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PharmacoEconomics - Open Nov 2023Dementia prevalence is increasing, with no cure at present. Drug therapies have potential side effects and risk of mortality. People with dementia are frequently offered...
BACKGROUND
Dementia prevalence is increasing, with no cure at present. Drug therapies have potential side effects and risk of mortality. People with dementia are frequently offered non-pharmacological interventions to improve quality of life and relieve symptoms. Identifying which interventions are cost-effective is important due to finite resources in healthcare services.
AIMS
The aims were to review published economic evaluations of community and nursing home non-pharmacological interventions for people with mild cognitive impairment or dementia and assess the usefulness of these evaluations for decision making in health services, for use by policy and local and national decision makers.
METHODS
We conducted a systematic review (PROSPERO CRD42021252999) of economic evaluations of non-pharmacological interventions for dementia or mild cognitive impairment with a narrative approach to data synthesis.
EXCLUSIONS
interventions for dementia prevention/early detection/end of life care. Databases searched: Academic Search Premier, MEDLINE, Web of Science, EMBASE, Google Scholar, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Psychology and Behavioural Sciences Collection, PsycArticles, Cochrane Database of Systematic Reviews, Business Source Premier and Regional Business News; timeframe 1 January 2011-11 May 2023. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS).
RESULTS
The review included 37 economic evaluations and four reviews worldwide across several distinct forms of care: physical activity, cognition, training, multicomponent, assistive technology and other (specialist dementia care, group living, home care vs care home). The intervention with the strongest evidence of cost-effectiveness was maintenance cognitive stimulation therapy. Case management, occupational therapy and dementia care management also showed good evidence of cost-effectiveness.
CONCLUSION
More economic evidence on the cost-effectiveness of specific dementia care interventions is needed, with consistency of methods and outcome measures. This could improve local and national decision makers' confidence to promote future cost-effective dementia interventions.
PubMed: 37747616
DOI: 10.1007/s41669-023-00440-z -
Preventive Medicine Reports Jan 2024To identify barriers and facilitators of the implementation of shared decision-making (SDM) on PSA testing in primary care. (Review)
Review
OBJECTIVE
To identify barriers and facilitators of the implementation of shared decision-making (SDM) on PSA testing in primary care.
DESIGN
Systematic review of articles.
DATA SOURCES
PubMed, Scopus, Embase and Web of Science.
ELIGIBILITY CRITERIA
Original studies published in English or Spanish that assessed the barriers to and facilitators of SDM before PSA testing in primary care were included. No time restrictions were applied.
DATA EXTRACTION AND SYNTHESIS
Two review authors screened the titles, abstracts and full texts for inclusion, and assessed the quality of the included studies. A thematic synthesis of the results were performed and developed a framework. Quality assessment of the studies was based on three checklists: STROBE for quantitative cross-sectional studies, GUIDED for intervention studies and SRQR for qualitative studies.
RESULTS
The search returned 431 articles, of which we included 13: five cross-sectional studies, two intervention studies, five qualitative studies and one mixed methods study. The identified barriers included lack of time (healthcare professionals), lack of knowledge (healthcare professionals and patients), and preestablished beliefs (patients). The identified facilitators included decision-making training for professionals, education for patients and healthcare professionals, and dissemination of information.
CONCLUSIONS
SDM implementation in primary care seems to be a recent field. Many of the barriers identified are modifiable, and the facilitators can be leveraged to strengthen the implementation of SDM.
PubMed: 38179441
DOI: 10.1016/j.pmedr.2023.102539 -
BMJ Open Jul 2023To systematically review preoperative and intraoperative Anastomotic Leak Prediction Scores (ALPS) and validation studies to evaluate performance and utility in surgical...
OBJECTIVE
To systematically review preoperative and intraoperative Anastomotic Leak Prediction Scores (ALPS) and validation studies to evaluate performance and utility in surgical decision-making. Anastomotic leak (AL) is the most feared complication of colorectal surgery. Individualised leak risk could guide anastomosis and/or diverting stoma.
METHODS
Systematic search of Ovid MEDLINE and Embase databases, 30 October 2020, identified existing ALPS and validation studies. All records including >1 risk factor, used to develop new, or to validate existing models for preoperative or intraoperative use to predict colorectal AL, were selected. Data extraction followed CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies guidelines. Models were assessed for applicability for surgical decision-making and risk of bias using Prediction model Risk Of Bias ASsessment Tool.
