-
PloS One 2016Countries in Latin America and the Caribbean (LAC) have experienced a rapid increase in their proportion of older people. This region is marked by a high prevalence of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Countries in Latin America and the Caribbean (LAC) have experienced a rapid increase in their proportion of older people. This region is marked by a high prevalence of chronic diseases and disabilities among aging adults. Frailty appears in the context of LAC negatively affecting quality of life among many older people.
AIM
To investigate the prevalence of frailty among community-dwelling older people in LAC through a systematic review and meta-analysis.
METHODS
A literature search was performed in indexed databases and in the grey literature. Studies investigating the prevalence of frailty with representative samples of community-dwelling older people in Latin America and the Caribbean were retrieved. Independent investigators carried out the study selection process and the data extraction. A meta-analysis and meta-regression were performed using STATA 11 software. The systematic review was registered at the International Prospective Register of Systematic Reviews under the number CRD42014015203.
RESULTS
A total of 29 studies and 43,083 individuals were included in the systematic review. The prevalence of frailty was 19.6% (95% CI: 15.4-24.3%) in the investigated region, with a range of 7.7% to 42.6% in the studies reviewed. The year of data collection influenced the heterogeneity between the studies.
CONCLUSION
Frailty is very common among older people in LAC. As a result, countries in the region need to adapt their health and social care systems to demands of an older population.
Topics: Aged, 80 and over; Aging; Caribbean Region; Frail Elderly; Geriatric Assessment; Health Status; Humans; Latin America; Prevalence
PubMed: 27500953
DOI: 10.1371/journal.pone.0160019 -
International Journal of Environmental... Feb 2021Gestational diabetes mellitus (GDM) is a major public health problem and a threat to maternal and child health. There is a lack of integrated and systematically... (Review)
Review
Gestational diabetes mellitus (GDM) is a major public health problem and a threat to maternal and child health. There is a lack of integrated and systematically synthesized knowledge about the prevalence GDM in Norway. Therefore, this systemic review aimed to present the best available peer-reviewed published evidence from the past 20 years about the prevalence of GDM in Norway. A comprehensive literature search was performed on online databases consisting of PubMed (including Medline), Web of Science, and Scopus to retrieve original research articles published on the prevalence of GDM up to August 2020. Also, databases of Norart and SveMed in the Norwegian language were searched to enhance the search coverage. Data were extracted using a standardized protocol and data collection form and were presented narratively. A total of 11 studies were selected to include for data analysis and synthesis with the total sample size of 2,314,191 pregnant women. The studies included heterogenous populations and mostly reported the prevalence of GDM in healthy mothers with singleton pregnancies. The prevalence of GDM in population registered-based studies in Norway was reported to be lower than 2%, using the World Health Organization (WHO) 1999 criteria. However, studies on high-risk populations such as the non-European ethnicity reported prevalence rates ranging from 8% to 15%. Given the evidence from available literature that reported trends in the prevalence of GDM, an increase in the prevalence of GDM across most racial/ethnic groups studied in Norway was observed. Overall, the prevalence of GDM in the low risk population of Norway is fairly low, but the available literature supports the perspective that the prevalence of GDM has shown an increasing trend in recent decades. This finding is very important for health service planning and evaluation, policy development, and research in Norway. Large-scale prospective studies, using the national data, are warranted to provide firm evidence over coming years. Our review findings can help policy makers devise appropriate strategies for improving women's reproductive health.
Topics: Child; Diabetes, Gestational; Female; Humans; Norway; Pregnancy; Prevalence; Prospective Studies; Risk Factors
PubMed: 33546492
DOI: 10.3390/ijerph18041423 -
BMC Psychiatry Oct 2022The experience sampling method (ESM) is an intensive longitudinal research method. Participants complete questionnaires at multiple times about their current or very...
BACKGROUND
The experience sampling method (ESM) is an intensive longitudinal research method. Participants complete questionnaires at multiple times about their current or very recent state. The design of ESM studies is complex. People with psychosis have been shown to be less adherent to ESM study protocols than the general population. It is not known how to design studies that increase adherence to study protocols. A lack of typology makes it is hard for researchers to decide how to collect data in a way that allows for methodological rigour, quality of reporting, and the ability to synthesise findings. The aims of this systematic review were to characterise the design choices made in ESM studies monitoring the daily lives of people with psychosis, and to synthesise evidence relating the data completeness to different design choices.
