-
Ultrasound in Medicine & Biology Feb 2017In this systematic review and meta-analysis, we report measured elasticities of benign and malignant breast pathologies from shear wave elastography (SWE),... (Meta-Analysis)
Meta-Analysis Review
In this systematic review and meta-analysis, we report measured elasticities of benign and malignant breast pathologies from shear wave elastography (SWE), quantitatively confirm the effect of the selected region of interest (ROI) on these measures and test the hypothesis that a metric of heterogeneity based on the mean and maximum elasticity can improve specificity of diagnosis. The elasticities of benign, malignant and specific pathologic states are reported from 22 publications encompassing 2989 patients, identified from a structured search of the literature from May to September 2015. Twelve articles were included in a meta-analysis that grouped results by the method of ROI selection to discriminate between different pathologies. We observe a significant correlation between the method of selection of ROI for malignant mean (p < 0.001) and maximum (p = 0.027) elasticities, but no correlation with benign measures. We define a quantitative heterogeneity parameter, the "stiffness gradient," computed from the mean and maximum measured elasticities. The stiffness gradient out-performed the current standard maximum elasticity metric in stratifying malignancy risk by a margin of 15% for the partial ROI, and 42% for the maximized ROI. An anecdotal example of improved differentiation using the stiffness gradient on pathology-specific lesions is also provided. These results quantitatively indicate that the method of ROI selection in SWE not only has a significant impact on the resulting mean reported elasticity of a lesion, but may provide some insight into lesion heterogeneity. Our results suggest that further exploration of quantitative heterogeneity is warranted to improve the specificity of diagnosis.
Topics: Breast; Breast Neoplasms; Diagnosis, Differential; Elasticity Imaging Techniques; Female; Humans; Reproducibility of Results; Ultrasonography, Mammary
PubMed: 27746010
DOI: 10.1016/j.ultrasmedbio.2016.09.002 -
Clinical Trials (London, England) Dec 2022Self-management interventions are increasingly being developed and researched to improve long-term condition outcomes. To understand and interpret findings, it is... (Review)
Review
BACKGROUND/AIMS
Self-management interventions are increasingly being developed and researched to improve long-term condition outcomes. To understand and interpret findings, it is essential that fidelity of intervention delivery and participant engagement are measured and reported. Before developing fidelity checklists to assess treatment fidelity of interventions, current recommendations suggest that a synthesis of fidelity measures reported in the literature is completed. Therefore, here we aim to identify what the current measures of fidelity of intervention delivery and engagement for self-management interventions for long-term conditions are and whether there is treatment fidelity.
METHODS
Four databases (MEDLINE, PubMed, CINAHL Plus and ScienceDirect) and the journal implementation science were systematically searched to identify published reports from inception to December 2020 for experimental studies measuring fidelity of intervention delivery and/or participant engagement in self-management interventions for long-term conditions. Data on fidelity of delivery and engagement measures and the findings were extracted and synthesised.
RESULTS
Thirty-nine articles were identified as eligible, with 25 studies measuring fidelity of delivery, 19 reporting engagement and 5 measuring both. For fidelity of delivery, measures included structured checklists, participant completed measures and researcher observations/notes. These were completed by researchers, participants and intervention leaders. Often there was little information around the development of these measures, particularly when the measure had been developed by the researchers, rather than building on others work. Eighteen of 25 studies reported there was fidelity of intervention delivery. For engagement, measures included data analytics, participant completed measures and researcher observations. Ten out of 19 studies reported participants were engaged with the intervention.
CONCLUSION
In complex self-management interventions, it is essential to assess whether treatment fidelity of each core component of interventions is delivered, as outlined in the protocol, to understand which components are having an effect. Treatment fidelity checklists comparing what was planned to be delivered, with what was delivered should be developed with pre-defined cut-offs for when fidelity has been achieved. Similarly, when measuring engagement, while data analytics continue to rise with the increase in digital interventions, clear cut-offs for participant use and content engaged with to be considered an engagement participant need to be pre-determined.
