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BMC Medicine Jul 2023Chronic disease management (CDM) through sustained knowledge translation (KT) interventions ensures long-term, high-quality care. We assessed implementation of KT... (Meta-Analysis)
Meta-Analysis
Efficacy of sustained knowledge translation (KT) interventions in chronic disease management in older adults: systematic review and meta-analysis of complex interventions.
BACKGROUND
Chronic disease management (CDM) through sustained knowledge translation (KT) interventions ensures long-term, high-quality care. We assessed implementation of KT interventions for supporting CDM and their efficacy when sustained in older adults.
METHODS
Design: Systematic review with meta-analysis engaging 17 knowledge users using integrated KT.
ELIGIBILITY CRITERIA
Randomized controlled trials (RCTs) including adults (> 65 years old) with chronic disease(s), their caregivers, health and/or policy-decision makers receiving a KT intervention to carry out a CDM intervention for at least 12 months (versus other KT interventions or usual care).
INFORMATION SOURCES
We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from each database's inception to March 2020.
OUTCOME MEASURES
Sustainability, fidelity, adherence of KT interventions for CDM practice, quality of life (QOL) and quality of care (QOC). Data extraction, risk of bias (ROB) assessment: We screened, abstracted and appraised articles (Effective Practice and Organisation of Care ROB tool) independently and in duplicate.
DATA SYNTHESIS
We performed both random-effects and fixed-effect meta-analyses and estimated mean differences (MDs) for continuous and odds ratios (ORs) for dichotomous data.
RESULTS
We included 158 RCTs (973,074 participants [961,745 patients, 5540 caregivers, 5789 providers]) and 39 companion reports comprising 329 KT interventions, involving patients (43.2%), healthcare providers (20.7%) or both (10.9%). We identified 16 studies described as assessing sustainability in 8.1% interventions, 67 studies as assessing adherence in 35.6% interventions and 20 studies as assessing fidelity in 8.7% of the interventions. Most meta-analyses suggested that KT interventions improved QOL, but imprecisely (36 item Short-Form mental [SF-36 mental]: MD 1.11, 95% confidence interval [CI] [- 1.25, 3.47], 14 RCTs, 5876 participants, I = 96%; European QOL-5 dimensions: MD 0.01, 95% CI [- 0.01, 0.02], 15 RCTs, 6628 participants, I = 25%; St George's Respiratory Questionnaire: MD - 2.12, 95% CI [- 3.72, - 0.51] 44 12 RCTs, 2893 participants, I = 44%). KT interventions improved QOC (OR 1.55, 95% CI [1.29, 1.85], 12 RCTS, 5271 participants, I = 21%).
CONCLUSIONS
KT intervention sustainability was infrequently defined and assessed. Sustained KT interventions have the potential to improve QOL and QOC in older adults with CDM. However, their overall efficacy remains uncertain and it varies by effect modifiers, including intervention type, chronic disease number, comorbidities, and participant age.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42018084810.
Topics: Humans; Aged; Translational Science, Biomedical; Chronic Disease; Health Personnel; Knowledge; Disease Management
PubMed: 37488589
DOI: 10.1186/s12916-023-02966-9 -
Cancer Medicine Nov 2023Non-surgical therapies are frequently used for patients with early or very early hepatocellular carcinoma (HCC). The aim of this systematic review and network... (Meta-Analysis)
Meta-Analysis
BACKGROUND & AIMS
Non-surgical therapies are frequently used for patients with early or very early hepatocellular carcinoma (HCC). The aim of this systematic review and network meta-analysis (NMA) was to evaluate and compare the effectiveness of ablative and non-surgical therapies for patients with small HCC.
METHODS
Nine databases were searched (March 2021) along with clinical trial registries. Randomised controlled trials (RCTs) of any ablative or non-surgical therapy versus any comparator in patients with HCC ≤3 cm were eligible. Risk of bias (RoB) was assessed using the Cochrane RoB 2 tool. The effectiveness of therapies was compared using NMA. Threshold analysis was undertaken to identify which NMA results had less robust evidence.
