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BMJ Open Apr 2024Speech sound disorder (SSD) describes a 'persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal... (Review)
Review
OBJECTIVE
Speech sound disorder (SSD) describes a 'persistent difficulty with speech sound production that interferes with speech intelligibility or prevents verbal communication'. There is a need to establish which care pathways are most effective and efficient for children with SSD. Comparison of care pathways requires clearly defined, evidence-based, interventions and agreement on how to measure the outcomes. At present, no definitive list of assessments, interventions or outcomes exists. The objective of this umbrella review paper is to provide a rigorous and detailed list of assessments, interventions and outcomes which target SSD in children.
DESIGN
In December 2022, a systematic search of Ovid Medline, OVID Embase, CINAHL, PsycInfo and Cochrane and a number of grey literature platforms were undertaken. 18 reviews were included, and subsequently 415 primary research articles were assessed for data related to assessments, interventions or outcomes. The AMSTAR (Assessing the Methodological Quality of Systematic Reviews) framework was used to assess the quality of the retained reviews.
SETTING
Reviews were retained which took place in any setting.
PARTICIPANTS
The population is children of any age with a diagnosis of SSD of unknown origin.
PRIMARY AND SECONDARY OUTCOME MEASURES
Reviews reporting outcomes, assessment and interventions for children with SSD.
RESULTS
Extraction and analysis identified 37 assessments, 46 interventions and 30 outcome measures used in research reporting of SSD. Not all of the listed outcomes were linked to specific outcome measurement tools, but these were measurable through the use of one or more of the assessments extracted from the retained reviews.
CONCLUSIONS
The findings of this review will be used to develop a Core Outcome Set for children with SSD. The findings are part of a rigorous process essential for advancing healthcare research and practice in the specific area of speech and language therapy for children with SSD.
PROSPERO REGISTRATION NUMBER
CRD42022316284.
Topics: Humans; Child; Speech Sound Disorder; Outcome Assessment, Health Care; Speech Therapy
PubMed: 38684261
DOI: 10.1136/bmjopen-2023-081446 -
Patient Education and Counseling Nov 2023The objective was to identify candidate patient reported outcomes with potential to inform individual patient care and service development for inclusion in a digital... (Review)
Review
Which diabetes specific patient reported outcomes should be measured in routine care? A systematic review to inform a core outcome set for adults with Type 1 and 2 diabetes mellitus: The European Health Outcomes Observatory (H2O) programme.
OBJECTIVES
The objective was to identify candidate patient reported outcomes with potential to inform individual patient care and service development for inclusion in a digital outcome set to be collected in routine care, as part of an international project to enhance care outcomes for people with diabetes.
METHODS
PubMed, COSMIN and COMET databases were searched. Published studies were included if they recommended patient reported outcomes that were clinically useful and/or important to people with diabetes. To aid selection decisions, recommended outcomes were considered in terms of the evidence endorsing them and their importance to people with diabetes.
RESULTS
Twenty-seven studies recommending 53 diabetes specific outcomes, and patient reported outcome measures, were included. The outcomes reflected the experience of living with diabetes (e.g. psychological well-being, symptom experience, health beliefs and stigma) and behaviours (e.g. self-management). Diabetes distress and self-management behaviours were most endorsed by the evidence.
CONCLUSIONS
The review provides a comprehensive list of candidate outcomes endorsed by international evidence and informed by existing outcome sets, and suggestions for measures.
PRACTICE IMPLICATIONS
The review offers evidence to guide clinical application. Integrated measurement of these outcomes in care settings holds enormous potential to improve provision of care and outcomes in diabetes.
Topics: Humans; Adult; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Outcome Assessment, Health Care
PubMed: 37672919
DOI: 10.1016/j.pec.2023.107933 -
Drug and Alcohol Review Nov 2023Routine outcome monitoring (ROM) involves regularly measuring clients' outcomes during treatment, which can then be fed back to clinicians and/or clients. In the mental... (Review)
Review
ISSUES
Routine outcome monitoring (ROM) involves regularly measuring clients' outcomes during treatment, which can then be fed back to clinicians and/or clients. In the mental health field, ROM and feedback have been shown to improve client outcomes; however, no systematic reviews have examined whether improvement is also seen in alcohol and other drug (AOD) treatment outcomes. This review examines whether feedback to clients and/or clinicians of ROM data in AOD treatment improves future client outcomes.
