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World Journal of Gastroenterology Apr 2015To examine the available evidence on safety, competency and cost-effectiveness of nursing staff providing gastrointestinal (GI) endoscopy services. (Review)
Review
AIM
To examine the available evidence on safety, competency and cost-effectiveness of nursing staff providing gastrointestinal (GI) endoscopy services.
METHODS
The literature was searched for publications reporting nurse endoscopy using several databases and specific search terms. Studies were screened against eligibility criteria and for relevance. Initial searches yielded 74 eligible and relevant articles; 26 of these studies were primary research articles using original datasets relating to the ability of non-physician endoscopists. These publications included a total of 28883 procedures performed by non-physician endoscopists.
RESULTS
The number of publications in the field of non-specialist gastrointestinal endoscopy reached a peak between 1999 and 2001 and has decreased thereafter. 17/26 studies related to flexible sigmoidoscopies, 5 to upper GI endoscopy and 6 to colonoscopy. All studies were from metropolitan centres with nurses working under strict supervision and guidance by specialist gastroenterologists. Geographic distribution of publications showed the majority of research was conducted in the United States (43%), the United Kingdom (39%) and the Netherlands (7%). Most studies conclude that after appropriate training nurse endoscopists safely perform procedures. However, in relation to endoscopic competency, safety or patient satisfaction, all studies had major methodological limitations. Patients were often not randomized (21/26 studies) and not appropriately controlled. In relation to cost-efficiency, nurse endoscopists were less cost-effective per procedure at year 1 when compared to services provided by physicians, due largely to the increased need for subsequent endoscopies, specialist follow-up and primary care consultations.
CONCLUSION
Contrary to general beliefs, endoscopic services provided by nurse endoscopists are not more cost effective compared to standard service models and evidence suggests the opposite. Overall significant shortcomings and biases limit the validity and generalizability of studies that have explored safety and quality of services delivered by non-medical endoscopists.
Topics: Clinical Competence; Cost Savings; Cost-Benefit Analysis; Education, Nursing; Endoscopy, Gastrointestinal; Health Care Costs; Humans; Nurse Practitioners; Nursing Staff
PubMed: 25945022
DOI: 10.3748/wjg.v21.i16.5056 -
Implementation Science : IS Feb 2018Improvement initiatives offer a valuable mechanism for delivering and testing innovations in healthcare settings. Many of these initiatives deliver meaningful and... (Review)
Review
BACKGROUND
Improvement initiatives offer a valuable mechanism for delivering and testing innovations in healthcare settings. Many of these initiatives deliver meaningful and necessary changes to patient care and outcomes. However, many improvement initiatives fail to sustain to a point where their full benefits can be realised. This has led many researchers and healthcare practitioners to develop frameworks, models and tools to support and monitor sustainability. This work aimed to identify what approaches are available to assess and influence sustainability in healthcare and to describe the different perspectives, applications and constructs within these approaches to guide their future use.
METHODS
A systematic review was carried out following PRISMA guidelines to identify publications that reported approaches to support or influence sustainability in healthcare. Eligibility criteria were defined through an iterative process in which two reviewers independently assessed 20% of articles to test the objectivity of the selection criteria. Data were extracted from the identified articles, and a template analysis was undertaken to identify and assess the sustainability constructs within each reported approach.
RESULTS
The search strategy identified 1748 publications with 227 articles retrieved in full text for full documentary analysis. In total, 62 publications identifying a sustainability approach were included in this review (32 frameworks, 16 models, 8 tools, 4 strategies, 1 checklist and 1 process). Constructs across approaches were compared and 40 individual constructs for sustainability were found. Comparison across approaches demonstrated consistent constructs were seen regardless of proposed interventions, setting or level of application with 6 constructs included in 75% of the approaches. Although similarities were found, no approaches contained the same combination of the constructs nor did any single approach capture all identified constructs. From these results, a consolidated framework for sustainability constructs in healthcare was developed.
CONCLUSIONS
Choosing a sustainability method can pose a challenge because of the diverse approaches reported in the literature. This review provides a valuable resource to researchers, healthcare professionals and improvement practitioners by providing a summary of available sustainability approaches and their characteristics.
