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Body Image Jun 2023Functionality appreciation is a component of positive body image that refers to respecting and honoring the body for what it is capable of doing. A growing number of... (Meta-Analysis)
Meta-Analysis Review
Functionality appreciation is a component of positive body image that refers to respecting and honoring the body for what it is capable of doing. A growing number of studies have investigated the features, correlates, and outcomes of functionality appreciation, yet a synthesis of this literature is missing. We conducted a systematic review and meta-analysis of research on functionality appreciation. Fifty-six studies were included (85 % cross-sectional). Random effects meta-analyses were performed on 21 cross-sectional correlates and on seven randomized trials of psychological interventions that assessed functionality appreciation as an outcome. Meta-analyses showed that functionality appreciation was consistently associated with fewer body image problems, lower levels of eating disorder symptoms, and better mental health and wellbeing. Functionality appreciation was unrelated to age and gender, but weakly (and negatively) related to body mass index. Preliminary evidence from prospective designs suggests that the appreciation of body functionality may promote adaptive eating patterns and prevent maladaptive eating and body image patterns over time. Psychological interventions designed to cultivate functionality appreciation in full or in part produced greater improvements in this construct than control conditions. Findings confirm that functionality appreciation is associated with numerous wellbeing constructs and could serve as a potentially useful target for intervention.
Topics: Humans; Body Image; Cross-Sectional Studies; Feeding Behavior; Feeding and Eating Disorders; Mental Health
PubMed: 36796304
DOI: 10.1016/j.bodyim.2023.02.002 -
Trials Oct 2018Although children have historically been excluded from clinical trials (CTs), many require medicines tested and approved in CTs, forcing health care providers to treat...
BACKGROUND
Although children have historically been excluded from clinical trials (CTs), many require medicines tested and approved in CTs, forcing health care providers to treat their pediatric patients based on extrapolated data. Unfortunately, traditional randomized CTs can be slow and resource-intensive, and they often require multi-center collaboration. However, an adaptive design (AD) framework for CTs could be used to increase the efficiency of pediatric CTs by incorporating prospectively planned modifications to CT methods without undermining the integrity or validity of the study. There are many possible adaptations, but each will have ethical, logistical, and statistical implications. It remains unclear which adaptations (or combinations thereof) will lead to real-world improvements in pediatric CT efficiency. This study will identify, evaluate, and synthesize the various regulatory, ethical, logistical, and statistical considerations and emerging issues of AD in CTs that could be used to evaluate the use of drugs in children.
METHODS/DESIGN
Following the development of a peer-reviewed search strategy, a systematic review on AD in CTs will be conducted. Data on regulatory, ethical, logistic, and statistical considerations as well as population and trial design characteristics will be synthesized. A mixed-methods study including surveys and focus groups with regulators, research ethics board members, biostatisticians, clinicians, and scientists, as well as representatives from patient groups and the public will evaluate the opportunities and challenges in applying AD in trials enrolling children and propose recommendations on best practices.
DISCUSSION
This study will deliver practical recommendations on the use of AD in pediatric CTs. Collaboration and consultation with national and global partners will ensure that our results meet the needs of researchers, regulators, and patients, both locally and globally, and that they remain current and relevant by engaging a wide variety of stakeholders. Overall, this research will enrich the knowledge base regarding if, how, and when AD can be used to answer research questions with fewer resources while still meeting the highest ethical standards and regulatory requirements for CTs. In turn, this will result in increased high-quality clinical research needed by health care providers so they have access to appropriate, population-specific evidence regarding the safe and effective use of medicines in children.
Topics: Child; Clinical Protocols; Clinical Trials as Topic; Focus Groups; Humans; Research Design; Translational Research, Biomedical
PubMed: 30340624
DOI: 10.1186/s13063-018-2934-7 -
BMJ Open Jul 2021In order to reduce safety risks associated with medication administrations, technologies such as barcode medication administration (BCMA) are increasingly used....
BACKGROUND
In order to reduce safety risks associated with medication administrations, technologies such as barcode medication administration (BCMA) are increasingly used. Examining how human factors influence adoption and usability of this technology can potentially highlight areas for improvement in design and implementation.
OBJECTIVE
To describe how human factors related determinants for BCMA have been researched and reported by healthcare and human-computer interaction disciplines.
DATA SOURCES
The Cumulative Index of Nursing, and Allied Health Literature, PubMed, OVID MEDLINE and Google Scholar.
STUDY ELIGIBILITY CRITERIA
Primary research published from April 2000 to April 2020, search terms developed to identity different disciplinary research perspectives that examined BCMA use, used a human factors lens and were published in English.
SYNTHESIS METHODS
Computerised systematic searches were conducted in four databases. Eligible papers were systematically analysed for themes. Themes were discussed with a second reviewer and supervisors to ensure they were representative of content.