Topics: Humans; Self-Management; Checklist; Data Science; Databases, Factual; MEDLINE
PubMed: 36017707
DOI: 10.1177/17407745221118555 -
Journal of General Internal Medicine Jan 2018Physicians routinely encounter diagnostic uncertainty in practice. Despite its impact on health care utilization, costs and error, measurement of diagnostic uncertainty...
BACKGROUND
Physicians routinely encounter diagnostic uncertainty in practice. Despite its impact on health care utilization, costs and error, measurement of diagnostic uncertainty is poorly understood. We conducted a systematic review to describe how diagnostic uncertainty is defined and measured in medical practice.
METHODS
We searched OVID Medline and PsycINFO databases from inception until May 2017 using a combination of keywords and Medical Subject Headings (MeSH). Additional search strategies included manual review of references identified in the primary search, use of a topic-specific database (AHRQ-PSNet) and expert input. We specifically focused on articles that (1) defined diagnostic uncertainty; (2) conceptualized diagnostic uncertainty in terms of its sources, complexity of its attributes or strategies for managing it; or (3) attempted to measure diagnostic uncertainty.
KEY RESULTS
We identified 123 articles for full review, none of which defined diagnostic uncertainty. Three attributes of diagnostic uncertainty were relevant for measurement: (1) it is a subjective perception experienced by the clinician; (2) it has the potential to impact diagnostic evaluation-for example, when inappropriately managed, it can lead to diagnostic delays; and (3) it is dynamic in nature, changing with time. Current methods for measuring diagnostic uncertainty in medical practice include: (1) asking clinicians about their perception of uncertainty (surveys and qualitative interviews), (2) evaluating the patient-clinician encounter (such as by reviews of medical records, transcripts of patient-clinician communication and observation), and (3) experimental techniques (patient vignette studies).
CONCLUSIONS
The term "diagnostic uncertainty" lacks a clear definition, and there is no comprehensive framework for its measurement in medical practice. Based on review findings, we propose that diagnostic uncertainty be defined as a "subjective perception of an inability to provide an accurate explanation of the patient's health problem." Methodological advancements in measuring diagnostic uncertainty can improve our understanding of diagnostic decision-making and inform interventions to reduce diagnostic errors and overuse of health care resources.
Topics: Clinical Decision-Making; Delivery of Health Care; Humans; Medicine; Uncertainty
PubMed: 28936618
DOI: 10.1007/s11606-017-4164-1 -
BMJ Clinical Evidence Apr 2011Adherence to medication is generally defined as the extent to which people take medications as prescribed by their healthcare providers. It can be assessed in many ways... (Review)
Review
INTRODUCTION
Adherence to medication is generally defined as the extent to which people take medications as prescribed by their healthcare providers. It can be assessed in many ways (e.g., by self-reporting, pill counting, direct observation, electronic monitoring, or by pharmacy records). This review reports effects of intervention on adherence to cardiovascular medications however adherence has been measured.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of interventions to improve adherence to long-term medication for cardiovascular disease in adults? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 39 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: patient health education, prescriber education, prompting mechanisms, reminder packaging (calendar [blister] packs, multi-dose pill boxes), and simplified dosing.
Topics: Antihypertensive Agents; Cardiovascular Agents; Drug Packaging; Humans; Medication Adherence; Patient Compliance; Self Report
PubMed: 21481286
DOI: No ID Found -
Pathogens (Basel, Switzerland) Feb 2022In order to better understand transmission dynamics and appropriately target control and preventive measures, studies have aimed to identify who-infected-whom in actual... (Review)
Review
In order to better understand transmission dynamics and appropriately target control and preventive measures, studies have aimed to identify who-infected-whom in actual outbreaks. Numerous reconstruction methods exist, each with their own assumptions, types of data, and inference strategy. Thus, selecting a method can be difficult. Following PRISMA guidelines, we systematically reviewed the literature for methods combing epidemiological and genomic data in transmission tree reconstruction. We identified 22 methods from the 41 selected articles. We defined three families according to how genomic data was handled: a non-phylogenetic family, a sequential phylogenetic family, and a simultaneous phylogenetic family. We discussed methods according to the data needed as well as the underlying sequence mutation, within-host evolution, transmission, and case observation. In the non-phylogenetic family consisting of eight methods, pairwise genetic distances were estimated. In the phylogenetic families, transmission trees were inferred from phylogenetic trees either simultaneously (nine methods) or sequentially (five methods). While a majority of methods (17/22) modeled the transmission process, few (8/22) took into account imperfect case detection. Within-host evolution was generally (7/8) modeled as a coalescent process. These practical and theoretical considerations were highlighted in order to help select the appropriate method for an outbreak.