TRIAL REGISTRATION
This review was registered on the PROSPERO database: CRD42016040081 in June 2016.
Topics: Checklist; Delivery of Health Care; Health Personnel; Humans; Quality Assurance, Health Care; Quality Improvement
PubMed: 29426341
DOI: 10.1186/s13012-017-0707-4 -
JAMA Network Open Oct 2023Despite its prohibition by the United Nations Convention against Torture and other international treaties, torture has been perpetrated against countless individuals... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Despite its prohibition by the United Nations Convention against Torture and other international treaties, torture has been perpetrated against countless individuals worldwide, and health care practitioners globally are increasingly encountering refugee torture survivors in their clinical practices. The methods, geographic distribution, and frequency of torture globally are not well described, which limits health care practitioners' ability to adequately diagnose and treat the sequelae of torture.
OBJECTIVE
To rank the commonness of torture methods and identify the regions of the world with which they are associated.
DATA SOURCES
For this systematic review and meta-analysis, Ovid MEDLINE, Ovid Embase, Web of Science, and The Cochrane Library were searched from inception to July 2021.
STUDY SELECTION
Included studies were peer-reviewed articles in English, contained an independent sample population of individuals who experienced torture, and outlined the type(s) of torture experienced. Excluded studies were not peer reviewed, lacked an independent sample population, or did not specify torture methods. Articles were chosen for inclusion by 2 independent and blinded reviewers, and a third, independent reviewer resolved discrepancies. Overall, 266 articles-15.3% of the 1739 studies initially identified for full review-met the inclusion criteria.
DATA EXTRACTION AND SYNTHESIS
Data abstraction and quality assessment followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were extracted by 2 independent and blinded reviewers into predefined templates, and a third, independent reviewer resolved discrepancies. The risk of bias was evaluated using the Downs and Black Checklist.
MAIN OUTCOMES AND MEASURES
Torture methods were ranked by their average frequencies, numbers of reporting studies, and numbers of countries wherein the methods occurred.
RESULTS
A total of 9937 titles and abstracts were screened, and 266 studies encompassing 103 604 individuals (13 350 men, 5610 women, and 84 644 unspecified) were analyzed. Torture was reported for 105 countries; 21 methods accounted for 84% of all reported methods and 10 methods accounted for 78% of all physical tortures. The top 3 methods were beating or blunt-force trauma (reported in 208 studies and 59 countries; average frequency, 62.4%; 95% CI, 57.7%-67.1%), electrical torture (reported in 114 studies and 28 countries; average frequency, 17.2%; 95% CI, 15.0%-19.4%), and starvation or dehydration (reported in 65 studies in 26 countries; average frequency, 12.7%; 95% CI, 10.2%-15.2%). According to the Downs and Black appraisal tool, 50 studies were rated as good or excellent and 216 as fair or poor.
CONCLUSIONS AND RELEVANCE
The findings of this study suggest that torture remains widespread. Although innumerable torture methods exist, a limited number account for the vast majority of reported tortures. So that targeted therapies may be developed, additional investigation is needed to better elucidate the sequelae associated with the most common torture methods, described here.
Topics: Male; Humans; Female; Torture; Checklist; Concept Formation; Disease Progression; Health Facilities
PubMed: 37787994
DOI: 10.1001/jamanetworkopen.2023.36629 -
Drug Design, Development and Therapy 2018Theophylline has been used for decades to treat both acute and chronic asthma. Despite its longevity in the practitioner's formulary, no detailed meta-analysis has been... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND OBJECTIVE
Theophylline has been used for decades to treat both acute and chronic asthma. Despite its longevity in the practitioner's formulary, no detailed meta-analysis has been performed to determine the conditions, including concomitant medications, under which theophylline should be used for acute exacerbations of asthma. We aimed to quantify the usefulness and side effects of theophylline with or without ethylene diamine (aminophylline) in acute asthma, with particular emphasis on patient subgroups, such as children, adults, and concomitant medications.