RESULTS
Of 3707 papers screened, 11 were included. Studies did not fit neatly into a clinical or human-computer interaction perspective but instead uncovered a range of overlapping narratives, demonstrating consensus on the key themes despite differing research approaches. Prevalent themes were misaligned design and workflow, adaptation and workarounds, mediating factors, safety, users' perceptions and design and usability. Inadequate design frequently led to workarounds, which jeopardised safety. Reported mediating factors included clarity of user needs, pre/post implementation evaluations, analysis of existing workarounds and appropriate technology, infrastructure and staffing.
LIMITATIONS
Most studies were relatively small and qualitative, making it difficult to generalise findings.
CONCLUSION
Evaluating interdisciplinary perspectives including human factors approaches identified similar and complementary enablers and barriers to successful technology use. Often, mediating factors were developed to compensate for unsuitable design; a collaborative approach between system designer and end users is necessary for BCMA to achieve its true safety potential.
Topics: Delivery of Health Care; Humans; Interdisciplinary Studies; Technology; Workflow
PubMed: 34210721
DOI: 10.1136/bmjopen-2020-044419 -
BMC Medical Research Methodology Sep 2023Trial design plays a key role in clinical trials. Traditional group sequential design has been used in cardiovascular clinical trials over decades as the trials can...
BACKGROUND
Trial design plays a key role in clinical trials. Traditional group sequential design has been used in cardiovascular clinical trials over decades as the trials can potentially be stopped early, therefore, it can reduce pre-planned sample size and trial resources. In contrast, trials with adoptive designs provide greater flexibility and are more efficient due to the ability to modify trial design according to the interim analysis results. In this systematic review, we aim to explore characteristics of adaptive and traditional group sequential trials in practice and to gain an understanding how these trial designs are currently being reported in cardiology.
METHODS
PubMed, Embase and Cochrane Central Register of Controlled Trials database were searched from January 1980 to June 2022. Randomised controlled phase 2/3 trials with either adaptive or traditional group sequential design in patients with cardiovascular disease were included. Descriptive statistics were used to present the collected data.
RESULTS
Of 456 articles found in the initial search, 56 were identified including 43 (76.8%) trials with traditional group sequential design and 13 (23.2%) with adaptive. Most trials were large, multicentre, led by the USA (50%) and Europe (28.6%), and were funded by companies (78.6%). For trials with group sequential design, frequency of interim analyses was determined mainly by the number of events (47%). 67% of the trials stopped early, in which 14 (32.6%) were due to efficacy, and 5 (11.6%) for futility. The commonly used stopping rule to terminate trials was O'Brien- Fleming-type alpha spending function (10 (23.3%)). For trials with adaptive designs, 54% of the trials stopped early, in which 4 (30.8%) were due to futility, and 2 (15.4%) for efficacy. Sample size re-estimation was commonly used (8 (61.5%)). In 69% of the trials, simulation including Bayesian approach was used to define the statistical stopping rules. The adaptive designs have been increasingly used (from 0 to 1999 to 38.6% after 2015 amongst adaptive trials). 25% of the trials reported "adaptive" in abstract or title of the studies.
CONCLUSIONS
The application of adaptive trials is increasingly popular in cardiovascular clinical trials. The reporting of adaptive design needs improving.
Topics: Humans; Bayes Theorem; Cardiovascular Diseases; Computer Simulation; Data Collection; Death; Clinical Trials, Phase II as Topic; Randomized Controlled Trials as Topic
PubMed: 37679710
DOI: 10.1186/s12874-023-02024-1 -
Journal of Medical Internet Research May 2019A blockchain is a list of records that uses cryptography to make stored data immutable; their use has recently been proposed for electronic medical record (EMR) systems....
BACKGROUND
A blockchain is a list of records that uses cryptography to make stored data immutable; their use has recently been proposed for electronic medical record (EMR) systems. This paper details a systematic review of trade-offs in blockchain technologies that are relevant to EMRs. Trade-offs are defined as "a compromise between two desirable but incompatible features."
OBJECTIVE
This review's primary research question was: "What are the trade-offs involved in different blockchain designs that are relevant to the creation of blockchain-based electronic medical records systems?"
METHODS
Seven databases were systematically searched for relevant articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Papers published from January 1, 2017 to June 15, 2018 were selected. Quality assessments of papers were performed using the Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) tool and the Critical Assessment Skills Programme (CASP) tool. Database searches identified 2885 articles, of which 15 were ultimately included for analysis.
RESULTS
A total of 17 trade-offs were identified impacting the design, development, and implementation of blockchain systems; these trade-offs are organized into themes, including business, application, data, and technology architecture.