RESULTS
Thirty-seven eligible RCTs were included (including over 3700 patients). Most were from China (n = 17) or Japan (n = 7). Sample sizes ranged from 30 to 308 patients. The majority had a high RoB or some RoB concerns. No RCTs were identified for some therapies and no RCTs reported quality of life outcomes. The results of the NMA and treatment effectiveness rankings were very uncertain. However, the evidence demonstrated that percutaneous ethanol injection was worse than radiofrequency ablation for overall survival (hazard ratio [HR]: 1.45, 95% credible interval [CrI]: 1.16-1.82), progression-free survival (HR: 1.36, 95% CrI: 1.11-1.67), overall recurrence (relative risk [RR]: 1.19, 95% CrI: 1.02-1.39) and local recurrence (RR: 1.80, 95% CrI: 1.19-2.71). The threshold analysis suggested that robust evidence was lacking for some comparisons.
CONCLUSIONS
It is unclear which treatment is most effective for patients with small HCC because of limitations in the evidence base. It is also not known how these treatments would impact on quality of life. Further high quality RCTs are needed to provide robust evidence but may be difficult to undertake.
Topics: Humans; Carcinoma, Hepatocellular; Network Meta-Analysis; Treatment Outcome; Liver Neoplasms; China; Randomized Controlled Trials as Topic
PubMed: 37902128
DOI: 10.1002/cam4.6643 -
NPJ Digital Medicine Sep 2023Skin diseases affect one-third of the global population, posing a major healthcare burden. Deep learning may optimise healthcare workflows through processing skin images... (Review)
Review
Skin diseases affect one-third of the global population, posing a major healthcare burden. Deep learning may optimise healthcare workflows through processing skin images via neural networks to make predictions. A focus of deep learning research is skin lesion triage to detect cancer, but this may not translate to the wider scope of >2000 other skin diseases. We searched for studies applying deep learning to skin images, excluding benign/malignant lesions (1/1/2000-23/6/2022, PROSPERO CRD42022309935). The primary outcome was accuracy of deep learning algorithms in disease diagnosis or severity assessment. We modified QUADAS-2 for quality assessment. Of 13,857 references identified, 64 were included. The most studied diseases were acne, psoriasis, eczema, rosacea, vitiligo, urticaria. Deep learning algorithms had high specificity and variable sensitivity in diagnosing these conditions. Accuracy of algorithms in diagnosing acne (median 94%, IQR 86-98; n = 11), rosacea (94%, 90-97; n = 4), eczema (93%, 90-99; n = 9) and psoriasis (89%, 78-92; n = 8) was high. Accuracy for grading severity was highest for psoriasis (range 93-100%, n = 2), eczema (88%, n = 1), and acne (67-86%, n = 4). However, 59 (92%) studies had high risk-of-bias judgements and 62 (97%) had high-level applicability concerns. Only 12 (19%) reported participant ethnicity/skin type. Twenty-four (37.5%) evaluated the algorithm in an independent dataset, clinical setting or prospectively. These data indicate potential of deep learning image analysis in diagnosing and monitoring common skin diseases. Current research has important methodological/reporting limitations. Real-world, prospectively-acquired image datasets with external validation/testing will advance deep learning beyond the current experimental phase towards clinically-useful tools to mitigate rising health and cost impacts of skin disease.
PubMed: 37758829
DOI: 10.1038/s41746-023-00914-8 -
Frontiers in Neuroscience 2024Previous studies have explored the relationship between bipolar disorder and gut microbiota. However, there has been no bibliometric analysis to summarize and analyze...
BACKGROUND
Previous studies have explored the relationship between bipolar disorder and gut microbiota. However, there has been no bibliometric analysis to summarize and analyze these publications. Our objective was to perform a bibliometric analysis to investigate the current status and frontiers of the publications in the field of the association between bipolar disorder and the gut microbiota.
METHODS
We retrieved publications concerning the interplay between the gut microbiota and bipolar disorder from the Web of Science Core Collection (WoSCC). The analysis was executed using WoSCC's literature analysis tool and VOSviewer 1.6.16.
