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Does the duration of ambulatory consultations affect the quality of healthcare? A systematic review.BMJ Open Quality Oct 2023The objective is to examine and synthesise the best available experimental evidence about the effect of ambulatory consultation duration on quality of healthcare.
BACKGROUND
The objective is to examine and synthesise the best available experimental evidence about the effect of ambulatory consultation duration on quality of healthcare.
METHODS
We included experimental studies manipulating the length of outpatient clinical encounters between adult patients and clinicians (ie, therapists, pharmacists, nurses, physicians) to determine their effect on quality of care (ie, effectiveness, efficiency, timeliness, safety, equity, patient-centredness and patient satisfaction).
INFORMATION SOURCES
Using controlled vocabulary and keywords, without restriction by language or year of publication, we searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews and Scopus from inception until 15 May 2023.
RISK OF BIAS
Cochrane Risk of Bias instrument.
DATA SYNTHESIS
Narrative synthesis.
RESULTS
11 publications of 10 studies explored the relationship between encounter duration and quality. Most took place in the UK's general practice over two decades ago. Study findings based on very sparse and outdated evidence-which suggested that longer consultations improved indicators of patient-centred care, education about prevention and clinical referrals; and that consultation duration was inconsistently related to patient satisfaction and clinical outcomes-warrant low confidence due to limited protections against bias and indirect applicability to current practice.
CONCLUSION
Experimental evidence for a minimal or optimal duration of an outpatient consultation is sparse and outdated. To develop evidence-based policies and practices about encounter length, randomised trials of different consultation lengths-in person and virtually, and with electronic health records-are needed.
TRIAL REGISTRATION NUMBER
OSF Registration DOI:10.17605/OSF.IO/EUDK8.
Topics: Adult; Humans; Family Practice; Health Facilities; Quality of Health Care; Referral and Consultation
PubMed: 37875307
DOI: 10.1136/bmjoq-2023-002311 -
Acta Psychologica Sep 2023Previous reviews of the nature and consequences of adult-child book reading have focused on seeking impacts of interactive reading on the acquisition of vocabulary and...
Previous reviews of the nature and consequences of adult-child book reading have focused on seeking impacts of interactive reading on the acquisition of vocabulary and emergent literacy skills. In this systematic review we examined to what extent there has been systematic study of the effects of interactive reading on four less frequently studied developmental outcomes important to children's academic and life prospects: socio-emotional and socio-cognitive (SEL) skills, narrative skills, grammar, and world knowledge. We identified 67 studies of interactive reading that met the inclusion criteria and that examined the targeted outcomes, using either experimental, quasi-experimental, correlational, or single-group intervention methods. We found that studies of effects on grammar and world knowledge outcomes were very sparsely represented; though narrative was often studied as an outcome, the wide variation in conceptualizing and assessing the construct hampered any clear conclusion about book-reading effects. The most robust research strand focused on SEL skill outcomes, though here too the outcome assessments varied widely. We speculate that better instrumented approaches to assessing vocabulary and emergent literacy have led to the persistent emphasis on these domains, despite robust evidence of only modest associations, and argue that work to develop sound shared measures of narrative and SEL skills would enable cross-study comparison and the accumulation of findings. In addition, we note that the various studies implicated different explanatory principles for the value of reading with children: specific interactional features (open-ended questions, following the child's lead, expanding child utterances) or content features (emotion-enhanced books, talk about mental states, science topics), raising another topic for more focused study in the future.
Topics: Adult; Humans; Child, Preschool; Reading; Vocabulary; Literacy; Linguistics; Books
PubMed: 37562321
DOI: 10.1016/j.actpsy.2023.103997 -
European Journal of Medical Research Mar 2024Dravet Syndrome (DS) is a rare and severe form of childhood epilepsy that is often refractory to conventional antiepileptic drugs. Emerging evidence suggests that... (Review)
Review
BACKGROUND
Dravet Syndrome (DS) is a rare and severe form of childhood epilepsy that is often refractory to conventional antiepileptic drugs. Emerging evidence suggests that Cannabidiol (CBD) offer therapeutic benefits for DS. This review aims to evaluate the efficacy and safety of CBD in pediatric patients with DS based on data from ten clinical trials.
METHODS
A review was conducted to identify clinical trials assessing the efficacy and safety of CBD in pediatric patients diagnosed with DS. PubMed, MEDLINE, Scopus, Web of Science, and relevant grey literature were systematically searched for relevant articles up to October 2023, and clinical trials within the last 10 years were included. The search strategy incorporated controlled vocabulary terms and keywords related to "Cannabidiol," "Dravet Syndrome," and "pediatric patients."