METHODS
A systematic review was conducted of published literature on studies using ESM with people with psychosis. Studies were included if they used digital technology for data collection and reported the completeness of the data set. The constant comparative method was used to identify design decisions, using inductive identification of design decisions with simultaneous comparison of design decisions observed. Weighted regression was used to identify design decisions that predicted data completeness. The review was pre-registered (PROSPERO CRD42019125545).
RESULTS
Thirty-eight studies were included. A typology of design choices used in ESM studies was developed, which comprised three superordinate categories of design choice: Study context, ESM approach and ESM implementation. Design decisions that predict data completeness include type of ESM protocol used, length of time participants are enrolled in the study, and if there is contact with the research team during data collection.
CONCLUSIONS
This review identified a range of design decisions used in studies using ESM in the context of psychosis. Design decisions that influence data completeness were identified. Findings will help the design and reporting of future ESM studies. Results are presented with the focus on psychosis, but the findings can be applied across different mental health populations.
Topics: Humans; Ecological Momentary Assessment; Psychotic Disorders; Research Design; Surveys and Questionnaires
PubMed: 36307752
DOI: 10.1186/s12888-022-04319-x -
The Cochrane Database of Systematic... Dec 2014Endogenous glutamine biosynthesis may be insufficient to meet the needs of people with severe gastrointestinal disease. Results from studies using experimental animal... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Endogenous glutamine biosynthesis may be insufficient to meet the needs of people with severe gastrointestinal disease. Results from studies using experimental animal models of gastrointestinal disease have suggested that glutamine supplementation improves clinical outcomes. This review examines evidence on the effect of glutamine supplementation in young infants with severe gastrointestinal disease.
OBJECTIVES
To assess the effect of supplemental glutamine on mortality and morbidity in young infants with severe gastrointestinal disease.
SEARCH METHODS
We searcheed the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2014, Issue 8), MEDLINE, EMBASE, and CINAHL (from inception to September 2014), conference proceedings, and reference lists from previous reviews.
SELECTION CRITERIA
Randomised or quasi-randomised controlled trials that compared glutamine supplementation versus no glutamine supplementation in infants up to three months old (corrected for preterm birth if necessary) with severe gastrointestinal disease defined as a congenital or acquired gastrointestinal condition that is likely to necessitate providing parenteral nutrition for at least 24 hours.
DATA COLLECTION AND ANALYSIS
Two review authors assessed trial eligibility and risk of bias and undertook data extraction independently. We analysed the treatment effects in the individual trials and reported the risk ratio (RR) and risk difference (RD) for dichotomous data and mean difference for continuous data, with 95% confidence intervals (CI). We used a fixed-effect model in meta-analyses and explored the potential causes of heterogeneity in sensitivity analyses.
MAIN RESULTS
We found three trials in which a total of 274 infants participated. The trials were of good methodological quality but were too small to detect clinically important effects of glutamine supplementation. Meta-analyses did not reveal a statistically significant difference in the risk of death before hospital discharge (typical RR 0.79, 95% CI 0.19 to 3.20; typical RD -0.01, 95% CI -0.05 to 0.03) or in the rate of invasive infection (typical RR 1.37, 95% CI 0.89 to 2.11; typical RD 0.08, 95% CI -0.03 to 0.18]).
AUTHORS' CONCLUSIONS
The available data from randomised controlled trials do not suggest that glutamine supplementation has any important benefits for young infants with severe gastrointestinal disease.
Topics: Dietary Supplements; Gastrointestinal Diseases; Glutamine; Hospital Mortality; Humans; Infant; Infant, Newborn; Infant, Premature; Randomized Controlled Trials as Topic
PubMed: 25504522
DOI: 10.1002/14651858.CD005947.pub4 -
The Cochrane Database of Systematic... Mar 2015Many hospitalised patients are affected by medication errors (MEs) that may cause discomfort, harm and even death. Children are at especially high risk of harm as the... (Review)
Review
BACKGROUND
Many hospitalised patients are affected by medication errors (MEs) that may cause discomfort, harm and even death. Children are at especially high risk of harm as the result of MEs because such errors are potentially more hazardous to them than to adults. Until now, interventions to reduce MEs have led to only limited improvements.
OBJECTIVES
To determine the effectiveness of interventions aimed at reducing MEs and related harm in hospitalised children.
SEARCH METHODS
The Effective Practice and Organisation of Care Group (EPOC) Trials Search Co-ordinator searched the following sources for primary studies: The Cochrane Library, including the Cochrane Central Register of Controlled Trials (CENTRAL), the Economic Evaluation Database (EED) and the Health Technology Assessments (HTA) database; MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Proquest Dissertations & Theses, Web of Science (citation indexes and conference proceedings) and the EPOC Register of Studies. Related reviews were identified by searching the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects (DARE). Review authors searched grey literature sources and trial registries. They handsearched selected journals, contacted researchers in the field and scanned reference lists of relevant reviews. They conducted searches in November 2013 and November 2014. They applied neither language nor date limits.