METHODS
We searched PubMed, EMBASE, The Cochrane Library, ClinicalTrials.gov, and the WHO Clinical Trials Registry for randomized, controlled clinical trials. We planned a priori subgroup analyses by time post-medication, concomitant medication, control type, and age.
RESULTS
We included 52 study arms from 42 individual trials. Of these, 29 study arms included an active control, such as adrenaline, beta-2 agonists, or leukotriene receptor antagonists, and 23 study arms compared theophylline (with or without ethylene diamine) with placebo or no drug. Theophylline significantly reduced heart rate when compared with active control (=0.01) and overall duration of stay (=0.002), but beta-2 agonists were superior to theophylline at improving forced expiratory volume in one second (FEV1) (=0.002). Theophylline was not significantly different from other drugs in its effects on respiratory rate, forced vital capacity (FVC), peak expiratory flow rate, admission rate, use of rescue medication, oxygen saturation, or symptom score. Closer examination of the data revealed that the medications given in addition to theophylline or control significantly changed the effectiveness of theophylline (subgroup difference: <0.00001).
CONCLUSION
Given the low cost of theophylline, and its similar efficacy and rate of side effects compared with other drugs, we suggest that theophylline, when given with bronchodilators with or without steroids, is a cost-effective and safe choice for acute asthma exacerbations.
Topics: Acute Disease; Administration, Intravenous; Anti-Asthmatic Agents; Asthma; Bronchodilator Agents; Humans; Theophylline
PubMed: 29391776
DOI: 10.2147/DDDT.S156509 -
Canadian Journal of Surgery. Journal... Jun 2017With the introduction of resident duty hour restrictions and the resulting in-house trainee shortages, a long-term solution to ensure safe and efficient patient care is... (Review)
Review
BACKGROUND
With the introduction of resident duty hour restrictions and the resulting in-house trainee shortages, a long-term solution to ensure safe and efficient patient care is needed. One solution is the integration of nurse practitioners (NPs) and physician assistants (PAs) in a variety of health care settings. We sought to examine the use of NPs and PAs on surgical/trauma services and their effect on patient outcomes and resident workload.
METHODS
We performed a systematic review of EMBASE, Medline, CINAHL, and the Cochrane Central Register of Controlled Trials. We included studies (all designs) examining the use of NPs and PAs on adult surgical and trauma services that reported the following outcomes: complications, length of stay, readmission rates, patient satisfaction and perceived quality of care, resident workload, resident work hours, resident sleep hours, resident satisfaction, resident perceived quality of care, other health care worker satisfaction and perceived quality of care, and economic impact assessments. We excluded studies assessing nonsurgical/trauma services or pediatrics and review articles.
RESULTS
Twenty-nine articles met the inclusion criteria. With the addition of NPs and PAs, patient length of stay decreased, and morbidity and mortality were unchanged. In addition, resident workload decreased, sleep time increased, and operating time improved. Patient and health care worker satisfaction rates were high. Several studies reported cost savings after the addition of NPs/PAs.
CONCLUSION
The addition of NPs and PAs to surgical/trauma services appears to be a safe, cost-effective method to manage some of the challenges arising because of resident duty hour restrictions. More high-quality research is needed to confirm these findings and to further assess the economic impact of adding NPs and PAs to the surgical team.
Topics: Humans; Internship and Residency; Nurse Practitioners; Outcome and Process Assessment, Health Care; Physician Assistants; Surgery Department, Hospital; Surgical Procedures, Operative; Trauma Centers
PubMed: 28327274
DOI: 10.1503/cjs.001516 -
Frontiers in Psychology 2021Both yoga practice and spirituality are associated with beneficial mental health outcomes. Within yoga research, however, spirituality is still a widely neglected area.... (Review)
Review
OBJECTIVE
Both yoga practice and spirituality are associated with beneficial mental health outcomes. Within yoga research, however, spirituality is still a widely neglected area. The present systematic review aims to explore empirical studies, which do, in fact, investigate the relationship between yoga and spirituality in order to provide an overview and future directions for research on this topic. The review examines whether available empirical research supports an association between yoga practice and spirituality and, if so, which specific aspects of spirituality are associated with yoga practice.