RESULTS
The analysis revealed promising efficacy outcomes. Notably, CBD demonstrated substantial reductions in seizure frequency, with some patients achieving seizure freedom. The findings emphasised the consistency of CBD's efficacy across different patient subgroups. The safety profile of CBD was generally acceptable, with adverse events often being manageable.
CONCLUSION
This review consolidates evidence from multiple clinical trials, affirming the potential of CBD as a promising treatment option for pediatric patients with DS. While further research is needed to address existing knowledge gaps, CBD's efficacy and acceptable safety profile make it a valuable addition to the therapeutic tools for DS.
Topics: Child; Humans; Anticonvulsants; Cannabidiol; Epilepsies, Myoclonic; Lennox Gastaut Syndrome; Seizures
PubMed: 38500226
DOI: 10.1186/s40001-024-01788-6 -
Archives of Orthopaedic and Trauma... Jan 2021Although of high relevance for clinical decision making, there exists no consensus throughout the literature of the terms "acute" and "traumatic" used in the...
BACKGROUND
Although of high relevance for clinical decision making, there exists no consensus throughout the literature of the terms "acute" and "traumatic" used in the classification of rotator cuff tears. With differing definitions, the comparability of outcome studies may be limited. The aim was to provide a detailed systematic review of the definitions used in the literature and present a suggestion for a standardization in nomenclature based on the findings.
METHODS
Four different internet databases were searched in February 2020 using the terms ("acute" OR "traumatic" OR "trauma" OR "athlete" OR "young") AND ("rotator cuff tears" OR "rotator cuff tear" OR "rotator cuff" OR "rotator cuff rupture" OR "supraspinatus" OR "infraspinatus" OR "subscapularis" OR "teres minor"). Prospective, retrospective, cohort and case-control studies as well as case series were included. Systematic reviews, cadaveric or laboratory studies and studies on non-traumatic or non-acute rotator cuff tears were excluded.
RESULTS
The literature search conducted 10,349 articles of which 10,151 were excluded based on the title, 119 based on the abstract and 33 based on the manuscript. A total of 46 studies were finally included for review and subsequently analyzed. Overall, there exists no consensus neither on the term "acute" nor on "traumatic" in the context of rotator cuff tears in the literature. The time span for acute injuries ranged between 2 weeks and 6 months. For traumatic injuries, only 20% of the selected studies described a specific and adequate injury mechanism in combination with adequate imaging.
CONCLUSION
The term "acute" should be reserved for RCT showing muscle edema, wavelike appearance of the central part of the torn tendon and joint effusion, which typically requires adequate imaging within 2 weeks from trauma. Repair of acute tears should occur within 8 weeks from trauma to benefit from possibly superior biological healing capacities. The term "traumatic" should be used for a sudden onset of symptoms in a previously asymptomatic patient, triggered by an adequate trauma, e.g., a fall on the retroverted arm with an axial cranioventral force or a traumatic shoulder dislocation.
Topics: Humans; Rotator Cuff Injuries; Terminology as Topic; Vocabulary, Controlled
PubMed: 33130936
DOI: 10.1007/s00402-020-03656-4 -
Head & Neck Jan 2021The aims of this systematic review are to (a) evaluate the current literature on the impact of postoperative therapy for resected squamous cell carcinoma of the head and...
Systematic review of postoperative therapy for resected squamous cell carcinoma of the head and neck: Executive summary of the American Radium Society appropriate use criteria.
BACKGROUND
The aims of this systematic review are to (a) evaluate the current literature on the impact of postoperative therapy for resected squamous cell carcinoma of the head and neck (SCCHN) on oncologic and non-oncologic outcomes and (b) identify the optimal evidence-based postoperative therapy recommendations for commonly encountered clinical scenarios.
METHODS
An analysis of the medical literature from peer-reviewed journals was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. Prospective studies and methodology-based systematic reviews and meta-analyses of postoperative therapy for SCCHN were identified by searching Medline (OVID) and EMBASE (Elsevier) using controlled vocabulary terms (ie, National Library of Medicine Medical Subject Headings [MeSH], EMTREE). Study screening and selection was performed with Covidence software and full-text review. The RAND/UCLA appropriateness method was used by the expert panel to rate the appropriate use of postoperative therapy, and the modified Delphi method was used to come to consensus.
RESULTS
A total of 5660 studies were identified and screened using the title and abstract, leading to 201 studies assessed for relevance using full-text review. After limitation to the eligibility criteria, 101 studies from 1977 to 2020 were identified, including 77 with oncologic endpoints and 24 with function and quality of life endpoints. All studies reported staging prior to the implementation of American Joint Committee on Cancer (AJCC-8).