APPROACH
This systematic review of papers identified in Medline, PsycInfo and Scopus examines the effect on client outcomes of feeding back ROM data to clinicians and/or clients in AOD treatment settings. Key client outcomes included substance use, treatment attendance and wellbeing measures.
KEY FINDINGS
Ten studies were included-five randomised controlled trials and five pre-post within-subjects designs. Six studies were deemed good- or fair-quality. Of these six, three provided feedback to clinicians only, one to clients only, and two to both clients and clinicians. Only one of the six found feedback was associated with significant reductions in substance use and only among off-track clients. Four of the six found feedback improved other outcomes, including treatment retention, global functioning, therapeutic alliance and mood symptoms.
CONCLUSIONS
There may be some positive effects for clients of providing feedback to clients and/or clinicians; however, the small number of randomised trials and the heterogeneity of methods, outcome measures and findings, mean that firm conclusions cannot be drawn about the efficacy of feedback until larger randomised studies are conducted.
Topics: Humans; Feedback; Mental Health; Treatment Outcome; Substance-Related Disorders; Outcome Assessment, Health Care
PubMed: 37654103
DOI: 10.1111/dar.13742 -
European Journal of Trauma and... Aug 2023
Topics: Humans; Registries; Outcome Assessment, Health Care; Wounds and Injuries
PubMed: 37555992
DOI: 10.1007/s00068-023-02332-7 -
Medical Care Dec 2023PCORnet, the National Patient-Centered Clinical Research Network, provides the ability to conduct prospective and observational pragmatic research by leveraging...
PCORnet, the National Patient-Centered Clinical Research Network, provides the ability to conduct prospective and observational pragmatic research by leveraging standardized, curated electronic health records data together with patient and stakeholder engagement. PCORnet is funded by the Patient-Centered Outcomes Research Institute (PCORI) and is composed of 8 Clinical Research Networks that incorporate at total of 79 health system "sites." As the network developed, linkage to commercial health plans, federal insurance claims, disease registries, and other data resources demonstrated the value in extending the networks infrastructure to provide a more complete representation of patient's health and lived experiences. Initially, PCORnet studies avoided direct economic comparative effectiveness as a topic. However, PCORI's authorizing law was amended in 2019 to allow studies to incorporate patient-centered economic outcomes in primary research aims. With PCORI's expanded scope and PCORnet's phase 3 beginning in January 2022, there are opportunities to strengthen the network's ability to support economic patient-centered outcomes research. This commentary will discuss approaches that have been incorporated to date by the network and point to opportunities for the network to incorporate economic variables for analysis, informed by patient and stakeholder perspectives. Topics addressed include: (1) data linkage infrastructure; (2) commercial health plan partnerships; (3) Medicare and Medicaid linkage; (4) health system billing-based benchmarking; (5) area-level measures; (6) individual-level measures; (7) pharmacy benefits and retail pharmacy data; and (8) the importance of transparency and engagement while addressing the biases inherent in linking real-world data sources.
Topics: Aged; Humans; United States; Prospective Studies; Medicare; Patient Outcome Assessment; Outcome Assessment, Health Care; Patient-Centered Care
PubMed: 37963035
DOI: 10.1097/MLR.0000000000001929 -
Rhinology Aug 2023Evaluating the effectiveness of the management of Olfactory Dysfunction (OD) has been limited by a paucity of high-quality randomised and/or controlled trials. A major... (Review)
Review
STATEMENT OF PROBLEM
Evaluating the effectiveness of the management of Olfactory Dysfunction (OD) has been limited by a paucity of high-quality randomised and/or controlled trials. A major barrier is heterogeneity of outcomes in such studies. Core outcome sets (COS) - standardized sets of outcomes that should be measured/reported as determined by consensus-would help overcome this problem and facilitate future meta-analyses and/or systematic reviews (SRs). We set out to develop a COS for interventions for patients with OD.
