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The British Journal of General Practice... Apr 2017The numbers of GPs and training places in general practice are declining, and retaining GPs in their practices is an increasing problem. (Review)
Review
BACKGROUND
The numbers of GPs and training places in general practice are declining, and retaining GPs in their practices is an increasing problem.
AIM
To identify evidence on different approaches to retention and recruitment of GPs, such as intrinsic versus extrinsic motivational determinants.
DESIGN AND SETTING
Synthesis of qualitative and quantitative research using seven electronic databases from 1990 onwards (Medline, Embase, Cochrane Library, Health Management Information Consortium [HMIC], Cumulative Index to Nursing and Allied Health Literature (Cinahl), PsycINFO, and the Turning Research Into Practice [TRIP] database).
METHOD
A qualitative approach to reviewing the literature on recruitment and retention of GPs was used. The studies included were English-language studies from Organisation for Economic Cooperation and Development countries. The titles and abstracts of 138 articles were reviewed and analysed by the research team.
RESULTS
Some of the most important determinants to increase recruitment in primary care were early exposure to primary care practice, the fit between skills and attributes, and a significant experience in a primary care setting. Factors that seemed to influence retention were subspecialisation and portfolio careers, and job satisfaction. The most important determinants of recruitment and retention were intrinsic and idiosyncratic factors, such as recognition, rather than extrinsic factors, such as income.
CONCLUSION
Although the published evidence relating to GP recruitment and retention is limited, and most focused on attracting GPs to rural areas, the authors found that there are clear overlaps between strategies to increase recruitment and retention. Indeed, the most influential factors are idiosyncratic and intrinsic to the individuals.
Topics: Attitude of Health Personnel; Career Choice; General Practitioners; Health Care Reform; Job Satisfaction; Motivation; Personnel Selection; Primary Health Care; United Kingdom; Workforce
PubMed: 28289014
DOI: 10.3399/bjgp17X689929 -
Anesthesia and Analgesia Dec 2021This review discusses the present strategies in lung separation, the various types of double-lumen tubes (DLTs), and the use of bronchial blockers (BBs). Methods of...
This review discusses the present strategies in lung separation, the various types of double-lumen tubes (DLTs), and the use of bronchial blockers (BBs). Methods of selecting the correct DLT size and the role of videolaryngoscopy in placing a DLT are reviewed. Mechanisms whereby inhaled anesthetics may be protective during one-lung ventilation (OLV) are highlighted. The risk and prevention of fire during thoracic procedures are discussed.
Topics: Anesthesia; Humans; Intubation, Intratracheal; Laryngoscopy; Lung; One-Lung Ventilation; Thoracic Surgical Procedures
PubMed: 34784334
DOI: 10.1213/ANE.0000000000005707 -
Public Health Mar 2020Austerity in government funding, and public service reform, has heightened expectations on UK communities to develop activities and resources supportive of population...
OBJECTIVES
Austerity in government funding, and public service reform, has heightened expectations on UK communities to develop activities and resources supportive of population health and become part of a transformed place-based system of community health and social care. As non-monetary place-based approaches, Community Exchange/Time Currencies could improve social contact and cohesion, and help mobilise families, neighbourhoods, communities and their assets in beneficial ways for health. Despite this interest, the evidence base for health outcomes resulting from such initiatives is underdeveloped.
STUDY DESIGN
A systematic review.
METHODS
A literature review was conducted to identify evidence gaps and advance understanding of the potential of Community Exchange System. Studies were quality assessed, and evidence was synthesised on 'typology', population targeted and health-related and wider community outcomes.
RESULTS
The overall study quality was low, with few using objective measures of impact on health or well-being, and none reporting costs. Many drew on qualitative accounts of impact on health, well-being and broader community outcomes. Although many studies lacked methodological rigour, there was consistent evidence of positive impacts on key indicators of health and social capital, and the data have potential to inform theory.
CONCLUSIONS
Methodologies for capturing impacts are often insufficiently robust to inform policy requirements and economic assessment, and there remains a need for objective, systematic evaluation of Community Exchange and Time Currency systems. There is also a strong argument for deeper investigation of 'programme theories' underpinning these activities, to better understand what needs to be in place to trigger their potential for generating positive health and well-being outcomes.