CONCLUSIONS
Prospective clinical studies and systematic reviews identified through the PRISMA systematic review provided good evidence for consensus statements regarding the appropriate use of postoperative therapy for resected SCCHN. Further research is needed in domains where consensus by the expert panel could not be achieved for the appropriateness of specific postoperative therapeutic interventions.
Topics: Head and Neck Neoplasms; Humans; Prospective Studies; Quality of Life; Radium; Squamous Cell Carcinoma of Head and Neck; United States
PubMed: 33098180
DOI: 10.1002/hed.26490 -
Scandinavian Journal of Trauma,... Dec 2021Non-technical skills (NTS) concepts from high-risk industries such as aviation have been enthusiastically applied to medical teams for decades. Yet it remains unclear... (Review)
Review
BACKGROUND
Non-technical skills (NTS) concepts from high-risk industries such as aviation have been enthusiastically applied to medical teams for decades. Yet it remains unclear whether-and how-these concepts impact resuscitation team performance. In the context of ad hoc teams in prehospital, emergency department, and trauma domains, even less is known about their relevance and impact.
METHODS
This scoping review, guided by PRISMA-ScR and Arksey & O'Malley's framework, included a systematic search across five databases, followed by article selection and extracting and synthesizing data. Articles were eligible for inclusion if they pertained to NTS for resuscitation teams performing in prehospital, emergency department, or trauma settings. Articles were subjected to descriptive analysis, coherence analysis, and citation network analysis.
RESULTS
Sixty-one articles were included. Descriptive analysis identified fourteen unique non-technical skills. Coherence analysis revealed inconsistencies in both definition and measurement of various NTS constructs, while citation network analysis suggests parallel, disconnected scholarly conversations that foster discordance in their operationalization across domains. To reconcile these inconsistencies, we offer a taxonomy of non-technical skills for ad hoc resuscitation teams.
CONCLUSION
This scoping review presents a vigorous investigation into the literature pertaining to how NTS influence optimal resuscitation performance for ad hoc prehospital, emergency department, and trauma teams. Our proposed taxonomy offers a coherent foundation and shared vocabulary for future research and education efforts. Finally, we identify important limitations regarding the traditional measurement of NTS, which constrain our understanding of how and why these concepts support optimal performance in team resuscitation.
Topics: Communication; Emergency Service, Hospital; Humans; Patient Care Team; Resuscitation
PubMed: 34863278
DOI: 10.1186/s13049-021-00980-5 -
Nutricion Hospitalaria Apr 2024The objective of this review is to study the relationship between food insecurity (FI) and malnutrition in schoolchildren from low-and middle-income countries (LMIC)....
The objective of this review is to study the relationship between food insecurity (FI) and malnutrition in schoolchildren from low-and middle-income countries (LMIC). The review was conducted using the databases PubMed, MEDLINE, CENTRAL, LILACS and SCiELO during the months of March to April 2022 without language or publication date restrictions. The search strategy consisted of combinations of text words and controlled vocabulary (MeSH terms and DeCS) related to "schoolchildren", "low- and middle-income countries" and "food insecurity". Fifteen studies were included in this review. Studies assessing FI and undernutrition in LMIC schoolchildren have indicated that FI is associated with lower height-for-age and higher prevalence of undernutrition overall. Only two studies identified a positive risk association between FI and overweight and obesity, the remaining studies suggested that schoolchildren with FI have a lower risk of overweight and obesity than those without FI. The review suggests a link between FI and undernutrition in schoolchildren from LMIC, with controversial results on overweight and obesity. Comprehensive public health policies should consider contextual and population-specific factors in addressing FI's impact on nutritional status.
PubMed: 38666331
DOI: 10.20960/nh.04847 -
The Journal of Clinical Psychiatry Jul 2019To summarize the effects of antenatal benzodiazepine exposure as monotherapy and in combination with antidepressants on the risk of congenital malformations. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To summarize the effects of antenatal benzodiazepine exposure as monotherapy and in combination with antidepressants on the risk of congenital malformations.
DATA SOURCES
MEDLINE, PsycINFO, CINAHL, Embase, and the Cochrane Library were searched from inception to June 30, 2018, using controlled vocabulary and keywords (eg, prenatal, benzodiazepines, malformation).
STUDY SELECTION
English-language cohort studies with prospectively collected data on the risk of malformations in benzodiazepine-exposed and -unexposed offspring were evaluated. 23,909 records were screened, 56 studies were assessed for eligibility, and 8 studies were included.