RESULTS
34 studies were identified containing 31 individual ALPS (12 colonic/colorectal, 19 rectal) and 6 papers with validation studies only. Development dataset patient populations were heterogeneous in terms of numbers, indication for surgery, urgency and stoma inclusion. Heterogeneity precluded meta-analysis. Definitions and timeframe for AL were available in only 22 and 11 ALPS, respectively. 26/31 studies used some form of multivariable logistic regression in their modelling. Models included 3-33 individual predictors. 27/31 studies reported model discrimination performance but just 18/31 reported calibration. 15/31 ALPS were reported with external validation, 9/31 with internal validation alone and 4 published without any validation. 27/31 ALPS and every validation study were scored high risk of bias in model analysis.
CONCLUSIONS
Poor reporting practices and methodological shortcomings limit wider adoption of published ALPS. Several models appear to perform well in discriminating patients at highest AL risk but all raise concerns over risk of bias, and nearly all over wider applicability. Large-scale, precisely reported external validation studies are required.
PROSPERO REGISTRATION NUMBER
CRD42020164804.
Topics: Humans; Anastomosis, Surgical; Anastomotic Leak; Colorectal Neoplasms; Risk Factors
PubMed: 37463818
DOI: 10.1136/bmjopen-2023-073085 -
Journal of Pharmacy & Bioallied Sciences Apr 2024In the field of healthcare delivery, shared decision making (SDM) refers to a collaborative process, wherein both patients and the healthcare professionals mutually work... (Review)
Review
In the field of healthcare delivery, shared decision making (SDM) refers to a collaborative process, wherein both patients and the healthcare professionals mutually work to make informed and consensus decisions with reference to the kind of medical care that will be administered to patients. The purpose of the current review is to explore SDM in health care, ascertain the role of medical education, and identify the ways to train and assess undergraduate medical students in competencies pertaining to SDM. An extensive search of all materials related to the topic was carried out on the PubMed and Google Scholar search engines and a total of 29 articles were selected based on their suitability with the current review objectives and analyzed. Keywords used in the search include learning resources in the title alone only (viz. shared decision making [ti] AND patient [ti]; shared decision making [ti] AND medical education [ti]; shared decision making [ti] AND assessment [ti]; shared decision making [ti] AND self-assessment [ti]; shared decision making [ti]; shared decision making [ti]). In the domain of medical education, the promotion of SDM essentially will require a multipronged approach to enable its integration into the medical curriculum. However, we must remember that mere teaching-learning methods would not improve it unless they are supplemented with assessment methods, otherwise, we will fail to deliver sustained results. In conclusion, SDM in medical education and healthcare industry represents a transformative shift from the traditional paradigm to a patient-centered approach that empowers both patients and healthcare providers, including budding medical students. The need of the hour is to advocate and encourage structured integration of SDM in the medical curriculum and support the same with periodic assessments.
PubMed: 38882796
DOI: 10.4103/jpbs.jpbs_1231_23 -
Cancers Feb 2024Perihilar cholangiocarcinoma (pCCA) is an uncommon malignancy with generally poor prognosis. Surgery is the primary curative treatment; however, the perioperative... (Review)
Review
Perihilar cholangiocarcinoma (pCCA) is an uncommon malignancy with generally poor prognosis. Surgery is the primary curative treatment; however, the perioperative mortality and morbidity rates are high, with a low 5-year survival rate. Use of preoperative prognostic biomarkers to predict survival outcomes after surgery for pCCA are not well-established currently. This systematic review aimed to identify and summarise preoperative biomarkers associated with survival in pCCA, thereby potentially improving treatment decision-making. The Embase, Medline, and Cochrane databases were searched, and a systematic review was performed using the PRISMA guidelines. English-language studies examining the association between serum and/or tissue-derived biomarkers in pCCA and overall and/or disease-free survival were included. Our systematic review identified 64 biomarkers across 48 relevant studies. Raised serum CA19-9, bilirubin, CEA, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and tumour MMP9, and low serum albumin were most associated with poorer survival; however, the cutoff values used widely varied. Several promising molecular markers with prognostic significance were also identified, including tumour HMGA2, MUC5AC/6, IDH1, PIWIL2, and DNA index. In conclusion, several biomarkers have been identified in serum and tumour specimens that prognosticate overall and disease-free survival after pCCA resection. These, however, require external validation in large cohort studies and/or in preoperatively obtained specimens, especially tissue biopsy, to recommend their use.
PubMed: 38398089
DOI: 10.3390/cancers16040698 -
Reproductive Health Jul 2023Maternity waiting homes (MHWs) are recommended to help bridge the geographical gap to accessing maternity services. This study aimed to provide an analysis of... (Review)
Review
BACKGROUND
Maternity waiting homes (MHWs) are recommended to help bridge the geographical gap to accessing maternity services. This study aimed to provide an analysis of stakeholders' perspectives (women, families, communities and health workers) on the acceptability and feasibility of MWHs.