RESULTS
In total, we identified 177 publications originating from 362 institutions across 39 countries/regions, and these articles were disseminated in 104 different journals. The most productive institutions, authors, countries/regions, and journals were Zhejiang University contributing 18 publications, Shaohua Hu authoring 12 publications, China with 53 publications, and with 11 publications. The first high-cited document was published in the Journal of Psychiatric Research in 2017, and authored by Evans. In this article, they found gut microbiome composition was associated with BD and its illness severity, and they concluded that targeting the gut microbiota may be helpful to develop the effective treatment for bipolar disorder. The top 5 keywords with the highest frequency except for bipolar disorder and gut microbiota were as follows: depression, inflammation, probiotic, gut-brain axis, and anxiety.
CONCLUSION
In conclusion, this is the first bibliometric analysis to explore the publications in the field of the association between bipolar disorder and the gut microbiota. The main research hotspots regarding this field were the characteristics, abundance, and diversity of gut microbiome in bipolar disorder, the role of treatment and gut microbiome in bipolar disorder, microbiome-brain connections in bipolar disorder, and interventions for bipolar disorder based on microbiota composition modification. The number of studies about the association between gut microbiota and bipolar disorder is relatively small, and more studies are needed to expand our understanding the association between gut microbiota and bipolar disorder.
PubMed: 38576868
DOI: 10.3389/fnins.2024.1290826 -
Pediatric Blood & Cancer Jun 2024Approximately one third of children with rhabdomyosarcoma relapse or have refractory disease. Treatment approaches include a combination of systemic therapies and local... (Review)
Review
Approximately one third of children with rhabdomyosarcoma relapse or have refractory disease. Treatment approaches include a combination of systemic therapies and local therapies, directed at tumour site(s). This review was conducted to evaluate the effectiveness and safety of the combination of surgery and brachytherapy as local therapy for treating children and young people with relapsed/refractory rhabdomyosarcoma. This review identified studies based on a previous systematic review looking at the treatments for children and young people under 18 years old with relapsed/refractory rhabdomyosarcoma. Studies conducted after 2000 were included. Survival outcomes, relapse rates, adverse events and functional outcomes were extracted. From 16,965 records identified in the baseline systematic review, 205 included the words 'AMORE' or 'brachytherapy', and were screened for eligibility in this substudy. Thirteen studies met the inclusion criteria for Local-REFoRMS, including over 55 relapsed and refractory rhabdomyosarcoma patients. Most studies were retrospective cohort studies conducted within Europe. Most patients had embryonal disease within the head and neck or bladder/prostate regions, and received local therapy for first relapse. Approximately one quarter of patients relapsed following surgery and brachytherapy, with local relapses occurring more than metastatic relapse. Adverse events and functional outcomes were infrequently reported, but related to the site of surgery and brachytherapy. Study quality was limited by inconsistent reporting and potential selection bias. Outcomes following surgery and brachytherapy for a selected group of relapsed and refractory rhabdomyosarcoma show reasonable benefits, but reporting was often unclear and based on small sample sizes.
Topics: Humans; Brachytherapy; Rhabdomyosarcoma; Child; Adolescent; Neoplasm Recurrence, Local; Combined Modality Therapy; Male; Child, Preschool; Female
PubMed: 38566349
DOI: 10.1002/pbc.30952 -
PloS One 2023Physical activity and exercise during pregnancy have paramount importance for both the mother and fetus. Regardless of the benefits of exercise during pregnancy,... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Physical activity and exercise during pregnancy have paramount importance for both the mother and fetus. Regardless of the benefits of exercise during pregnancy, significant proportion of women usually opt sedentary lifestyle during pregnancy. The aim of this systematic review and meta-analysis is to synthesis evidences on knowledge, attitude, and practice towards antenatal physical exercise among pregnant women in Ethiopia.