DATA EXTRACTION
Quality was assessed by 2 independent reviewers and data extracted. Random-effects models were used for outcomes (≥ 3 studies). Subanalyses examined effect of potential moderators including study quality and timing of exposure, among others.
RESULTS
Prenatal benzodiazepine use was not associated with an increased risk of congenital malformations (odds ratio [OR] = 1.13; 95% CI, 0.99 to 1.30, 8 studies, n = 222/5,195 exposed and 64,335/2,082,467 unexposed), including with first trimester exposure specifically (OR = 1.08; 95% CI, 0.93 to 1.25, P = .33; 5 studies, n = 181/4,331 exposed and 64,308/2,081,463 unexposed). There was no significant association with cardiac malformation following exposure (OR = 1.27; 95% CI, 0.98 to 1.65, P = .07; 4 studies, n = 61/4,414 exposed and 19,260/2,033,402 unexposed). However, concurrent use of benzodiazepine and antidepressants during pregnancy was associated with a significantly increased risk of congenital malformations (OR = 1.40; 95% CI, 1.09 to 1.80, P = .008; 3 studies).
CONCLUSIONS
Benzodiazepine exposure during pregnancy does not appear to be associated with congenital malformations or with cardiac malformations specifically. There may be an increased risk of congenital malformations when benzodiazepines are used in conjunction with antidepressants, suggesting that caution with this combination is warranted.
Topics: Abnormalities, Drug-Induced; Antidepressive Agents; Anxiety Disorders; Benzodiazepines; Drug Therapy, Combination; Female; Heart Defects, Congenital; Humans; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects
PubMed: 31294935
DOI: 10.4088/JCP.18r12412 -
Global Health Promotion Sep 2023An agreed definition, model, and indicators of positive health would contribute to a better understanding and wider use of the term, thus favoring the development of the...
An agreed definition, model, and indicators of positive health would contribute to a better understanding and wider use of the term, thus favoring the development of the positive health approach in public health. However, there is no consensus even on the definition of positive health. In this study, we systematically reviewed its definitions. We conducted a scoping review as per PRISMA guidelines. We queried the MEDLINE, Embase, PsychINFO, and Web of Science databases. The PubMed search equation was: 'positive health' [Title/Abstract] AND ('health' [MeSH] OR 'health status' [MeSH] OR 'health status indicators' [MeSH]). Definitions of positive health referring to a 'one-dimensional' conceptualization of health are: (i) positive health as a state 'far beyond a mere absence of disease'; (ii) positive health as wellbeing; and those referring to a 'two-dimensional' conceptualization are (iii) positive health as resilience and (iv) positive health as (a reserve in) capacities. This work contributes to the refining of the salutogenic vocabulary. At this stage of the ongoing discussion on health promotion vocabulary, we propose the 'reserve in capacities' as the candidate for the definition of positive health.
PubMed: 36625421
DOI: 10.1177/17579759221139802 -
Clinical Genetics Dec 2021Exome sequencing (ES) enhanced the diagnostic yield of genetic testing, but has also increased the possibility of uncertain findings. Prenatal ES is increasingly being...
Exome sequencing (ES) enhanced the diagnostic yield of genetic testing, but has also increased the possibility of uncertain findings. Prenatal ES is increasingly being offered after a fetal abnormality is detected through ultrasound. It is important to know how to handle uncertainty in this particularly stressful period. This systematic review aimed to provide a comprehensive overview of guidelines available for addressing uncertainty related to prenatal chromosomal microarray (CMA) and ES. Ten uncertainty types associated with prenatal ES and CMA were identified and defined by an international multidisciplinary team. Medline (all) and Embase were systematically searched. Laboratory scientists, clinical geneticists, psychologists, and a fetal medicine specialist screened the papers and performed the data extraction. Nineteen papers were included. Recommendations generally emphasized the importance of trio analysis, clinical information, data sharing, validation and re-analysis, protocols, multidisciplinary teams, genetic counselling, whether to limit the possible scope of results, and when to report particular findings. This systematic review helps provide a vocabulary for uncertainties, and a compass to navigate uncertainties. Prenatal CMA and ES guidelines provide a strong starting point for determining how to handle uncertainty. Gaps in guidelines and recommendations were identified and discussed to provide direction for future research and policy making.
Topics: Clinical Decision-Making; Disease Management; Female; Genetic Association Studies; Genetic Predisposition to Disease; Genomics; Health Policy; Humans; Practice Guidelines as Topic; Pregnancy; Prenatal Diagnosis; Uncertainty
PubMed: 34155632
DOI: 10.1111/cge.14010