Topics: Community Participation; Health Promotion; Humans; Program Evaluation; Public Health; Time Factors; United Kingdom
PubMed: 31887608
DOI: 10.1016/j.puhe.2019.11.011 -
Preventive Medicine Jun 2021Increasing use of parks for physical activity has been proposed for improving population health, including mental health. Interventions that aim to increase park use and... (Review)
Review
Increasing use of parks for physical activity has been proposed for improving population health, including mental health. Interventions that aim to increase park use and park-based physical activity include place-based interventions (e.g., park renovations) and person-based interventions (e.g., park-based walking or exercise classes). Using adapted methods from the Community Guide, a systematic review (search period through September 2019) was conducted to evaluate the effectiveness of park-based interventions among adults. The primary outcomes of interest were health-related, including physical and mental health and moderate-to-vigorous physical activity. Twenty-seven studies that met review criteria were analyzed in 2019 and 2020. Seven person-based studies included generally small samples of specific populations and interventions involved mostly exercise programming in parks; all but one had an average quality rating as "high" and all had at least one statistically significant outcome. Of the 20 place-based interventions, 7 involved only 1 or 2 parks; however, 7 involved from 9 to 78 parks. Types of interventions were predominantly park renovations; only 5 involved park-based exercise programming. Most of the renovations were associated with increased park-level use and physical activity, however among those implementing programming, park-level effects were more modest. Less than half of the place-based intervention studies had an average quality rating of "high." The study of parks as sites for physical activity interventions is nascent. Hybrid methods that combine placed-based evaluations and cohort studies could inform how to best optimize policy, programming, design and management to promote health and well-being.
Topics: Adult; Environment Design; Exercise; Health Promotion; Humans; Mental Health; Parks, Recreational; Recreation; Residence Characteristics; Walking
PubMed: 33745954
DOI: 10.1016/j.ypmed.2021.106528 -
Pediatric Transplantation May 2017The process of pediatric solid organ transplantation (SOT) places new and increased stressors on patients and family members. Measures of family functioning may predict... (Review)
Review
The process of pediatric solid organ transplantation (SOT) places new and increased stressors on patients and family members. Measures of family functioning may predict psychological and health outcomes for pediatric patients and their families, and provide opportunity for targeted intervention. This systematic review investigated parent and family functioning and factors associated with poorer functioning in the pediatric SOT population. Thirty-seven studies were identified and reviewed. Studies featured a range of organ populations (eg, heart, liver, kidney, lung, intestine) at various stages in the transplant process. Findings highlighted that parents of pediatric SOT populations commonly report increased stress and mental health symptoms, including posttraumatic stress disorder. Pediatric SOT is also associated with increased family stress and burden throughout the transplant process. Measures of parent and family functioning were associated with several important health-related factors, such as medication adherence, readiness for discharge, and number of hospitalizations. Overall, findings suggest that family stress and burden persists post-transplant, and parent and family functioning is associated with health-related factors in SOT, highlighting family-level functioning as an important target for future intervention.
Topics: Caregivers; Child; Family; Family Health; Female; Hospitalization; Humans; Male; Medication Adherence; Organ Transplantation; Parenting; Parents; Patient Discharge; Postoperative Period; Stress Disorders, Post-Traumatic; Stress, Psychological
PubMed: 28181361
DOI: 10.1111/petr.12900 -
Seminars in Arthritis and Rheumatism Dec 2017The aims of this study were as follows: (1) to analyze the literature systematically regarding the seasonal and monthly variation of the occurrence of episodes of acute... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The aims of this study were as follows: (1) to analyze the literature systematically regarding the seasonal and monthly variation of the occurrence of episodes of acute gouty arthritis, and (2) to investigate the relationship between the occurrence of episodes of acute gouty arthritis and meteorological parameters.
METHODS
The present authors systematically reviewed databases for articles published before November 2015. Studies with quantitative data on episodes of acute gouty arthritis by months and/or seasons were included. Meteorological data such as the highest temperature, lowest temperature, diurnal temperature range, change in mean temperature between neighboring days, relative humidity and wind speed for the geographic place(s), and study period where and when each study took place were obtained from meteorological websites.
