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Viruses Nov 2023Background and Aims Coinfection of hepatitis delta virus (HDV) with hepatitis B virus (HBV) causes the most severe form of viral hepatitis, and the global prevalence of... (Meta-Analysis)
Meta-Analysis Review
Background and Aims Coinfection of hepatitis delta virus (HDV) with hepatitis B virus (HBV) causes the most severe form of viral hepatitis, and the global prevalence of HDV infection is underestimated. Although serological testing of anti-HDV antibodies is widely used in the diagnosis of HDV, its diagnostic efficacy remains unclear. This study aimed to evaluate the diagnostic efficacy of HDV serological tests, the results of which may assist in the diagnosis of HDV. Methods Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. The PubMed, Web of Science and Cochrane Library databases were searched from the beginning to 31 May 2023. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. STATA SE was used for the meta-analysis of the sensitivity, specificity, positive likelihood ratio and negative likelihood ratio. Results Among a total of 1376 initially identified studies, only 12 articles met the final inclusion criteria. The pooled sensitivity and specificity were 1.00 (95% CI: 0.00-1.00) and 0.71 (95% CI: 0.50-0.78) for HDV total antibodies, 0.96 (95% CI: 0.83-0.99) and 0.98 (95% CI: 0.82-1.00) for anti-HDV IgM and 0.95 (95% CI: 0.86-0.98) and 0.96 (95% CI: 0.67-1.00) for anti-HDV IgG. The pooled sensitivity and specificity for HDV serological tests were 0.99 (95% CI: 0.96-1.00) and 0.90 (95% CI: 0.79-0.96). Conclusions This meta-analysis suggests that serological tests have high diagnostic performance in detecting antibodies against HDV, especially in HDV IgM and IgG. However, this conclusion is based on studies of a limited number and quality, and the development of new diagnostic tools with higher precision and reliability is still necessary.
Topics: Humans; Hepatitis B; Hepatitis Delta Virus; Reproducibility of Results; Hepatitis Antibodies; Immunoglobulin M; Immunoglobulin G
PubMed: 38140586
DOI: 10.3390/v15122345 -
JMIR MHealth and UHealth Jan 2021Interventions aimed at modifying behavior for promoting health and disease management are traditionally resource intensive and difficult to scale. Mobile health apps are... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Interventions aimed at modifying behavior for promoting health and disease management are traditionally resource intensive and difficult to scale. Mobile health apps are being used for these purposes; however, their effects on health outcomes have been mixed.
OBJECTIVE
This study aims to summarize the evidence of rigorously evaluated health-related apps on health outcomes and explore the effects of features present in studies that reported a statistically significant difference in health outcomes.
METHODS
A literature search was conducted in 7 databases (MEDLINE, Scopus, PsycINFO, CINAHL, Global Index Medicus, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews). A total of 5 reviewers independently screened and extracted the study characteristics. We used a random-effects model to calculate the pooled effect size estimates for meta-analysis. Sensitivity analysis was conducted based on follow-up time, stand-alone app interventions, level of personalization, and pilot studies. Logistic regression was used to examine the structure of app features.
RESULTS
From the database searches, 8230 records were initially identified. Of these, 172 met the inclusion criteria. Studies were predominantly conducted in high-income countries (164/172, 94.3%). The majority had follow-up periods of 6 months or less (143/172, 83.1%). Over half of the interventions were delivered by a stand-alone app (106/172, 61.6%). Static/one-size-fits-all (97/172, 56.4%) was the most common level of personalization. Intervention frequency was daily or more frequent for the majority of the studies (123/172, 71.5%). A total of 156 studies involving 21,422 participants reported continuous health outcome data. The use of an app to modify behavior (either as a stand-alone or as part of a larger intervention) confers a slight/weak advantage over standard care in health interventions (standardized mean difference=0.38 [95% CI 0.31-0.45]; I2=80%), although heterogeneity was high.
CONCLUSIONS
The evidence in the literature demonstrates a steady increase in the rigorous evaluation of apps aimed at modifying behavior to promote health and manage disease. Although the literature is growing, the evidence that apps can improve health outcomes is weak. This finding may reflect the need for improved methodological and evaluative approaches to the development and assessment of health care improvement apps.