METHODS
A long-list of potential outcomes was identified by a steering group utilising a literature review, thematic analysis of a wide range of stakeholders' views and systematic analysis of currently available Patient Reported Outcome Measures (PROMs). A subsequent e-Delphi process allowed patients and healthcare practitioners to individually rate the outcomes in terms of importance on a 9-point Likert scale.
RESULTS
After 2 rounds of the iterative eDelphi process, the initial outcomes were distilled down to a final COS including subjective questions (visual analogue scores, quantitative and qualitative), quality of life measures, psychophysical testing of smell, baseline psychophysical testing of taste, and presence of side effects along with the investigational medicine/device and patient's symptom log.
CONCLUSIONS
Inclusion of these core outcomes in future trials will increase the value of research on clinical interventions for OD. We include recommendations regarding the outcomes that should be measured, although future work will be required to further develop and revalidate existing outcome measures.
Topics: Humans; Quality of Life; Research Design; Delphi Technique; Endpoint Determination; Outcome Assessment, Health Care; Olfaction Disorders; Treatment Outcome
PubMed: 37243690
DOI: 10.4193/Rhin22.116 -
Journal of Adolescence Oct 2023The association between family adversity and young people's mental health outcomes in communities that experience economic instability has not been well explored in the...
BACKGROUND
The association between family adversity and young people's mental health outcomes in communities that experience economic instability has not been well explored in the South African context. Furthermore, the overtime interaction between resilience factors, family adversity, and young people's psychological functioning in African settings, like South Africa, is under-investigated.
PURPOSE
This study investigates the relationship between family adversity and conduct problems and depression at two-time points in a sample of youths in two South African communities stressed by their dependency on economically volatile oil and gas industries.
METHOD
This article draws on longitudinal data generated by the Resilient Youth in Stressed Environments (RYSE) study in South Africa, which included 914 and 528 (wave 1 and 3) adolescents and emerging adults (14-27-year-olds; M age = 18.36 years) living in Secunda/eMbalenhle and Sasolburg/Zamdela. Participants were sampled at baseline (wave 1) and 18-24 months later (wave 3). They self-reported experience of community violence, family adversity, resilience-enabling resources, conduct difficulties, and depression symptoms. Regression analyses were used to examine the unadjusted and adjusted association of family adversity on conduct problem and depression.
RESULTS
About 60% of participants reported high family adversity. Regressions, however, revealed no association between family adversity and conduct problems and depression cross-sectionally and over time. Individual resilience, biological sex, and experience of victimization in the community, however, were associated with conduct difficulty while all three resilience factors were associated with decreased depression among participants.
CONCLUSION
Our study sheds light on the risk and protective factors for mental health outcomes of adolescents and youths who reside in volatile, turbulent communities and experience ongoing familial challenges. To effectively support the mental well-being of young individuals in such contexts, interventions must consider the potential ambivalence of the resilience factors they aim to strengthen.
Topics: Adult; Humans; Adolescent; Resilience, Psychological; Mental Health; Violence; Problem Behavior; Outcome Assessment, Health Care
PubMed: 37335052
DOI: 10.1002/jad.12205 -
Systematic Reviews Nov 2023The relative treatment effects estimated from network meta-analysis can be employed to rank treatments from the most preferable to the least preferable option. These... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The relative treatment effects estimated from network meta-analysis can be employed to rank treatments from the most preferable to the least preferable option. These treatment hierarchies are typically based on ranking metrics calculated from a single outcome. Some approaches have been proposed in the literature to account for multiple outcomes and individual preferences, such as the coverage area inside a spie chart, that, however, does not account for a trade-off between efficacy and safety outcomes. We present the net-benefit standardised area within a spie chart, [Formula: see text] to explore the changes in treatment performance with different trade-offs between benefits and harms, according to a particular set of preferences.
METHODS
We combine the standardised areas within spie charts for efficacy and safety/acceptability outcomes with a value λ specifying the trade-off between benefits and harms. We derive absolute probabilities and convert outcomes on a scale between 0 and 1 for inclusion in the spie chart.
RESULTS
We illustrate how the treatments in three published network meta-analyses perform as the trade-off λ varies. The decrease of the [Formula: see text] quantity appears more pronounced for some drugs, e.g. haloperidol. Changes in treatment performance seem more frequent when SUCRA is employed as outcome measures in the spie charts.