PubMed: 35215195
DOI: 10.3390/pathogens11020252 -
Transfusion Jan 2018Incentives are often used to enhance the effectiveness of recruitment and retention campaigns targeting blood donors. However, the degree to which incentives succeed in... (Review)
Review
BACKGROUND
Incentives are often used to enhance the effectiveness of recruitment and retention campaigns targeting blood donors. However, the degree to which incentives succeed in attracting and facilitating repeat donation is unclear. A systematic literature review, following PRISMA guidelines, investigated the existing empirical evidence regarding the use of monetary and nonmonetary incentives within blood donation.
STUDY DESIGN AND METHODS
A comprehensive search of relevant databases identified a total of 71 papers for inclusion in the review for defining and operationalizing incentives (Objective 1), of which nine papers empirically investigated attitudes toward incentives (Objective 2), 31 papers investigated the impact on blood donation behavior (Objective 3), and eight papers investigated the impact on blood safety (Objective 4).
RESULTS
Overall, research into the use of incentives in blood donation is limited, characterized by comparatively few studies, predominantly focused on whole blood donors, that are confounded by current operating context (paid or voluntary). No incentive has been identified that all segments of the nondonor and donor panel report positive attitudes toward, that has a positive impact on behavior, and that has no negative impact on blood safety. Certain incentives (i.e., discounts, tickets, gifts, and paid time off work) have the strongest evidence base for potential inclusion within voluntary nonremunerated (VNR) donation systems.
CONCLUSION
Due to the limited nature of the existing literature (particularly for apheresis donors) and inconsistencies observed within the results, additional research investigating the likely impact of introducing (or removing) monetary or nonmonetary incentives in VNR donor recruitment or retention is essential.
Topics: Blood Donors; Blood Safety; Humans; Motivation; Program Evaluation; Remuneration; Volunteers
PubMed: 29106732
DOI: 10.1111/trf.14387 -
BMC Medicine Sep 2015Achieving adequate antimalarial drug exposure is essential for curing malaria. Day 7 blood or plasma lumefantrine concentrations provide a simple measure of drug... (Meta-Analysis)
Meta-Analysis Review
Artemether-lumefantrine treatment of uncomplicated Plasmodium falciparum malaria: a systematic review and meta-analysis of day 7 lumefantrine concentrations and therapeutic response using individual patient data.
BACKGROUND
Achieving adequate antimalarial drug exposure is essential for curing malaria. Day 7 blood or plasma lumefantrine concentrations provide a simple measure of drug exposure that correlates well with artemether-lumefantrine efficacy. However, the 'therapeutic' day 7 lumefantrine concentration threshold needs to be defined better, particularly for important patient and parasite sub-populations.
METHODS
The WorldWide Antimalarial Resistance Network (WWARN) conducted a large pooled analysis of individual pharmacokinetic-pharmacodynamic data from patients treated with artemether-lumefantrine for uncomplicated Plasmodium falciparum malaria, to define therapeutic day 7 lumefantrine concentrations and identify patient factors that substantially alter these concentrations. A systematic review of PubMed, Embase, Google Scholar, ClinicalTrials.gov and conference proceedings identified all relevant studies. Risk of bias in individual studies was evaluated based on study design, methodology and missing data.