TRIAL REGISTRATION
PROSPERO International Prospective Register of Systematic Reviews CRD42018106868; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=106868.
Topics: Adolescent; Aged; Cell Phone; Child; Disease Management; Health Promotion; Humans; Mobile Applications; Pilot Projects; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 33427672
DOI: 10.2196/21563 -
MedEdPublish (2016) 2022Medical students commonly exhibit mental health issues. Despite the availability of professionals on medical campuses, seeking help continues to be a challenge for some...
Medical students commonly exhibit mental health issues. Despite the availability of professionals on medical campuses, seeking help continues to be a challenge for some students. Our review aimed to identify the barriers medical students face when seeking professional mental healthcare. A Medical Subject Headings (MeSH) search was created for articles using PubMed, Embase, and PsychINFO databases to identify articles specifically about medical students and their barriers to professional mental healthcare. Inclusion criteria included articles in which barriers to mental healthcare were either the primary variable or one of multiple study results. No date limits were imposed. Reviews, pilot projects, or articles that did not address barriers to mental healthcare faced by medical students or focused on veterinary or dental students were excluded. A total of 454 articles were identified and screened by title/abstract and then full text. Data were extracted from 33 articles using an independent framework. Barriers identified were compiled and reported. From a total of 33 articles, the most identified barriers were fear of negative effect on residency/career opportunities, fear of confidentiality breach, stigma and fear of shaming from peers, lack of perceived seriousness/normalization of symptoms, lack of time, and fear of documentation on academic record. Students also preferred to seek care outside of their institution from fear of their provider being an academic preceptor. Many of the barriers to mental healthcare faced by medical students relate to a fear of academic and career reprisal, and fear of confidentiality breach. It appears that despite recent efforts to decrease stigma surrounding mental illness, many medical students struggle to seek appropriate support. Access to mental healthcare can be improved by increasing transparency regarding what information will be displayed on academic records, dispelling common myths about mental healthcare, and increasing awareness about resources available for medical students.
PubMed: 37435431
DOI: 10.12688/mep.19115.1 -
Journal of Racial and Ethnic Health... Dec 2020Wide-reaching health promotion interventions are needed in influential, accessible community settings to address African American (AA) diabetes and CVD disparities. Most...
Wide-reaching health promotion interventions are needed in influential, accessible community settings to address African American (AA) diabetes and CVD disparities. Most AAs are overweight/obese, which is a primary clinical risk factor for diabetes/CVD. Using a faith-community-engaged approach, this study examined feasibility and outcomes of Project Faith Influencing Transformation (FIT), a diabetes/CVD screening, prevention, and linkage to care pilot intervention to increase weight loss in AA church-populations at 8 months. Six churches were matched and randomized to multilevel FIT intervention or standard education control arms. Key multilevel religiously tailored FIT intervention components included: (a) individual self-help materials (e.g., risk checklists, pledge cards); (b) YMCA-facilitated weekly group Diabetes Prevention Program (DPP) weight loss classes; (c) church service activities (e.g., sermons, responsive readings); and (d) church-community text/voice messages to promote healthy eating and physical activity. Health screenings (e.g., weight, blood pressure, blood glucose) were held during church services to identify participants with diabetes/CVD risks and refer them to their church's DPP class and linkage to care services. Participants (N = 352 church members and community members using churches' outreach ministries) were primarily female (67%) and overweight/obese (87%). Overall, FIT intervention participants were significantly more likely to achieve a > 5 lb weight loss (OR = 1.6; CI = 1.24, 2.01) than controls. Odds of intervention FIT-DPP participants achieving a > 5 lb weight loss were 3.6 times more than controls (p < .07). Exposure to sermons, text/email messages, brochures, commitment cards, and posters was significantly related to > 5 lb. weight loss. AA churches can feasibly assist in increasing reach and impact of diabetes/CVD risk reduction interventions with intensive weight loss components among at risk AA church-populations.