RESULTS
Ten studies published between 1920 and 2015 were included. A meta-analysis by season showed that acute gouty arthritis occurred significantly more frequently in spring than in other seasons. Analysis by month showed an increase in episodes of acute gouty arthritis from March to July, being the highest in July. The trend reversed, and episodes of acute gouty arthritis started decreasing from July to September, being the lowest in September. The change in mean temperature between neighboring days was the only meteorological parameter that was significantly correlated with the number of monthly episodes of acute gouty arthritis.
CONCLUSIONS
Acute gouty arthritis seems to develop more frequently during the period in which the temperature increases significantly between neighboring days: spring by season and between March and July by month in the northern hemisphere.
Topics: Arthritis, Gouty; Humans; Seasons; Weather
PubMed: 28583691
DOI: 10.1016/j.semarthrit.2017.05.006 -
The Cochrane Database of Systematic... Jan 2016Pneumothorax occurs more frequently in the neonatal period than at any other time of life and is associated with increased mortality and morbidity. It may be treated... (Review)
Review
BACKGROUND
Pneumothorax occurs more frequently in the neonatal period than at any other time of life and is associated with increased mortality and morbidity. It may be treated with either needle aspiration or insertion of a chest tube. The former consists of aspiration of air with a syringe through a needle or an angiocatheter, usually through the second or third intercostal space in the midclavicular line. The chest tube is usually placed in the anterior pleural space passing through the sixth intercostal space into the pleural opening, turned anteriorly and directed to the location of the pneumothorax, and then connected to a Heimlich valve or an underwater seal with continuous suction.
OBJECTIVES
To compare the efficacy and safety of needle aspiration and intercostal tube drainage in the management of neonatal pneumothorax.
SEARCH METHODS
We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 11), MEDLINE via PubMed (1966 to 30 November 2015), EMBASE (1980 to 30 November 2015), and CINAHL (1982 to 30 November 2015). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials.
SELECTION CRITERIA
Randomised controlled trials, quasi-randomised controlled trials and cluster trials comparing needle aspiration (either with the needle or angiocatheter left in situ or removed immediately after aspiration) to intercostal tube drainage in newborn infants with pneumothorax.
DATA COLLECTION AND ANALYSIS
For each of the included trial, two authors independently extracted data (e.g. number of participants, birth weight, gestational age, kind of needle and chest tube, choice of intercostal space, pressure and device for drainage) and assessed the risk of bias (e.g. adequacy of randomisation, blinding, completeness of follow-up). The primary outcomes considered in this review are mortality during the neonatal period and during hospitalisation.
MAIN RESULTS
One randomised controlled trial (72 infants) met the inclusion criteria of this review. We found no differences in the rates of mortality (risk ratio (RR) 1.50, 95% confidence interval (CI) 0.27 to 8.45) or complications related to the procedure. After needle aspiration, the angiocatheter was left in situ (mean 27.1 hours) and not removed immediately after the aspiration. The angiocatheter was in place for a shorter duration than the intercostal tube (mean difference (MD) -11.20 hours, 95% CI -15.51 to -6.89). None of the 36 newborns treated with needle aspiration with the angiocatheter left in situ required the placement of an intercostal tube drainage. Overall, the quality of the evidence supporting this finding is low.
AUTHORS' CONCLUSIONS
At present there is insufficient evidence to determine the efficacy and safety of needle aspiration versus intercostal tube drainage in the management of neonatal pneumothorax. Randomised controlled trials comparing the two techniques are warranted.
Topics: Chest Tubes; Humans; Infant, Newborn; Pneumothorax; Randomized Controlled Trials as Topic; Risk; Suction; Thoracentesis; Thoracostomy
PubMed: 26751585
DOI: 10.1002/14651858.CD011724.pub2 -
Public Health Oct 2022The cost of treating metastatic colorectal cancer places a significant economic burden on individuals, populations, and health care. However, there is a paucity of... (Review)
Review
OBJECTIVE
The cost of treating metastatic colorectal cancer places a significant economic burden on individuals, populations, and health care. However, there is a paucity of information on the costs of the contemporary management of metastatic colorectal cancer. This systematic review aims to review the literature to estimate the direct cost of treating metastatic colorectal cancer.