SELECTION CRITERIA
Randomised controlled trials, controlled before-after studies and interrupted time series investigating interventions to improve medication safety in hospitalised children (≤ 18 years). Participants were healthcare professionals authorised to prescribe, dispense or administer medications. Outcome measures included MEs, (potential) patient harm, resource utilisation and unintended consequences of the interventions.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected studies, extracted data and assessed study quality using the EPOC data collection checklist. We evaluated the risk of bias of included studies and used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach to assess the quality of the body of evidence. We described results narratively and presented them using GRADE tables.
MAIN RESULTS
We included seven studies describing five different interventions: participation of a clinical pharmacist in a clinical team (n = 2), introduction of a computerised physician order entry system (n = 2), implementation of a barcode medication administration system (n = 1), use of a structured prescribing form (n = 1) and implementation of a check and control checklist in combination with feedback (n = 1).Clinical and methodological heterogeneity between studies precluded meta-analyses. Although some interventions described in this review show a decrease in MEs, the results are not consistent, and none of the studies resulted in a significant reduction in patient harm. Based on the GRADE approach, the overall quality and strengfh of the evidence are low.
AUTHORS' CONCLUSIONS
Current evidence on effective interventions to prevent MEs in a paediatric population in hospital is limited. Comparative studies with robust study designs are needed to investigate interventions including components that focus on specific paediatric safety issues.
Topics: Adolescent; Checklist; Child; Child, Hospitalized; Drug Prescriptions; Electronic Data Processing; Humans; Medical Order Entry Systems; Medication Errors; Pharmacists; Randomized Controlled Trials as Topic
PubMed: 25756542
DOI: 10.1002/14651858.CD006208.pub3 -
Lesbian and bisexual women's likelihood of becoming pregnant: a systematic review and meta-analysis.BJOG : An International Journal of... Feb 2017Few data exist regarding pregnancy in lesbian and bisexual (LB) women. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Few data exist regarding pregnancy in lesbian and bisexual (LB) women.
OBJECTIVES
To determine the likelihood of LB women becoming pregnant, naturally or assisted, in comparison with heterosexual women SEARCH STRATEGY: Systematic review of papers published 1 January 2000 to 23 June 2015.
SELECTION CRITERIA
Studies contained details of pregnancy rates among LB women compared with heterosexual women. No restriction on study design.
DATA COLLECTION AND ANALYSIS
Inclusion decisions, data extraction and quality assessment were conducted in duplicate. Meta-analyses were carried out, with subgroups as appropriate.
MAIN RESULTS
Of 6859 papers identified, 104 full-text articles were requested, 30 papers (28 studies) were included. The odds ratio (OR) of ever being pregnant was 0.19 (95% CI 0.18-0.21) in lesbian women and 1.22 (95% CI 1.15-1.29) in bisexual women compared with heterosexual women. In the general population, the odds ratio for pregnancy was nine-fold lower among lesbian women and over two-fold lower among bisexual women (0.12 [95% CI 0.12-0.13] and 0.50 [95% CI 0.45-0.55], respectively). Odds ratios for pregnancy were higher for both LB adolescents (1.37 [95% CI 1.18-1.59] and 1.98 [95% CI 1.85, 2.13], respectively). There were inconsistent results regarding abortion rates. Lower rates of previous pregnancies were found in lesbian women undergoing artificial insemination (OR 0.17 [95% CI 0.11-0.26]) but there were higher assisted reproduction success rates compared with heterosexual women (OR 1.56 [95% CI 1.24-1.96]).
CONCLUSIONS
Heterosexuality must not be assumed in adolescents, as LB adolescents are at greater risk of unwanted pregnancies and terminations. Clinicians should provide appropriate information to all women, without assumptions about LB patients' desire for, or rejection of, fertility and childbearing.
TWEETABLE ABSTRACT
Review of likelihood of LB women becoming pregnant: LB teenagers at greater risk of unwanted pregnancies.
Topics: Female; Homosexuality, Female; Humans; Pregnancy; Pregnancy Rate; Probability; Sexual and Gender Minorities; Sexuality
PubMed: 27981741
DOI: 10.1111/1471-0528.14449 -
Archives of Physical Medicine and... Feb 2015To identify the most commonly used patient-reported outcome (PRO) measures in clinical vestibular research, and to assess their test characteristics and applicability to... (Review)
Review
OBJECTIVE
To identify the most commonly used patient-reported outcome (PRO) measures in clinical vestibular research, and to assess their test characteristics and applicability to the study of age-related vestibular loss in clinical trials.