Topics: Adolescent; Adult; Black or African American; Aged; Aged, 80 and over; Cardiovascular Diseases; Diabetes Mellitus; Feasibility Studies; Female; Health Promotion; Humans; Male; Mass Screening; Middle Aged; Outcome Assessment, Health Care; Protestantism; Risk Reduction Behavior; Young Adult
PubMed: 32329033
DOI: 10.1007/s40615-020-00740-8 -
JAMA Network Open May 2022Phase 3 trials for patients with metastatic colorectal cancer (mCRC) have been conducted with varying designs and often with surrogate end points for overall survival...
Overall Survival in Phase 3 Clinical Trials and the Surveillance, Epidemiology, and End Results Database in Patients With Metastatic Colorectal Cancer, 1986-2016: A Systematic Review.
IMPORTANCE
Phase 3 trials for patients with metastatic colorectal cancer (mCRC) have been conducted with varying designs and often with surrogate end points for overall survival (OS).
OBJECTIVES
To critically examine the factors associated with clinically relevant improvement in OS (defined as ≥2 months) in these trials and to evaluate their association with outcomes reflected in Surveillance, Epidemiology, and End Results (SEER) registry data.
EVIDENCE REVIEW
Medline, EMBASE, Cochrane, Web of Science, ClinicalTrials.gov, EU Clinical Trials Register, and the International Clinical Trials Registry Platform were searched for phase 3 trials of systemic therapy for patients with mCRC by decade (1986-1996, 1997-2006, and 2007-2016), excluding early or pilot studies, studies that did not involve an anticancer drug, studies on cancer screening and prevention, reports of pooled data from multiple trials, and studies with nonpharmaceutical approaches. The association of drug development with OS outside the clinical trial setting was evaluated using data from the SEER registry, including adult patients with a primary cancer site in the colon or rectum, including adenocarcinoma, mucinous adenocarcinoma, or signet ring cell carcinoma; a distant stage; and receipt of chemotherapy as first-line therapy. Kaplan-Meier curves and log-rank tests were used to assess OS.
FINDINGS
The literature search identified 150 phase III clinical trials with 77 494 total enrollments, and 67 126 patients with mCRC were identified from the SEER database. Significant increases in survival were noted over time, best reflected in the experimental arm of first-line therapy (OS increased by 5.7 months per 10 years; 95% CI, 4.7-6.6 months; progression-free survival increased by 1.4 months per 10 years; 95% CI, 0.7-2.1 months). Although 69 of 148 trials (46.6%) met their predefined primary end point (including 20 of 44 trials [45.5%] with OS as the primary end point), only 35 of 132 trials (26.5%) resulted in improvement in OS by 2 months or more (including 13 of 42 trials [31.0%] with OS as the primary end point). Multivariable logistic regression showed that third-line therapies or later (odds ratio, 0.57; 95% CI, 0.51-0.63) and funding by pharmaceutical companies (odds ratio, 0.57; 95% CI, 0.54-0.60) were less often associated with improvement in OS. Furthermore, there was a decrease in the novelty of targets and agents over time, with trials that evaluated regimens composed entirely of previously approved drugs for mCRC increasing from 28% to 50%. Data from the SEER database showed that median OS increased from 12 months (95% CI, 12-13 months) (1986-1996) to 21 months (95% CI, 21-22 months) (2007-2015) (P < .001), but the 5-year OS continued to be low at 12.2% in 2011.
CONCLUSIONS AND RELEVANCE
In this systematic review, OS for patients with mCRC appeared to improve significantly in trials, translating into meaningful benefits outside the clinical trial setting; however, these advances, although significant cumulatively, are largely incremental individually. These data should be a call to aim for larger gains from future trials with novel drugs, building on the increasing understanding of the biology of mCRC and sophisticated translational research tools.
