, Research Triangle Park, North Carolina, USA.
| | - Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Roger T Webb
- Division of Psychology and Mental Health, The University of Manchester, Manchester, UK; National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre (NIHR GM PSTRC), Manchester, UK
| | | | - Duleeka Knipe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily C Eyles
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; The National Institute of Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Ann John
- Population Data Science, Swansea University, Swansea, UK; Public Health Wales NHS Trust, Wales, UK
| | - David Gunnell
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; The National Institute of Health and Care Research Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Julian P T Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; The National Institute of Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK; The National Institute of Health and Care Research Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
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Neuhaus AL, Rombey T, Brunnhuber K, Pieper D. [Towards evidence based research]. Z Evid Fortbild Qual Gesundhwes 2022; 168:82-87. [PMID: 35153162 DOI: 10.1016/j.zefq.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/14/2021] [Indexed: 01/05/2023]
Affiliation(s)
- Annika Lena Neuhaus
- Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Köln, Deutschland
| | - Tanja Rombey
- Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Köln, Deutschland
| | | | - Dawid Pieper
- Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Köln, Deutschland
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Pieper D, Müller D, Stock S. Challenges in teaching systematic reviews to non-clinicians. Z Evid Fortbild Qual Gesundhwes 2019; 147-148:1-6. [PMID: 31734093 DOI: 10.1016/j.zefq.2019.10.004] [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] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/24/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
Systematic reviews are regarded as the cornerstone of evidence-based decision making across many disciplines. The teaching of systematic review methods is thus very important, yet it is a field that still remains unexplored. In this paper, we will outline an approach for teaching non-clinicians about systematic reviews at the University of Cologne. Our aim was to cast some light on the challenges involved and to stimulate discussion and discourse on this topic. Out of a total of twelve weeks of teaching (1.5hours per week), nine of them included hands-on exercises that cover all the steps involved in a systematic review, from defining a specific review question up to conducting and interpreting meta-analyses. The course was based on the Cochrane Handbook for Systematic Reviews of Interventions that provide specific guidance for the development and assessment of systematic reviews. A well-reported, well-conducted systematic review was used as a working example throughout the course. The course was taught by an experienced systematic reviewer without input from additional experts such as information specialists or biometricians. To improve the learning success, four fields of challenge were identified: the selection of appropriate topics for the course assignment, the selection of an appropriate guiding review, specific requirements related for the lecturer, and the integration of methodological progress.
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Affiliation(s)
- Dawid Pieper
- Institute for Research in Operative Medicine. Faculty of Health, School of Medicine. Witten/Herdecke University. 51109, Cologne, Germany.
| | - Dirk Müller
- Institute for Health Economics and Clinical Epidemiology. University Hospital of Cologne (AöR). Gleueler Straße 176-178. 50935, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology. University Hospital of Cologne (AöR). Gleueler Straße 176-178. 50935, Cologne, Germany
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Mertz M. [Quality appraisal in systematic reviews of normative literature. A problem analysis]. Z Evid Fortbild Qual Gesundhwes 2017; 127-128:11-20. [PMID: 28863987 DOI: 10.1016/j.zefq.2017.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 07/14/2017] [Accepted: 07/18/2017] [Indexed: 11/17/2022]
Abstract
Systematic reviews aim at searching, selecting, analyzing and synthesizing scientific literature in a transparent and systematic way in order to inform decision-making in the health care system on the basis of the best available evidence. In recent years, such reviews have also gained importance also in bio-, public health- and research ethics, as well as in health technology assessment. Such reviews do not only analyze ethically relevant empirical literature (e.g. on risk and benefit), but normative literature as well, i.e. literature consisting of ethical arguments. As the appraisal of the literature that should be included is paramount for a systematic review, the problem of how to appraise the quality of normative literature arises. This problem has not yet been solved satisfactorily. After developing a pragmatic definition for "normative literature", a typology of different types of systematic reviews of normative literature is presented. Based on existing approaches for quality appraisal, this paper identifies three possible strategies for solving the problem of quality appraisal of normative literature, and discusses their respective strength and weaknesses relative to the different types of systematic reviews. It becomes apparent that none of the existing approaches is able to solve the problem of quality appraisal in a general and convincing way. The paper concludes with stating minimal conditions regarding the elaboration of future strategies, and outlines a promising strategy that is theoretically acceptable and practically feasible.
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Affiliation(s)
- Marcel Mertz
- Institut für Geschichte, Ethik und Philosophie der Medizin, Medizinische Hochschule Hannover, Hannover, Deutschland.
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Pieper D, Mathes T, Palm R, Hoffmann F. [How do authors of systematic reviews restrict their literature searches when only studies from Germany should be included?]. Z Evid Fortbild Qual Gesundhwes 2016; 117:1-8. [PMID: 27938725 DOI: 10.1016/j.zefq.2016.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/31/2016] [Accepted: 08/31/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The use of search filters (e. g. for study types) facilitates the process of literature searching. Regional limits might be helpful depending on the research question. Regional search filters are already available for some regions, but not for Germany. Our aim is to give an overview of applied search strategies in systematic reviews (SRs) focusing on Germany. METHODS We searched Medline (via Pubmed) applying a focused search strategy to identify SRs focusing on Germany in January 2016. Study selection and data extraction were performed by two reviewers independently. The search strategies with a focus on Germany were analyzed in terms of reasonableness and completeness relying on the Peer Review of Electronic Search Strategies (PRESS) criteria. A narrative evidence synthesis was performed. RESULTS In total, 36 SRs (13 written in English) were included. 78% were published in 2012 or later. The majority (89%) of SRs utilized at least two different sources for their search with databases and checking references being the most common. 17 SRs did not use any truncations, ten SRs did not restrict their search to Germany, six SRs reported to have searched for German OR Germany. Only ten articles searched for the term Germany (occasionally jointly with the term Deutschland) without any use of an adjective such as German. DISCUSSION There is a high interest in regionally focused SRs. The identified search strategies revealed a need for improvement. It would be helpful to develop a regional search filter for Germany that is able to identify studies performed in Germany.
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Affiliation(s)
- Dawid Pieper
- IFOM - Institut für Forschung in der Operativen Medizin, Fakultät für Gesundheit, Department für Humanmedizin, Universität Witten/Herdecke, Köln, Germany.
| | - Tim Mathes
- IFOM - Institut für Forschung in der Operativen Medizin, Fakultät für Gesundheit, Department für Humanmedizin, Universität Witten/Herdecke, Köln, Germany
| | - Rebecca Palm
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Standort Witten, Witten, Germany; Department Pflegewissenschaft, Fakultät für Gesundheit, Private Universität Witten/Herdecke, Witten, Germany
| | - Falk Hoffmann
- Department für Versorgungsforschung, Fakultät für Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
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