METHODS
A qualitative evidence synthesis was conducted. Studies that were published between January 1990 and July 2020, containing qualitative data on the perspectives of the stakeholder groups were included. A combination of inductive and deductive coding and thematic synthesis was used to capture the main perspectives in a thematic framework.
RESULTS
Out of 4,532 papers that were found in the initial search, a total of 38 studies were included for the thematic analysis. Six themes emerged: (1) individual factors, such as perceived benefits, awareness and knowledge of the MWH; (2) interpersonal factors and domestic responsibilities, such as household and childcare responsibilities, decision-making processes and social support; (3) MWH characteristics, such as basic services and food provision, state of MWH infrastructure; (4) financial and geographical accessibility, such as transport availability, costs for MWH attendance and loss of income opportunity; (5) perceived quality of care in the MWH and the adjacent health facility, including regular check-ups by health workers and respectful care; and (6) Organization and advocacy, for example funding, community engagement, governmental involvement. The decision-making process of women and their families for using an MWH involves balancing out the gains and losses, associated with all six themes.
CONCLUSION
This systematic synthesis of qualitative literature provides in-depth insights of interrelating factors that influence acceptability and feasibility of MWHs according to different stakeholders. The findings highlight the potential of MWHs as important links in the maternal and neonatal health (MNH) care delivery system. The complexity and scope of these determinants of utilization underlines the need for MWH implementation strategy to be guided by context. Better documentation of MWH implementation, is needed to understand which type of MWH is most effective in which setting, and to ensure that those who most need the MWH will use it and receive quality services. These results can be of interest for stakeholders, implementers of health interventions, and governmental parties that are responsible for MNH policy development to implement acceptable and feasible MWHs that provide the greatest benefits for its users. Trial registration Systematic review registration number: PROSPERO 2020, CRD42020192219.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Family; Feasibility Studies; Health Facilities; Health Services Accessibility; Maternal Health Services; Rural Population
PubMed: 37407983
DOI: 10.1186/s12978-023-01615-x -
International Journal For Equity in... Sep 2023Forced displacement impacts the health, rights and safety of women, which is further compounded by gender inequality. In particular, this has consequences for forcibly... (Review)
Review
BACKGROUND
Forced displacement impacts the health, rights and safety of women, which is further compounded by gender inequality. In particular, this has consequences for forcibly displaced women's reproductive health once resettled in a new country. To ensure the reproductive health and rights of forcibly displaced women during and after resettlement, there must be careful consideration of their reproductive decision-making taking into account the context and environment of the host country.
AIM
This scoping review aimed to explore the influences on reproductive decision-making among forcibly displaced women resettling in high-income countries.
METHOD
A scoping review was conducted following the PRISMA-ScR for reporting. EBSCO was used to search databases covering global health, health policy, psychology, sociology, and philosophy for articles published from 1 January 2012 to 27 April 2022. Data extracted from each article included author(s), year of publication, publication type, aims/objectives, study design, sampling method, data collection or eligibility criteria, study population (i.e., sample size and characteristics), migration status, country(ies) of origin, host country(ies), key findings and limitations. Two independent reviewers screened all articles against eligibility criteria using Covidence. Data charting and thematic analysis were performed independently by one reviewer.
FINDINGS
Nineteen articles published between 2013 and 2022 mostly conducted in the United States (36.8%) and Australia (21.1%), with the majority reporting on qualitative findings (68.4%), and women from a wide array of countries and cultures (most commonly African countries) were included. Influences on women's reproductive decision-making related to the contexts before displacement, during displacement, and after arrival, with influences on women's reproductive decision-making identified specific to the context. The influences before displacement included conflict; religious beliefs; socio-cultural gendered expectations; and external control over reproductive autonomy. During displacement influences included paternalism and access to education. Influences after arrival included pressure, restriction, coercion; knowledge and misconceptions; patriarchal power dynamics; and seeking empowerment. An adapted socio-ecological model was developed to interpret the findings.
CONCLUSION
This review highlights the complexity and nuances within forcibly displaced women's experiences which influence their reproductive decision-making. Further research may review the evidence base to provide guidance for healthcare professionals and health policies aimed at empowering women to make autonomous reproductive decisions; develop training for healthcare professionals to prevent pressure, restriction and coercion of women's reproductive autonomy; and inform development of policy that takes an intersectional approach to women's health rights and gender equality.