Topics: Adult; Antineoplastic Agents; Colorectal Neoplasms; Databases, Factual; Humans; Progression-Free Survival
PubMed: 35608860
DOI: 10.1001/jamanetworkopen.2022.13588 -
Molecules (Basel, Switzerland) Nov 2022Oily sludge is a hazardous material generated from the petroleum industry that has attracted increasing research interest. Although several review articles have dealt... (Review)
Review
Oily sludge is a hazardous material generated from the petroleum industry that has attracted increasing research interest. Although several review articles have dealt with specific subtopics focusing on the treatment of oily sludge based on selected references, no attempt has been made to demonstrate the research trend of oily sludge comprehensively and quantitatively. This study conducted a systematic review to analyze and evaluate all oily sludge-related journal articles retrieved from the Web of Science database. The results show that an increase in oily sludge-related research did not take place until recent years and the distribution of the researchers is geographically out of balance. Most oily sludge-related articles focused on treatment for harmfulness reduction or valorization with limited coverage of formation, characterization, and environmental impact assessment of oily sludge. Pyrolytic treatment has attracted increasing research attention in recent years. So far, the research findings have been largely based on laboratory-scale experiments with insufficient consideration of the cost-effectiveness of the proposed treatment methods. Although many methods have been proposed, few alone could satisfactorily achieve cost-effective treatment goals. To enable sustainable management of oily sludge on a global scale, efforts need to be made to fund more research projects, especially in the major oil-producing countries. Pilot-scale experiments using readily available and affordable materials should be encouraged for practical purposes. This will allow a sensible cost-benefit analysis of a proposed method/procedure for oily sludge treatment. To improve the treatment performance, combined methods are more desirable. To inform the smart selection of methods for the treatment of different oily sludge types, it is suggested to develop universally accepted evaluation systems for characterization and environmental risk of oily sludge.
Topics: Sewage; Oils; Environment
PubMed: 36431896
DOI: 10.3390/molecules27227795 -
The Cochrane Database of Systematic... Jan 2023Continuous fetal heart rate monitoring by cardiotocography (CTG) is used in labour for women with complicated pregnancies. Fetal heart rate abnormalities are common and... (Review)
Review
BACKGROUND
Continuous fetal heart rate monitoring by cardiotocography (CTG) is used in labour for women with complicated pregnancies. Fetal heart rate abnormalities are common and may result in the decision to expedite delivery by caesarean section. Fetal scalp stimulation (FSS) is a second-line test of fetal well-being that may provide reassurance that the labour can continue.
OBJECTIVES
To evaluate methods of FSS as second-line tests of intrapartum fetal well-being in cases of non-reassuring CTG. FSS and CTG were compared to CTG alone, and to CTG with fetal blood sampling (FBS).
SEARCH METHODS
We searched Cochrane Pregnancy and Childbirth's Trials Register (which includes trials from CENTRAL, MEDLINE, Embase, CINAHL, the WHO ICTRP and conference proceedings), ClinicalTrials.gov (18 October 2022), and reference lists of retrieved studies.
SELECTION CRITERIA
Eligible studies were randomised controlled trials (RCTs) that compared any form of FSS to assess fetal well-being in labour. Quasi-RCTs, cluster-RCTs and studies published in abstract form were also eligible for inclusion, but none were identified.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed studies for inclusion and risk of bias, extracted data and checked them for accuracy. We assessed the certainty of the evidence using the GRADE approach.