DATA SOURCES
We performed a systematic review of the PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases from 1950 to August 13, 2013.
STUDY SELECTION
PRO measures were defined as outcomes that capture the subjective experience of the patient (eg, symptoms, functional status, health perceptions, quality of life). Two independent reviewers selected studies that used PRO measures in clinical vestibular research. Disparities were resolved with consensus between the reviewers. Of 2260 articles initially found in the literature search, 255 full-text articles were retrieved for assessment. Of these, 104 met inclusion criteria for data collection.
DATA EXTRACTION
PRO measures were identified by 2 independent reviewers. The 4 most commonly used PROs were evaluated for their applicability to the condition of age-related vestibular loss. Specifically, for these 4 PROs, data were collected pertaining to instrument test-retest reliability, item domains, and target population of the instrument.
DATA SYNTHESIS
A total of 50 PRO instruments were identified. The 4 most frequently used PROs were the Dizziness Handicap Inventory, Activities-specific Balance Confidence scale, Vertigo Symptom Scale-short form, and visual analog scale. Of these 4 PROs, 3 were validated for use in patients with vestibular disease and 1 was validated in community-dwelling older individuals with balance impairments. Items across the 4 PROs were categorized into 3 domains based on the International Classification of Functioning, Disability and Health: activity, participation, and body functions and structures.
CONCLUSIONS
None of the most commonly used PRO instruments were validated for use in community-dwelling older adults with age-related vestibular loss. Nevertheless, the 3 common domains of items identified across these 4 PRO instruments may be generalizable to older adults and provide a basis for developing a PRO instrument designed to evaluate the effectiveness of interventions targeted toward age-related vestibular loss.
Topics: Aging; Humans; Postural Balance; Self Report; Severity of Illness Index; Surveys and Questionnaires; Treatment Outcome; Vestibular Diseases
PubMed: 25305629
DOI: 10.1016/j.apmr.2014.09.017 -
Trials Apr 2021Patient-reported outcomes (PROs) are used in clinical trials to assess the effectiveness and tolerability of interventions. Inclusion of participants from different... (Review)
Review
BACKGROUND
Patient-reported outcomes (PROs) are used in clinical trials to assess the effectiveness and tolerability of interventions. Inclusion of participants from different ethnic backgrounds is essential for generalisability of cancer trial results. PRO data collection should include appropriately translated patient-reported outcome measures (PROMs) to minimise missing data and sample attrition.
METHODS
Protocols and/or publications from cancer clinical trials using a PRO endpoint and registered on the National Institute for Health Research Portfolio were systematically reviewed for information on recruitment, inclusion of ethnicity data, and use of appropriately translated PROMs. Semi-structured interviews were conducted with key stakeholders to explore barriers and facilitators for optimal PRO trial design, diverse recruitment and reporting, and use of appropriately translated PROMs.
RESULTS
Eighty-four trials met the inclusion criteria, only 14 (17%) (n = 4754) reported ethnic group data, and ethnic group recruitment was low, 611 (13%). Although 8 (57%) studies were multi-centred and multi-national, none reported using translated PROMs, although available for 7 (88%) of the studies. Interviews with 44 international stakeholders identified a number of perceived barriers to ethnically diverse recruitment including diverse participant engagement, relevance of ethnicity to research question, prominence of PROs, and need to minimise investigator burden. Stakeholders had differing opinions on the use of translated PROMs, the impact of trial designs, and recruitment strategies on diverse recruitment. Facilitators of inclusive research were described and examples of good practice identified.
CONCLUSIONS
Greater transparency is required when PROs are used as primary or secondary outcomes in clinical trials. Protocols and publications should demonstrate that recruitment was accessible to diverse populations and facilitated by trial design, recruitment strategies, and appropriate PROM usage. The use of translated PROMs should be made explicit when used in cancer clinical trials.
Topics: Clinical Trials as Topic; Humans; Neoplasms; Patient Reported Outcome Measures; Research Personnel
PubMed: 33902699
DOI: 10.1186/s13063-021-05255-z -
Antimicrobial Resistance and Infection... Aug 2023Intravascular catheter infections are associated with adverse clinical outcomes. However, a significant proportion of these infections are preventable. Evaluations of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Intravascular catheter infections are associated with adverse clinical outcomes. However, a significant proportion of these infections are preventable. Evaluations of the performance of automated surveillance systems for adequate monitoring of central-line associated bloodstream infection (CLABSI) or catheter-related bloodstream infection (CRBSI) are limited.