CONCLUSIONS
The key findings concluded the following: (1) multiple trade-offs can be managed adaptively to improve EMR utility; (2) multiple trade-offs involve improving the security of blockchain systems at the cost of other features, meaning EMR efficacy highly depends on data protection standards; and (3) multiple trade-offs result in improved blockchain scalability. Consideration of these trade-offs will be important to the specific environment in which electronic medical records are being developed. This review also uses its findings to suggest useful design choices for a hypothetical National Health Service blockchain.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
RR2-10.2196/10994.
Topics: Blockchain; Computer Security; Electronic Health Records; Health Information Exchange; Humans
PubMed: 31094344
DOI: 10.2196/12426 -
Journal of Thermal Biology Aug 2023Given the increasing trend of global warming and extreme weather conditions, including heat waves and its effects on health, the present study was done to investigate... (Review)
Review
BACKGROUND
Given the increasing trend of global warming and extreme weather conditions, including heat waves and its effects on health, the present study was done to investigate adaptive behaviors of communities in the world for combating heat waves.
METHOD
ology: In this systematic review, out of 1529 results, 57 relevant and authoritative English papers on adaptation to heat waves hazard were extracted and evaluated using valid keywords from valid databases (PubMed, WOS, EMBASE, and Scopus). In addition, multiple screening steps were done and then, the selected papers were qualitatively assessed. Evaluation results were summarized using an Extraction Table.
RESULTS
In this paper, the adaptive behaviors for combating heat waves hazard were summarized into 11 categories: Education and awareness raising, Adaptation of critical infrastructure, Governments measures, Health-related measures, Application of early warning system, Protective behaviors in workplace, Physical condition, Adaptive individual behaviors, Design and architecture of the building, Green infrastructure (green cover), and Urban design.
CONCLUSION
The findings of this study showed that community actions have significant effects on adaptation to heat wave. Therefore, for reducing heat wave-related negative health effects and vulnerability, more attention should be paid to the above-mentioned actions for mitigation, preparation, and responding regarding heat waves.
PROSPERO REGISTRATION NUMBER
CRD42021257747.
Topics: Hot Temperature; Acclimatization; Adaptation, Physiological; Global Warming; Adaptation, Psychological; Climate Change
PubMed: 37499408
DOI: 10.1016/j.jtherbio.2023.103588 -
BMJ Open Aug 2019Although adaptive e-learning environments (AEEs) can provide personalised instruction to health professional and students, their efficacy remains unclear. Therefore,... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Although adaptive e-learning environments (AEEs) can provide personalised instruction to health professional and students, their efficacy remains unclear. Therefore, this review aimed to identify, appraise and synthesise the evidence regarding the efficacy of AEEs in improving knowledge, skills and clinical behaviour in health professionals and students.
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
CINAHL, EMBASE, ERIC, PsycINFO, PubMed and Web of Science from the first year of records to February 2019.
ELIGIBILITY CRITERIA
Controlled studies that evaluated the effect of an AEE on knowledge, skills or clinical behaviour in health professionals or students.
SCREENING, DATA EXTRACTION AND SYNTHESIS
Two authors screened studies, extracted data, assessed risk of bias and coded quality of evidence independently. AEEs were reviewed with regard to their topic, theoretical framework and adaptivity process. Studies were included in the meta-analysis if they had a non-adaptive e-learning environment control group and had no missing data. Effect sizes (ES) were pooled using a random effects model.
RESULTS
From a pool of 10 569 articles, we included 21 eligible studies enrolling 3684 health professionals and students. Clinical topics were mostly related to diagnostic testing, theoretical frameworks were varied and the adaptivity process was characterised by five subdomains: method, goals, timing, factors and types. The pooled ES was 0.70 for knowledge (95% CI -0.08 to 1.49; p.08) and 1.19 for skills (95% CI 0.59 to 1.79; p<0.00001). Risk of bias was generally high. Heterogeneity was large in all analyses.
CONCLUSIONS
AEEs appear particularly effective in improving skills in health professionals and students. The adaptivity process within AEEs may be more beneficial for learning skills rather than factual knowledge, which generates less cognitive load. Future research should report more clearly on the design and adaptivity process of AEEs, and target higher-level outcomes, such as clinical behaviour.
PROSPERO REGISTRATION NUMBER
CRD42017065585.
Topics: Computer-Assisted Instruction; Education, Medical; Health Personnel; Humans; Learning
PubMed: 31467045
DOI: 10.1136/bmjopen-2018-025252 -
Journal of the American Medical... Jul 2021An increasing reliance on telemedicine for older adults with cognitive impairment requires a better understanding of the barriers and facilitators for this unique... (Review)
Review
OBJECTIVES
An increasing reliance on telemedicine for older adults with cognitive impairment requires a better understanding of the barriers and facilitators for this unique patient population.