MAIN RESULTS
Two trials, involving 377 women, met the inclusion criteria for this review. Both trials were conducted in hospital settings and included women with singleton, term (37+0 weeks or more) pregnancies, a cephalic presentation, and abnormal CTG. Follow-up was until hospital discharge after the birth. A pilot trial of 50 women in a high-income country (Ireland) compared CTG and digital fetal scalp stimulation (dFSS) with CTG and fetal blood sampling (FBS). A single-centre trial of 327 women in a lower middle-income country (India) compared CTG and manual fetal stimulation (abdominal or vaginal scalp stimulation) with CTG alone. The two included studies were at moderate or unclear risk of bias. Both trials provided clear information on allocation concealment but it was not possible to blind participants or health professionals in relation to the intervention. Although objective outcome measures were reported, outcome assessment was not blinded or blinding was unclear. dFSS and CTG versus FBS and CTG There were no perinatal deaths and data were not reported for neurodevelopmental disability at >/= 12 months. The risk of caesarean section (CS) may be lower with dFSS compared to FBS (risk ratio (RR) 0.38, 95% confidence interval (CI) 0.16 to 0.92; 1 pilot trial, 50 women; very low-certainty evidence) but the evidence is very uncertain. There were no cases of neonatal encephalopathy reported. The evidence was also very uncertain between dFSS and FBS for assisted vaginal birth (RR 1.44, 95% CI 0.76 to 2.75; very low-certainty evidence) and for the spontaneous vaginal birth rate (RR 2.33, 95% CI 0.68 to 8.01, very low-certainty evidence). Maternal acceptability of the procedures was not reported. FSS and CTG versus CTG alone Manual stimulation of the fetus was performed either abdominally (92/164) or vaginally (72/164). There were no perinatal deaths and data were not reported for neurodevelopmental disability at >/= 12 months. There may be little differences in the risk of CS on comparing manual fetal stimulation and CTG with CTG alone (RR 0.83, 95% CI 0.59 to 1.18; 1 trial, 327 women; very low-certainty evidence), but again the evidence was very uncertain. There were no cases of neonatal encephalopathy reported. There may be no differences in the risk of assisted vaginal birth (RR 1.43, 95% CI 0.78 to 2.60; very low-certainty evidence) or in the rates of spontaneous vaginal birth (RR 1.01, 95% CI 0.85 to 1.21, very low-certainty evidence), but again the evidence is very uncertain. Maternal acceptability of abdominal stimulation/FSS was not reported although 13 women withdrew consent after randomisation due to concerns about fetal well-being.
AUTHORS' CONCLUSIONS
There is very low-certainty evidence available which makes it unclear whether stimulating the fetal scalp is a safe and effective way to confirm fetal well-being in labour. Evidence was downgraded based on limitations in study design and imprecision. Further high-quality studies of adequate sample size are required to evaluate this research question. In order to be generalisable, these trials should be conducted in different settings, including broad clinical criteria at both preterm and term gestational ages, and standardising the method of stimulation. There is an ongoing study (FIRSST) that will be incorporated into this review in a subsequent update.
Topics: Infant, Newborn; Female; Pregnancy; Humans; Scalp; Labor, Obstetric; Parturition; Perinatal Death; Fetus; Brain Diseases
PubMed: 36625680
DOI: 10.1002/14651858.CD013808.pub2 -
BMC Medical Informatics and Decision... Nov 2022With the availability of several similar medical devices performing the same function, choosing one for reimbursement is not easy, especially if purchased for a large...
BACKGROUND
With the availability of several similar medical devices performing the same function, choosing one for reimbursement is not easy, especially if purchased for a large number of patients. The objective of this project was to create a multicriteria decision analysis (MCDA) tool, that captures and compares all implantable medical devices' attributes, to provide an objective method for choosing among the available options in Egypt.
METHOD
We conducted a systematic review and expert interviews, to identify the relevant criteria for inclusion in the tool. Subsequently, a workshop was conducted, that involved experts in procuring and tendering medical devices. Experts chose the criteria, ranked them, assigned weights and scoring functions for each criterion, and then created the draft tool. A pilot phase followed; then, another workshop was conducted to fine-tune the tool. We readjusted the tool based on experts' experience with the draft tool.
RESULTS
The final tool included eight criteria, arranged according to their weightage: technical characteristics (29.4%), country of origin (19.5%), use in reference countries (14.9%), supply reliability (11.7%), previous use in tenders (9.0%), instant replacement within product variety (6.9%), pharmacovigilance (4.6%), and refund or replacement (4.0%). Each medical device was assessed on these eight criteria to achieve a final score, that was compared to the alternative devices' scores. Price is not included in the MCDA tool, but it will be added in the financial evaluation phase.
CONCLUSION
Decisionmakers could use the MCDA tool, to make evidence-based and objective decisions for purchasing implantable devices, in the Egyptian public sector. Post price evaluation, the product with the best value will be chosen for reimbursement.