STUDY DESIGN
Systematic review.
METHODS
MEDLINE, Embase, Web of Science, Evidence-Based Medicine Reviews: National Health Service Economic Evaluation Database Guide, EconLit, and grey literature from the 1st of January 2000 to the 1st of February 2020 were all searched for studies reporting the direct costs of treating metastatic colorectal cancer. The methodological quality of the included studies was assessed using the Evers' Consensus on Health Economic Criteria checklist.
RESULTS
In total, 39,489 records were retrieved, and 29 studies were included. Costs of treating metastatic colorectal cancer varied because of the heterogeneity of treatment. Studies reported average costs ranged from $12,346 to $293,461. Studies that included the cost of systemic therapy reported an estimated cost of almost $300,000.
CONCLUSION
The existing evidence indicates that the cost of treating metastatic colorectal cancer places a significant economic burden on healthcare systems despite differences in methodology and treatment heterogeneity. Future research needs to define the cost components of treating metastatic colorectal cancer to improve comparability and examine the relationship between spending, overall survival, and quality of life. Identifying these costs and their impact on health care budgets can help policymakers plan health system expenditure.
Topics: Colorectal Neoplasms; Cost-Benefit Analysis; Health Expenditures; Humans; Quality of Life; State Medicine
PubMed: 36063775
DOI: 10.1016/j.puhe.2022.06.022 -
Sensors (Basel, Switzerland) May 2022The COVID-19 pandemic has changed our common habits and lifestyle. Occupancy information is valued more now due to the restrictions put in place to reduce the spread of... (Review)
Review
The COVID-19 pandemic has changed our common habits and lifestyle. Occupancy information is valued more now due to the restrictions put in place to reduce the spread of the virus. Over the years, several authors have developed methods and algorithms to detect/estimate occupancy in enclosed spaces. Similarly, different types of sensors have been installed in the places to allow this measurement. However, new researchers and practitioners often find it difficult to estimate the number of sensors to collect the data, the time needed to sense, and technical information related to sensor deployment. Therefore, this systematic review provides an overview of the type of environmental sensors used to detect/estimate occupancy, the places that have been selected to carry out experiments, details about the placement of the sensors, characteristics of datasets, and models/algorithms developed. Furthermore, with the information extracted from three selected studies, a technique to calculate the number of environmental sensors to be deployed is proposed.
Topics: Algorithms; COVID-19; Humans; Pandemics
PubMed: 35632178
DOI: 10.3390/s22103770 -
The Cochrane Database of Systematic... Oct 2017Asthma is a chronic inflammatory disease that affects the airways and is common in both adults and children. It is characterised by symptoms including wheeze, shortness... (Review)
Review
BACKGROUND
Asthma is a chronic inflammatory disease that affects the airways and is common in both adults and children. It is characterised by symptoms including wheeze, shortness of breath, chest tightness, and cough. People with asthma may be helped to manage their condition through shared decision-making (SDM). SDM involves at least two participants (the medical practitioner and the patient) and mutual sharing of information, including the patient's values and preferences, to build consensus about favoured treatment that culminates in an agreed action. Effective self-management is particularly important for people with asthma, and SDM may improve clinical outcomes and quality of life by educating patients and empowering them to be actively involved in their own health.
OBJECTIVES
To assess benefits and potential harms of shared decision-making for adults and children with asthma.
SEARCH METHODS
We searched the Cochrane Airways Trials Register, which contains studies identified in several sources including CENTRAL, MEDLINE, and Embase. We also searched clinical trials registries and checked the reference lists of included studies. We conducted the most recent searches on 29 November 2016.