DESIGN
The study team queried PubMed, Embase, the Cochrane Library, PsycINFO, CINAHL, Scopus, and ClinicalTrials.gov on May 1, 2020, for studies in English published from January 2010 to May 2020.
SETTING AND PARTICIPANTS
We conducted a systematic review of articles investigating the use of telemedicine among older adults with Alzheimer's disease and related dementia (ADRD) or mild cognitive impairment (MCI) that focused on the patient and care partner perspectives.
METHODS
Telemedicine encounter purpose, technological requirements, and findings regarding sensory needs were extracted. The Cochrane Collaboration's Risk of Bias Tool was applied for quality assessment.
RESULTS
The search yielded 3551 abstracts, from which 90 articles were reviewed and 17 were included. The purpose of telemedicine encounters included routine care, cognitive assessment, and telerehabilitation. All studies reported successful implementation of telemedicine, supported by patient and care partner satisfaction, similar results on cognitive assessment and diagnosis compared to in-person visits, and improvement in outcome measures following rehabilitation. Sixteen studies relied on staff and care partners to navigate technologies. Six studies reported participants reporting difficulty hearing the provider during the telemedicine visits. Five studies excluded participants with visual or hearing impairment because of the potential difficulty of using telemedicine technology. No studies reported technological adaptations to account for sensory impairment.
CONCLUSIONS AND IMPLICATIONS
Telemedicine is well received among patients and care partners, but successful delivery incorporates support staff and the care partners to navigate technologies. The exclusion of older adults with sensory impairment, especially given that it is highly prevalent, in developing telemedicine systems may further exacerbate access to care in this population. Adapting technologies for sensory needs is critical to the advancement of accessible dementia care through telemedicine.
Topics: Aged; Alzheimer Disease; Cognitive Dysfunction; Humans; Telemedicine
PubMed: 33887231
DOI: 10.1016/j.jamda.2021.03.015 -
Frontiers in Dentistry 2022Endocrown restorations were introduced for endodontically treated teeth as a conservative treatment. However, data about the effect of preparation design on marginal...
Endocrown restorations were introduced for endodontically treated teeth as a conservative treatment. However, data about the effect of preparation design on marginal integrity and fracture resistance of endocrowns are lacking. The purpose of this systematic review was to investigate the effect of preparation design of endocrown restorations on marginal integrity and fracture resistance. Based on PICO question and the search terms, PubMed, Embase, Scopus, and the Cochrane Library were searched. After including studies matched to predefined inclusion and exclusion criteria, the extracted data were tabulated in a table provided by the authors. Two reviewers assessed the methodological quality of each included study independently. Ten articles were selected for extracting the quantitative data. All included studies were in vitro. The potential risk of bias of the selected studies was assessed using the modified MINORS scale. Four studies assessed the marginal adaptation, five studies evaluated the fracture resistance and just one investigated both the marginal integrity and fatigue resistance of the specimens. The evaluated influencing items in preparation design were as follows: cavity depth, occlusal thickness, ferrule effect, internal divergence angle, type of finish line, and adding vents inside pulp chamber. Meta-analysis could not be done due to heterogeneity of preparation designs and evaluation methods. Marginal discrepancy of endocrowns is intensified with adding preparation features, higher cavity depth and increasing the divergence. Fracture resistance of endocrowns is increased with more occlusal reduction and cavity depth. However, it is still beyond the normal clinical force range.
PubMed: 36873612
DOI: 10.18502/fid.v19i37.11250 -
Pediatric Blood & Cancer Feb 2022Pediatric brain tumor survivors (PBTS) experience psychosocial difficulties and poor quality of life (QOL). Family functioning may be adversely impacted by the stress of... (Review)
Review
INTRODUCTION
Pediatric brain tumor survivors (PBTS) experience psychosocial difficulties and poor quality of life (QOL). Family functioning may be adversely impacted by the stress of diagnosis and associated symptoms, which may, in turn, affect PBTS outcomes. The objective of this study was to complete a systematic review of family functioning and psychosocial outcomes in PBTS.
METHODS
We conducted systematic searches of PubMed and PsychInfo. Full-text articles (n = 324) were screened and 14 were included. A risk-of-bias assessment was conducted to evaluate the quality of study conclusions.
RESULTS
Studies examined associations of family functioning with adaptive, social, emotional, and behavioral outcomes, and QOL. More adaptive family functioning (cohesiveness, effective communication, lower conflict) was associated with better PBTS outcomes. Studies were limited by heterogeneous/small samples and cross-sectional designs.
CONCLUSIONS
Results provide preliminary support for the relationship between family functioning and psychosocial outcomes. Common outcome measures and prospective research designs can further advance understanding.
Topics: Brain Neoplasms; Child; Cross-Sectional Studies; Humans; Prospective Studies; Quality of Life; Survivors
PubMed: 34842339
DOI: 10.1002/pbc.29470