METHODS
The systematic review and meta-analysis was conducted on knowledge, attitude, practice, and associated factors towards antenatal physical exercise among pregnant women in Ethiopia. The systematic review and meta-analysis protocol was registered on PROSPERO website with registration number CRD42023444723. Articles were searched on international databases using medical subject heading and keywords. After ensuring eligibility, data were extracted using Microsoft excel and imported to STATA 17 for analysis. Cochran Q test and I2 statistics were used to check presence of heterogeneity. Weighted Inverse variance random effect model was used to estimate the pooled level of knowledge, attitude, and practice on antenatal physical exercise among pregnant women in Ethiopia. Funnel plot and egger's test were used to check presence of publication bias.
RESULTS
A total of 11 studies were included in this systematic review and meta-analysis. The pooled prevalence of adequate knowledge, favorable attitude and good practice towards antenatal physical exercise were 46.04% with 95% CI (44.45%-47.63%), 43.71%, 95% CI (41.95%-45.46%) and 34.06, 95% CI (20.04%-48.08%) respectively. Good knowledge AOR 2.38 95% CI(1.80-3.14), unfavorable attitude AOR 0.43 95% CI (0.32-0.58), having no pre-pregnancy habit of physical exercise AOR 0.44 95 CI (0.24-0.79) and having diploma or above education status AOR 3.39 95% CI (1.92-5.98) were significantly associated with practice of antenatal physical exercise.
CONCLUSION
The level of knowledge, attitude and practice towards antenatal physical exercise among pregnant women was far below the recommended level in Ethiopia. Knowledge, attitude, education status and pre-pregnancy habit of physical exercise were significantly associated factors with antenatal physical exercise practice. It is highly essential to disseminate health information on the benefits of antenatal physical exercise for all pregnant women during antenatal care contacts.
Topics: Female; Humans; Pregnancy; Ethiopia; Exercise; Health Knowledge, Attitudes, Practice; Pregnant Women
PubMed: 38096224
DOI: 10.1371/journal.pone.0295275 -
ClinicoEconomics and Outcomes Research... 2023In the midst of the COVID-19 crisis, it might be difficult to provide the most vulnerable people with access to essential services. The main objective of this article is... (Review)
Review
INTRODUCTION
In the midst of the COVID-19 crisis, it might be difficult to provide the most vulnerable people with access to essential services. The main objective of this article is to lay the foundation for future solutions by collecting the results of previous published articles.
METHODS
This study used a systematic and integrated method that began by searching relevant literature in professional and generally published journal databases from March 2019- December 2021.
RESULTS
According to the results of the review, COVID-19 has had a significant effect on real and forecasted key macroeconomic variables such as economic growth, unemployment, inflation, poverty levels, and fiscal and monetary policy. In addition, this review reflects the sectorial effect of COVID-19 on health, factor productivity, domestic trade, exports, tourism, international aviation, remittances, the education sector, foreign direct investment, and the Ethiopian economy.
CONCLUSION
While appropriate social distance and personal protective equipment strategies exist in all types of markets across the country, the government should take precautions against the recurrence of Covid-19 by disseminating credible information. Finally, fiscal optimization should be seen as a broader intervention in the economy as a whole.
PubMed: 37492201
DOI: 10.2147/CEOR.S416625 -
BMC Psychiatry Sep 2023Stigma related to mental illness is increasingly and more effectively addressed. Although more research is being conducted, there is relatively little from low and...
BACKGROUND
Stigma related to mental illness is increasingly and more effectively addressed. Although more research is being conducted, there is relatively little from low and middle-income countries, with former Soviet bloc countries identified as a particular contributor to this evidence gap. Romania struggles with mental health stigma at many levels. The aim of this review was to bring together all relevant data regarding stigma and discrimination related to mental illness as well as actions to address these problems in Romania in order to prioritise further stigma research and identify priority targets for stigma reduction.
METHODS
A systematic literature search was conducted in three online databases and grey literature. After the analysis of full manuscripts, four were excluded based on lack of relevance or incomplete data reporting. Quality assessment was performed for included studies using the Mixed Methods Appraisal Tool (MMAT) and the narrative was synthesized based on the research questions.