RESULTS
Of 31 studies identified through a systematic review, 26 studies were shared with WWARN and 21 studies with 2,787 patients were included. Recrudescence was associated with low day 7 lumefantrine concentrations (HR 1.59 (95% CI 1.36 to 1.85) per halving of day 7 concentrations) and high baseline parasitemia (HR 1.87 (95% CI 1.22 to 2.87) per 10-fold increase). Adjusted for mg/kg dose, day 7 concentrations were lowest in very young children (<3 years), among whom underweight-for-age children had 23% (95% CI -1 to 41%) lower concentrations than adequately nourished children of the same age and 53% (95% CI 37 to 65%) lower concentrations than adults. Day 7 lumefantrine concentrations were 44% (95% CI 38 to 49%) lower following unsupervised treatment. The highest risk of recrudescence was observed in areas of emerging artemisinin resistance and very low transmission intensity. For all other populations studied, day 7 concentrations ≥200 ng/ml were associated with >98% cure rates (if parasitemia <135,000/μL).
CONCLUSIONS
Current artemether-lumefantrine dosing recommendations achieve day 7 lumefantrine concentrations ≥200 ng/ml and high cure rates in most uncomplicated malaria patients. Three groups are at increased risk of treatment failure: very young children (particularly those underweight-for-age); patients with high parasitemias; and patients in very low transmission intensity areas with emerging parasite resistance. In these groups, adherence and treatment response should be monitored closely. Higher, more frequent, or prolonged dosage regimens should now be evaluated in very young children, particularly if malnourished, and in patients with hyperparasitemia.
Topics: Antimalarials; Artemether; Artemisinins; Dose-Response Relationship, Drug; Drug Therapy, Combination; Ethanolamines; Fluorenes; Humans; Lumefantrine; Malaria, Falciparum; Recurrence; Treatment Failure
PubMed: 26381375
DOI: 10.1186/s12916-015-0456-7 -
JAMA Psychiatry Nov 2019This systematic review and meta-analysis is, to date, the first and most comprehensive to focus on the incidence of nonaffective psychoses among refugees. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
This systematic review and meta-analysis is, to date, the first and most comprehensive to focus on the incidence of nonaffective psychoses among refugees.
OBJECTIVE
To assess the relative risk (RR) of incidence of nonaffective psychosis in refugees compared with the RR in the native population and nonrefugee migrants.
DATA SOURCES
PubMed, PsycINFO, and Embase databases were searched for studies from January 1, 1977, to March 8, 2018, with no language restrictions (PROSPERO registration No. CRD42018106740).
STUDY SELECTION
Studies conducted in Denmark, Sweden, Norway, and Canada were selected by multiple independent reviewers. Inclusion criteria were (1) observation of refugee history in participants, (2) assessment of effect size and spread, (3) adjustment for sex, (4) definition of nonaffective psychosis according to standardized operationalized criteria, and (5) comparators were either nonrefugee migrants or the native population. Studies observing ethnic background only, with no explicit definition of refugee status, were excluded.
DATA EXTRACTION AND SYNTHESIS
The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed for extracting data and assessing data quality and validity as well as risk of bias of included studies. A random-effects model was created to pool the effect sizes of included studies.
MAIN OUTCOMES AND MEASURES
The primary outcome, formulated before data collection, was the pooled RR in refugees compared with the nonrefugee population.
RESULTS
Of the 4358 screened articles, 9 studies (0.2%) involving 540 000 refugees in Denmark, Sweden, Norway, and Canada were included in the analyses. The RR for nonaffective psychoses in refugees was 1.43 (95% CI, 1.00-2.05; I2 = 96.3%) compared with nonrefugee migrants. Analyses that were restricted to studies with low risk of bias had an RR of 1.39 (95% CI, 1.23-1.58; I2 = 0.0%) for refugees compared with nonrefugee migrants, 2.41 (95% CI, 1.51-3.85; I2 = 96.3%) for refugees compared with the native population, and 1.92 (95% CI, 1.02-3.62; I2 = 97.0%) for nonrefugee migrants compared with the native group. Exclusion of studies that defined refugee status not individually but only by country of origin resulted in an RR of 2.24 (95% CI, 1.12-4.49; I2 = 96.8%) for refugees compared with nonrefugee migrants and an RR of 3.26 (95% CI, 1.87-5.70; I2 = 97.6%) for refugees compared with the native group. In general, the RR of nonaffective psychosis was increased in refugees and nonrefugee migrants compared with the native population.