CONCLUSIONS
[Formula: see text] should not be interpreted as a ranking metric but it is a simple approach that could help identify which treatment is preferable when multiple outcomes are of interest and trading-off between benefits and harms is important.
Topics: Humans; Network Meta-Analysis; Haloperidol; Outcome Assessment, Health Care
PubMed: 37951949
DOI: 10.1186/s13643-023-02376-1 -
Pediatrics Jun 2024Variability in outcome reporting in necrotizing enterocolitis (NEC) treatment trials hinders conducting meta-analyses and implementing novel treatments. We aimed to...
BACKGROUND AND OBJECTIVES
Variability in outcome reporting in necrotizing enterocolitis (NEC) treatment trials hinders conducting meta-analyses and implementing novel treatments. We aimed to develop a core outcome set (COS) for NEC treatment trials including outcome measures most relevant to patients and physicians, from NEC diagnosis to adulthood.
METHODS
Clinicians and/or researchers from low-middle- and high-income countries were approached based on their scientific contributions to NEC literature, and patients and parents through local organizations. We presented participants with 45 outcomes used in NEC research, identified through a systematic review. To achieve consensus, outcomes were rated on a scale of 1 to 9 in 3 online Delphi rounds, and discussed at a final consensus meeting.
RESULTS
Seventy-one participants from 25 countries completed all Delphi rounds, including 15 patients and family representatives. Thirteen outcomes reached consensus in one of the stakeholder groups and were included in the consensus meeting, 6 outcomes reached consensus in both groups. Twenty-seven participants from both high- and low-middle-income countries attended the online consensus meeting, including family representatives and NEC patients. After discussion and a final vote, 5 outcomes reached consensus to be included: mortality, NEC-related mortality, short bowel syndrome, quality of life, and neurodevelopmental impairment.
CONCLUSIONS
This NEC COS includes 5 predominantly long-term outcomes agreed upon by clinicians, patients, and family representatives. Use of this international COS will help standardize outcome selection in clinical trials, ensure these are relevant to those most affected by NEC care, and, ultimately, improve the care of infants with NEC.
Topics: Enterocolitis, Necrotizing; Humans; Delphi Technique; Infant, Newborn; Clinical Trials as Topic; Outcome Assessment, Health Care; Consensus; Treatment Outcome; Infant
PubMed: 38726575
DOI: 10.1542/peds.2023-065619 -
Journal of General Internal Medicine Oct 2023Transitioning to a new electronic health record (EHR) presents different challenges than transitions from paper to electronic records. We synthesized the body of...
BACKGROUND
Transitioning to a new electronic health record (EHR) presents different challenges than transitions from paper to electronic records. We synthesized the body of peer-reviewed literature on EHR-to-EHR transitions to evaluate the generalizability of published work and identify knowledge gaps where more evidence is needed.
METHODS
We conducted a broad search in PubMed through July 2022 and collected all publications from two prior reviews. Peer-reviewed publications reporting on data from an EHR-to-EHR transition were included. We extracted data on study design, setting, sample size, EHR systems involved, dates of transition and data collection, outcomes reported, and key findings.
RESULTS
The 40 included publications were grouped into thematic categories for narrative synthesis: clinical care outcomes (n = 15), provider perspectives (n = 11), data migration (n = 8), patient experience (n = 4), and other topics (n = 5). Many studies described single sites that are early adopters of technology with robust research resources, switching from a homegrown system to a commercial system, and emphasized the dynamic effect of transitioning on important clinical care and other outcomes over time.
DISCUSSION
The published literature represents a heterogeneous mix of study designs and outcome measures, and while some of the stronger studies in this review used longitudinal approaches to compare outcomes across more sites, the current literature is primarily descriptive and is not designed to offer recommendations that can guide future EHR transitions. Transitioning from one EHR to another constitutes a major organizational change that requires nearly every person in the organization to change how they do their work. Future research should include human factors as well as diverse methodological approaches such as mixed methods and implementation science.
Topics: Humans; Electronic Health Records; Outcome Assessment, Health Care; Data Collection
PubMed: 37798580
DOI: 10.1007/s11606-023-08276-3