HIGHLIGHTS
We created an MCDA tool to help decision makers choose between alternative implantable medical devices in Egypt. The MCDA tool includes eight criteria, where price is evaluated as a separate step. "Technical characteristics" and "country of origin" criteria carried the highest weights, thus representing approximately 50% of the decision.
Topics: Humans; Decision Support Techniques; Egypt; Reproducibility of Results; Public Sector; Prostheses and Implants
PubMed: 36352382
DOI: 10.1186/s12911-022-02025-y -
Journal of Advanced Nursing Feb 2023To develop an emotional intelligence (EI) test and evaluate its psychometrics for social and healthcare student selection.
AIM
To develop an emotional intelligence (EI) test and evaluate its psychometrics for social and healthcare student selection.
DESIGN
A cross-sectional methodological design.
METHODS
The test was developed based on a systematic review and focus group interviews. Content validity was evaluated with expert panels, and preliminary psychometrics with two pilot studies. Descriptive statistics, correlations and item response theory were used.
DATA SOURCES
Search was conducted in six databases 2018. Focus group interviews were conducted with educators and professionals in 2019. Expert panels with doctoral students, researchers and educators were conducted in 2020. Pilot tests with students were conducted 2020-2021. The developed test was administered to 4808 applicants 2021.
RESULTS
The test included four subscales. Correlations support the test's theoretical structure. The items were mainly easy.
CONCLUSION
The test assesses EI objectively and comprehensively. The item-level distractor analysis can be used for further test development.
IMPACTS
Social care and healthcare students engage in clinical practice early in their studies, and these environments can be emotionally challenging. Assessing EI in student selection with adequate test can help the institutions of higher education to select the students with required abilities to succeed in the studies. The assessment of EI during student selection also provides information higher education institutions could use to develop and provide support interventions. The results may also encourage practice placements to include EI elements as learning objective. The results of this study and especially the use of IRT and detailed distractor analysis to evaluate the psychometric properties of EMI-T can benefit researchers and educators that develop or evaluate objective assessment tools with multiple choice questions.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE
Emotional intelligence is important for students to enable professional interaction.
Topics: Humans; Psychometrics; School Admission Criteria; Cross-Sectional Studies; Emotional Intelligence; Delivery of Health Care; Social Support
PubMed: 36575904
DOI: 10.1111/jan.15557 -
Evidence-based Mental Health Feb 2021The context for the implementation of evidence-based psychological treatments (EBPTs) often differs from the context in which the treatment was developed, which... (Review)
Review
QUESTION
The context for the implementation of evidence-based psychological treatments (EBPTs) often differs from the context in which the treatment was developed, which necessitates adaptations. In this systematic review we build on, and add to, prior approaches by examining the method used to guide such adaptations. In particular, we sought to elucidate the extent to which an empirical process is used.
STUDY SELECTION AND ANALYSIS
We focused on publications describing adaptations made to EBPTs for adults diagnosed with a mental illness. We searched PubMed, PsycINFO, Embase and Web of Science from database inception to July 2018. Two raters independently coded the articles for the method used to conduct the adaptation, the reason for and nature of the adaptation, and who made the adaptation.
FINDINGS
The search produced 20 194 citations, which yielded 152 articles after screening. The most commonly used methods for planned adaptations were literature review (57.7%), clinical intuition (47.0%) and theory (38.9%). The use of data from stakeholder interviews ranked fourth (21.5%) and the use of other types of data (eg, pilot study, experiment, survey, interview) ranked last at fifth (12.1%). Few publications reporting ad hoc adaptations were identified (n=3).
CONCLUSIONS
This review highlights a need to (a) educate providers and researchers to carefully consider the methods used for the treatment adaptation process, and to use empirical methods where possible and where appropriate, (b) improve the quality of reporting of stakeholder interviews and (c) develop reporting standards that articulate optimal methods for conducting treatment adaptations.
Topics: Adult; Humans; Mental Disorders; Pilot Projects
PubMed: 33355291
DOI: 10.1136/ebmental-2020-300225