OBJECTIVES
We evaluated the predictive performance of automated algorithms for CLABSI/CRBSI detection, and investigated which parameters included in automated algorithms provide the greatest accuracy for CLABSI/CRBSI detection.
METHODS
We performed a meta-analysis based on a systematic search of published studies in PubMed and EMBASE from 1 January 2000 to 31 December 2021. We included studies that evaluated predictive performance of automated surveillance algorithms for CLABSI/CRBSI detection and used manually collected surveillance data as reference. We estimated the pooled sensitivity and specificity of algorithms for accuracy and performed a univariable meta-regression of the different parameters used across algorithms.
RESULTS
The search identified five full text studies and 32 different algorithms or study populations were included in the meta-analysis. All studies analysed central venous catheters and identified CLABSI or CRBSI as an outcome. Pooled sensitivity and specificity of automated surveillance algorithm were 0.88 [95%CI 0.84-0.91] and 0.86 [95%CI 0.79-0.92] with significant heterogeneity (I = 91.9, p < 0.001 and I = 99.2, p < 0.001, respectively). In meta-regression, algorithms that include results of microbiological cultures from specific specimens (respiratory, urine and wound) to exclude non-CRBSI had higher specificity estimates (0.92, 95%CI 0.88-0.96) than algorithms that include results of microbiological cultures from any other body sites (0.88, 95% CI 0.81-0.95). The addition of clinical signs as a predictor did not improve performance of these algorithms with similar specificity estimates (0.92, 95%CI 0.88-0.96).
CONCLUSIONS
Performance of automated algorithms for detection of intravascular catheter infections in comparison to manual surveillance seems encouraging. The development of automated algorithms should consider the inclusion of results of microbiological cultures from specific specimens to exclude non-CRBSI, while the inclusion of clinical data may not have an added-value. Trail Registration Prospectively registered with International prospective register of systematic reviews (PROSPERO ID CRD42022299641; January 21, 2022). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022299641.
Topics: Humans; Central Venous Catheters; Algorithms; Data Collection; Sepsis
PubMed: 37653559
DOI: 10.1186/s13756-023-01286-0 -
Health-Related Data Sources Accessible to Health Researchers From the US Government: Mapping Review.Journal of Medical Internet Research Apr 2023Big data from large, government-sponsored surveys and data sets offers researchers opportunities to conduct population-based studies of important health issues in the... (Review)
Review
BACKGROUND
Big data from large, government-sponsored surveys and data sets offers researchers opportunities to conduct population-based studies of important health issues in the United States, as well as develop preliminary data to support proposed future work. Yet, navigating these national data sources is challenging. Despite the widespread availability of national data, there is little guidance for researchers on how to access and evaluate the use of these resources.
OBJECTIVE
Our aim was to identify and summarize a comprehensive list of federally sponsored, health- and health care-related data sources that are accessible in the public domain in order to facilitate their use by researchers.
METHODS
We conducted a systematic mapping review of government sources of health-related data on US populations and with active or recent (previous 10 years) data collection. The key measures were government sponsor, overview and purpose of data, population of interest, sampling design, sample size, data collection methodology, type and description of data, and cost to obtain data. Convergent synthesis was used to aggregate findings.
RESULTS
Among 106 unique data sources, 57 met the inclusion criteria. Data sources were classified as survey or assessment data (n=30, 53%), trends data (n=27, 47%), summative processed data (n=27, 47%), primary registry data (n=17, 30%), and evaluative data (n=11, 19%). Most (n=39, 68%) served more than 1 purpose. The population of interest included individuals/patients (n=40, 70%), providers (n=15, 26%), and health care sites and systems (n=14, 25%). The sources collected data on demographic (n=44, 77%) and clinical information (n=35, 61%), health behaviors (n=24, 42%), provider or practice characteristics (n=22, 39%), health care costs (n=17, 30%), and laboratory tests (n=8, 14%). Most (n=43, 75%) offered free data sets.
CONCLUSIONS
A broad scope of national health data is accessible to researchers. These data provide insights into important health issues and the nation's health care system while eliminating the burden of primary data collection. Data standardization and uniformity were uncommon across government entities, highlighting a need to improve data consistency. Secondary analyses of national data are a feasible, cost-efficient means to address national health concerns.
Topics: Humans; United States; Information Sources; Delivery of Health Care; Health Care Costs; Government; Surveys and Questionnaires
PubMed: 37103987
DOI: 10.2196/43802