RESULTS
The review included fifteen studies, the majority having a cross-sectional design. Stigma related to mental illness in Romania, has an impact on help-seeking attitudes and behaviours, workplace environment and social relationships of people with mental health problems. Negative stereotypes are maintained and validated by mass media reports. Significant stigma in healthcare and mental care settings has also been observed. Self-stigma was less frequently reported than public stigma. Despite a few stigma reduction actions, no rigorous evaluation of content, delivery and effectiveness has been conducted and no empirical evidence has been published.
CONCLUSIONS
Based on this review, three lines of action are recommended in Romania. Increase research concerning stigma in healthcare and mental care settings and use behavioural outcomes. Develop and deliver evidence-based tailored interventions to reduce stigma in identified priority subgroups of the population and ensure rigorous evaluation and scientific dissemination. Elaborate guidelines for working with community stigma and advocate for structural changes.
Topics: Humans; Mental Health; Cross-Sectional Studies; Romania; Mental Disorders; Social Stigma
PubMed: 37684591
DOI: 10.1186/s12888-023-05147-3 -
Sensors (Basel, Switzerland) Aug 2023Cybersecurity is a significant concern for businesses worldwide, as cybercriminals target business data and system resources. Cyber threat intelligence (CTI) enhances... (Review)
Review
Cybersecurity is a significant concern for businesses worldwide, as cybercriminals target business data and system resources. Cyber threat intelligence (CTI) enhances organizational cybersecurity resilience by obtaining, processing, evaluating, and disseminating information about potential risks and opportunities inside the cyber domain. This research investigates how companies can employ CTI to improve their precautionary measures against security breaches. The study follows a systematic review methodology, including selecting primary studies based on specific criteria and quality valuation of the selected papers. As a result, a comprehensive framework is proposed for implementing CTI in organizations. The proposed framework is comprised of a knowledge base, detection models, and visualization dashboards. The detection model layer consists of behavior-based, signature-based, and anomaly-based detection. In contrast, the knowledge base layer contains information resources on possible threats, vulnerabilities, and dangers to key assets. The visualization dashboard layer provides an overview of key metrics related to cyber threats, such as an organizational risk meter, the number of attacks detected, types of attacks, and their severity level. This relevant systematic study also provides insight for future studies, such as how organizations can tailor their approach to their needs and resources to facilitate more effective collaboration between stakeholders while navigating legal/regulatory constraints related to information sharing.
PubMed: 37631808
DOI: 10.3390/s23167273 -
Biological Psychiatry Jun 2024Research in machine-learning (ML) algorithms using natural behavior (i.e., text, audio, and video data) suggests that these techniques could contribute to... (Review)
Review
Use of Machine-Learning Algorithms Based on Text, Audio and Video Data in the Prediction of Anxiety and Post-Traumatic Stress in General and Clinical Populations: A Systematic Review.
Research in machine-learning (ML) algorithms using natural behavior (i.e., text, audio, and video data) suggests that these techniques could contribute to personalization in psychology and psychiatry. However, a systematic review of the current state-of-the-art is missing. Moreover, individual studies often target ML experts, and may overlook potential clinical implications of their findings. In a narrative accessible to mental health professionals, we present a systematic review, conducted in 5 psychology and 2 computer-science databases. We included 128 studies assessing the predictive power of ML algorithms using text, audio, and/or video data in the prediction of anxiety and post-traumatic stress (PTSD). Most studies (n = 87) aimed at predicting anxiety, the remainder (n = 41) focused on PTSD. They were mostly published since 2019, in computer science journals, and tested algorithms using text (n = 72), as opposed to audio or video. They focused mainly on general populations (n = 92), less on laboratory experiments (n = 23) or clinical populations (n = 13). Methodological quality varied, as did reported metrics of the predictive power, hampering comparison across studies. Two thirds of studies, focusing on both disorders, reported acceptable to very good predictive power (including high-quality studies only). Results of 33 studies were uninterpretable, mainly due to missing information. Research into ML algorithms using natural behavior is in its infancy, but shows potential to contribute to diagnostics of mental disorders, such as anxiety and PTSD, in the future, if standardization of methods, reporting of results, and research in clinical populations are improved.
PubMed: 38866173
DOI: 10.1016/j.biopsych.2024.06.002