SELECTION CRITERIA
We included studies of individual or cluster parallel randomised controlled design conducted to compare an SDM intervention for adults and children with asthma versus a control intervention. We included studies available as full-text reports, those published as abstracts only, and unpublished data, and we placed no restrictions on place, date, or language of publication. We included interventions targeting healthcare professionals or patients, their families or care-givers, or both. We included studies that compared the intervention versus usual care or a minimal control intervention, and those that compared an SDM intervention against another active intervention. We excluded studies of interventions that involved multiple components other than the SDM intervention unless the control group also received these interventions.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened searches, extracted data from included studies, and assessed risk of bias. Primary outcomes were asthma-related quality of life, patient/parent satisfaction, and medication adherence. Secondary outcomes included exacerbations of asthma, asthma control, acceptability/feasibility from the perspective of healthcare professionals, and all adverse events. We graded and presented evidence in a 'Summary of findings' table.We were unable to pool any of the extracted outcome data owing to clinical and methodological heterogeneity but presented findings in forest plots when possible. We narratively described skewed data.
MAIN RESULTS
We included four studies that compared SDM versus control and included a total of 1342 participants. Three studies recruited children with asthma and their care-givers, and one recruited adults with asthma. Three studies took place in the United States, and one in the Netherlands. Trial duration was between 6 and 24 months. One trial delivered the SDM intervention to the medical practitioner, and three trials delivered the SDM intervention directly to the participant. Two paediatric studies involved use of an online portal, followed by face-to-face consultations. One study delivered an SDM intervention or a clinical decision-making intervention through a mixture of face-to-face consultations and telephone calls. The final study randomised paediatric general practice physicians to receive a seminar programme promoting application of SDM principles. All trials were open-label, although one study, which delivered the intervention to physicians, stated that participants were unaware of their physicians' involvement in the trial. We had concerns about selection and attrition bias and selective reporting, and we noted that one study substantially under-recruited participants. The four included studies used different approaches to measure fidelity/intervention adherence and to report study findings.One study involving adults with poorly controlled asthma reported improved quality of life (QOL) for the SDM group compared with the control group, using the Asthma Quality of Life Questionnaire (AQLQ) for assessment (mean difference (MD) 1.90, 95% confidence interval (CI) 1.24 to 2.91), but two other trials did not identify a benefit. Patient/parent satisfaction with the performance of paediatricians was greater in the SDM group in one trial involving children. Medication adherence was better in the SDM group in two studies - one involving adults and one involving children (all medication adherence: MD 0.21, 95% CI 0.11 to 0.31; mean number of controlled medication prescriptions over 26 weeks: 1.1 in the SDM group (n = 26) and 0.7 in the control group (n = 27)). In one study, asthma-related visit rates were lower in the SDM group than in the usual care group (1.0/y vs 1.4/y; P = 0.016), but two other studies did not report a difference in exacerbations nor in prescriptions for short courses of oral steroids. Finally, one study described better odds of reporting no asthma problems in the SDM group than in the usual care group (odds ratio (OR) 1.90, 95% CI 1.26 to 2.87), although two other studies reporting asthma control did not identify a benefit with SDM. We found no information about acceptability of the intervention to the healthcare professional and no information on adverse events. Overall, our confidence in study results ranged from very low to moderate, and we downgraded outcomes owing to risk of bias, imprecision, and indirectness.
AUTHORS' CONCLUSIONS
Substantial differences between the four included randomised controlled trials (RCTs) indicate that we cannot provide meaningful overall conclusions. Individual studies demonstrated some benefits of SDM over control, in terms of quality of life; patient and parent satisfaction; adherence to prescribed medication; reduction in asthma-related healthcare visits; and improved asthma control. Our confidence in the findings of these individual studies ranges from moderate to very low, and it is important to note that studies did not measure or report adverse events.Future trials should be adequately powered and of sufficient duration to detect differences in patient-important outcomes such as exacerbations and hospitalisations. Use of core asthma outcomes and validated scales when possible would facilitate future meta-analysis. Studies conducted in lower-income settings and including an economic evaluation would be of interest. Investigators should systematically record adverse events, even if none are anticipated. Studies identified to date have not included adolescents; future trials should consider their inclusion. Measuring and reporting of intervention fidelity is also recommended.
Topics: Adult; Asthma; Child; Clinical Decision-Making; Decision Making; Disease Progression; Humans; Medication Adherence; Patient Participation; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 28972652
DOI: 10.1002/14651858.CD012330.pub2