Topics: Humans; Female; Developed Countries; Health Services Accessibility; Human Rights; Educational Status; Africa
PubMed: 37670302
DOI: 10.1186/s12939-023-01993-5 -
Sensors (Basel, Switzerland) Apr 2024Reinforcement learning (RL) has emerged as a dynamic and transformative paradigm in artificial intelligence, offering the promise of intelligent decision-making in... (Review)
Review
Reinforcement learning (RL) has emerged as a dynamic and transformative paradigm in artificial intelligence, offering the promise of intelligent decision-making in complex and dynamic environments. This unique feature enables RL to address sequential decision-making problems with simultaneous sampling, evaluation, and feedback. As a result, RL techniques have become suitable candidates for developing powerful solutions in various domains. In this study, we present a comprehensive and systematic review of RL algorithms and applications. This review commences with an exploration of the foundations of RL and proceeds to examine each algorithm in detail, concluding with a comparative analysis of RL algorithms based on several criteria. This review then extends to two key applications of RL: robotics and healthcare. In robotics manipulation, RL enhances precision and adaptability in tasks such as object grasping and autonomous learning. In healthcare, this review turns its focus to the realm of cell growth problems, clarifying how RL has provided a data-driven approach for optimizing the growth of cell cultures and the development of therapeutic solutions. This review offers a comprehensive overview, shedding light on the evolving landscape of RL and its potential in two diverse yet interconnected fields.
Topics: Robotics; Humans; Algorithms; Artificial Intelligence; Delivery of Health Care; Machine Learning
PubMed: 38676080
DOI: 10.3390/s24082461 -
Sensors (Basel, Switzerland) Aug 2023Shared decision making is crucial in the pain domain. The subjective nature of pain demands solutions that can facilitate pain assessment and management. The aim of the... (Review)
Review
Shared decision making is crucial in the pain domain. The subjective nature of pain demands solutions that can facilitate pain assessment and management. The aim of the current study is to review the current trends in both the commercial and the research domains in order to reveal the key issues and guidelines that could further help in the effective development of pain-focused apps. We searched for scientific publications and commercial apps in 22 databases and the two major app stores. Out of 3612 articles and 336 apps, 69 met the requirements for inclusion following the PRISMA guidelines. An analysis of their features (technological approach, design methodology, evaluation strategy, and others) identified critical points that have to be taken into consideration in future efforts. For example, commercial and research efforts target different types of pain, while no participatory design is followed in the majority of the cases examined. Moreover, the evaluation of the final apps remains a challenge that hinders their success. The examined domain is expected to experience a substantial increase. More research is needed towards the development of non-intrusive wearables and sensors for pain detection and assessment, along with artificial intelligence techniques and open data.
Topics: Humans; Mobile Applications; Pain Management; Artificial Intelligence; Telemedicine; Pain
PubMed: 37571747
DOI: 10.3390/s23156965 -
Health Expectations : An International... Dec 2023Patient engagement, encompassing both patient experience and opportunities for involvement in care, has been associated with increased patient satisfaction and the... (Review)
Review
INTRODUCTION
Patient engagement, encompassing both patient experience and opportunities for involvement in care, has been associated with increased patient satisfaction and the overall quality of care. Despite its importance, there is limited knowledge regarding patient engagement in the transition from nondialysis-dependent chronic kidney disease (CKD) to dialysis-dependent treatment. This systematic review employs meta-ethnography to synthesize findings from qualitative studies examining patients' experiences of engagement during this transition, with the aim of developing a comprehensive theoretical understanding of patient engagement in the transition from nondialysis-dependent CKD to dialysis.
METHODS
A systematic search of six databases, namely the Cochrane Library, PsycINFO, Scopus, Embase, PubMed and Web of Science was conducted to identify eligible articles published between 1990 and 2022. Meta-ethnography was utilized to translate and synthesize the findings and develop a novel theoretical interpretation of 'patient engagement' during the transition to dialysis.
RESULTS
A total of 24 articles were deemed eligible for review, representing 21 studies. Patient engagement during a transition to dialysis was found to encompass three major domains: psychosocial adjustment, decision-making and engagement in self-care. These three domains could be experienced as an iterative and mutually reinforcing process, guiding patients toward achieving control and proficiency in their lives as they adapt to dialysis. Additionally, patient engagement could be facilitated by factors including patients' basic capability to engage, the provision of appropriate education, the establishment of supportive relationships and the alignment with values and resources.
CONCLUSIONS
The findings of this review underscore the necessity of involving patients in transitional dialysis care, emphasizing the need to foster their engagement across multiple domains. Recommendations for future interventions include the provision of comprehensive support to enhance patient engagement during this critical transition phase. Additional research is warranted to explore the effects of various facilitators at different levels.
PATIENT OR PUBLIC CONTRIBUTION
The studies included in our review involved 633 participants (547 patients, 14 family members, 63 healthcare providers and 9 managers). Based on their experiences, views and beliefs, we developed a deeper understanding of patient engagement and how to foster it in the future.
Topics: Humans; Renal Dialysis; Patient Participation; Anthropology, Cultural; Qualitative Research; Renal Insufficiency, Chronic
PubMed: 37641530
DOI: 10.1111/hex.13850