METHODS
The systematic review followed the PRISMA guideline (Prospero registration number: CRD42020155043). Empirical studies written in English, German, or Hungarian language were selected from a database search in Google Scholar, PsycINFO, and Science Direct. A total of 30 studies met the final inclusion criteria.
RESULTS
According to the quantitative and qualitative studies reviewed, yoga practice seems to be positively associated with spirituality. This association concerns various aspects of spirituality, such as spiritual aspirations, a search for insight/wisdom, an integrative worldview, a sense of meaning and peace, faith, hope, compassion, and happiness within. To harness the potential spiritual benefits of yoga, regular practice appears to be essential. Yoga practitioners seem to have both physical and spiritual motives for practicing. At least in Western societies, however, physical intentions are more prevalent than spiritual ones. The meaning of spirituality for yoga practitioners is also discussed. Due to risk of bias of the majority of the reviewed studies, however, outcomes must be taken with caution.
CONCLUSION
Yoga practice may be positively associated with several aspects of spirituality. For more evidence, further investigation of the topic is suggested. Particularly, we propose the inclusion of holistic forms of yoga practice and a comparison of Eastern and Western approaches to yoga.
PubMed: 34408712
DOI: 10.3389/fpsyg.2021.695939 -
BMJ Open Jul 2022Naturopathy is a traditional medicine system informed by codified philosophies and principles, and an emphasis on non-pharmacologic therapeutic interventions. While... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Naturopathy is a traditional medicine system informed by codified philosophies and principles, and an emphasis on non-pharmacologic therapeutic interventions. While naturopathy is practised by approximately 75 000-100 000 000 naturopathic practitioners in at least 98 countries, little is known about the international prevalence of history of consultation with a naturopathic practitioner. This study reports a systematic review and meta-analysis of studies describing the global prevalence of history of consultation with a naturopathic practitioner by the general population.
SETTING
The included literature was identified through a systematic search of eight databases between September and October 2019, as well as the grey literature.
PARTICIPANTS
Studies were included if they reported the prevalence rate of consultations with a naturopathic practitioner by the general population.
INTERVENTIONS
Survey items needed to report consultations with a naturopathic practitioner as defined in the country where data was collected, and not combine naturopathic consultations with other health services or only report consulations for illness populations.
PRIMARY AND SECONDARY OUTCOME MEASURES
Primary measures used for the analysis was consultations in the previous 12 months. Other prevalence timeframes were reported as secondary measures.
METHODS
Meta-analysis of prevalence data was conducted using random effects models based on individual countries and WHO world regions.
RESULTS
The literature search identified eight manuscripts summarising 14 studies reporting prevalence for inclusion in the review. All included studies had a low risk of bias. Meta-analysis of the included studies by world region found the 12-month prevalence of history of naturopathy consultations ranged from 1% in the Region of the Americas to 6% in the European and Western Pacific Regions.
CONCLUSIONS
There are up to sixfold differences in the prevalence of naturopathy consults over 12 months between and within world regions, which may be driven by a range of policy, legislative and social factors.
PROSPERO REGISTRATION NUMBER
CRD42020145529.
Topics: Humans; Naturopathy; Prevalence; Referral and Consultation; Surveys and Questionnaires
PubMed: 35879017
DOI: 10.1136/bmjopen-2021-056075 -
Journal of Personalized Medicine Nov 2022PGx testing requires a complex set of activities undertaken by practitioners and patients, resulting in varying implementation success. This systematic review aimed... (Review)
Review
PGx testing requires a complex set of activities undertaken by practitioners and patients, resulting in varying implementation success. This systematic review aimed (PROSPERO: CRD42019150940) to identify barriers and enablers to practitioners and patients implementing pharmacogenomic testing. We followed PRISMA guidelines to conduct and report this review. Medline, EMBASE, CINAHL, PsycINFO, and PubMed Central were systematically searched from inception to June 2022. The theoretical domain framework (TDF) guided the organisation and reporting of barriers or enablers relating to pharmacogenomic testing activities. From the twenty-five eligible reports, eleven activities were described relating to four implementation stages: ordering, facilitating, interpreting, and applying pharmacogenomic testing. Four themes were identified across the implementation stages: IT infrastructure, effort, rewards, and unknown territory. Barriers were most consistently mapped to TDF domains: memory, attention and decision-making processes, environmental context and resources, and belief about consequences.
PubMed: 36579514
DOI: 10.3390/jpm12111821 -
Sensors (Basel, Switzerland) Feb 2022Processes for evaluating software architecture (SA) help to investigate problems and potential risks in SA. It is derived from many studies that proposed a plethora of... (Review)
Review
Processes for evaluating software architecture (SA) help to investigate problems and potential risks in SA. It is derived from many studies that proposed a plethora of systematic SA evaluation methods, while industrial practitioners currently refrain from applying them since they are heavyweight. Nowadays, heterogeneous software architectures are organized based on the new infrastructure. Hardware and associated software allow different systems, such as embedded, sensor-based, modern AI, and cloud-based systems, to cooperate efficiently. It brings more complexities to SA evaluation. Alternatively, lightweight architectural evaluation methods have been proposed to satisfy the practitioner's concerns, but practitioners still do not adopt these methods. This study employs a systematic literature review with a text analysis of SA's definitions to propose a comparison framework for SA. It identifies lightweight features and factors to improve the architectural evaluation methods among industrial practitioners. The features are determined based on the practitioner's concerns by analyzing the architecture's definitions from stakeholders and reviewing architectural evaluation methods. The lightweight factors are acquired by studying the five most commonly used lightweight methods and the Architecture-based Tradeoff Analysis Method (ATAM), the most well-known heavyweight method. Subsequently, the research addresses these features and factors.
Topics: Hernia, Inguinal; Herniorrhaphy; Humans; Industry; Software; Surgical Mesh
PubMed: 35161996
DOI: 10.3390/s22031252 -
BMJ Open Feb 2016To explore medication-related burden (MRB) and patients' lived experience with medicines (PLEM) without regard to particular medication therapies or medical conditions. (Review)
Review
OBJECTIVE
To explore medication-related burden (MRB) and patients' lived experience with medicines (PLEM) without regard to particular medication therapies or medical conditions.
DESIGN
Systematic review and metasynthesis of qualitative studies.
DATA SOURCES
MEDLINE, EMBASE, International Pharmaceutical Abstracts, PsycINFO, Global health, CINAHL and Web of Science were searched from January 2000 to August 2014 using medication burden and patients' lived experience terms.
SYNTHESIS METHODS
Synthesis was undertaken following metaethnography methods and a comparative thematic analysis technique.
RESULTS
34 articles from 12 countries with a total of 1144 participants were included. 3 major inter-related themes emerged central to PLEM: MRB, medication related beliefs and medication taking practice. The negative impact of MRB, due to its interference on patients' daily lives and effects on well-being, its influence on patients' beliefs and behaviours, and a potential risk for drug-related problems (DRPs) was evident. This resulted in non-adherence and poorer outcomes (unachieved therapeutic goals and damage to patients' health). Patients who experienced MRB interference in their life over time begin to juggle their medicines. Others continue their medicines despite experiencing MRB resulting in compromised physical, social or psychological well-being.
CONCLUSIONS
There is a shared commonality of PLEM among the studies. MRB plays a central role in influencing patients' health and well-being, beliefs and behaviour towards medicines. Given the complexity of MRB and its impact evident from this review, there is a need for healthcare practitioners to have insight into PLEM in therapeutic care plans. Understanding PLEM is an opportunity for practitioners to identify particular MRBs that patients encounter, and provide individualised care through selection of therapeutic care plans that suit a patient's life. This may assist in helping to achieve patients' medication-related needs, and improve medication therapy and health outcomes.
Topics: Cost of Illness; Drug Therapy; Health Knowledge, Attitudes, Practice; Humans; Medication Adherence; Qualitative Research
PubMed: 26839015
DOI: 10.1136/bmjopen-2015-010035