CONCLUSIONS AND RELEVANCE
Refugee experience appeared to be an independent risk factor in developing nonaffective psychosis among refugees in Denmark, Sweden, Norway, and Canada. These findings suggest that applying the conclusions to non-Scandinavian countries should include a consideration of the characteristics of the native society and its specific interaction with the refugee population.
Topics: Canada; Denmark; Humans; Incidence; Mental Health; Norway; Psychotic Disorders; Refugees; Risk; Sweden
PubMed: 31411649
DOI: 10.1001/jamapsychiatry.2019.1937 -
The Journal of the American Academy of... Apr 2021The term "outpatient" has a variety of meanings regarding the location of arthroplasty and the duration of stay postoperatively. The purpose of this systematic review...
INTRODUCTION
The term "outpatient" has a variety of meanings regarding the location of arthroplasty and the duration of stay postoperatively. The purpose of this systematic review was to evaluate the literature and more accurately define the term "outpatient."
METHODS
A PubMed search (2014 to 2019) using the terms "outpatient AND arthroplasty" identified 76 studies; 35 studies that met the inclusion criteria were assessed to determine the definition of "outpatient." The level of evidence, type of arthroplasty, location of surgery (hospital or ambulatory surgery center [ASC]), approach used for hip arthroplasty, number of patients, number of surgeons, and length of time the patients were kept at the location after surgery were evaluated.
RESULTS
Arthroplasties analyzed were total hip (11), total knee (seven), unicompartmental knee (five), and hip and knee (12). Only 16.8% of surgeries defined as outpatient hip or knee arthroplasty were done in a freestanding ASC, and 44.2% of patients defined as outpatients were kept overnight for the 23-hour observation.
DISCUSSION
We propose "DASH" (Discharge from ASC to Home) as a new term to define arthroplasties done in an outpatient setting with the patient discharged home the same day.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Knee Joint; Outpatients; Patient Discharge
PubMed: 32925385
DOI: 10.5435/JAAOS-D-19-00636 -
Journal of Virus Eradication Sep 2023Understanding the clinical potency of latency-reversing agents (LRAs) on the HIV-1 reservoir is useful to deploy future strategies. This systematic review evaluated the... (Review)
Review
INTRODUCTION
Understanding the clinical potency of latency-reversing agents (LRAs) on the HIV-1 reservoir is useful to deploy future strategies. This systematic review evaluated the effects of LRAs in human intervention studies.
METHODS
A literature search was performed using medical databases focusing on studies with adults living with HIV-1 receiving LRAs. Eligibility criteria required participants from prospective clinical studies, a studied compound hypothesised as LRA, and reactivation or tolerability assessments. Relevant demographical data, LRA reactivation capacity, reservoir size, and adverse events were extracted. A study quality assessment with analysis of bias was performed by RoB 2 and ROBINS-I tools. The primary endpoints were HIV-1 reservoir reactivation after LRA treatment quantified by cell-associated unspliced HIV-1 RNA, and LRA tolerability defined by adverse events. Secondary outcomes were reservoir size and the effect of LRAs on analytical treatment interruption (ATI) duration.
RESULTS
After excluding duplicates, 5182 publications were screened. In total 45 publications fulfilled eligibility criteria including 26 intervention studies and 16 randomised trials. The risk of bias was evaluated as high. Chromatin modulators were the main investigated LRA class in 24 studies. Participants were mostly males (90.1%). Where reported, HIV-1 subtype B was most frequently observed. Reactivation after LRA treatment occurred in 78% of studies and was observed with nearly all chromatin modulators. When measured, reactivation mostly occurred within 24 h after treatment initiation. Combination LRA strategies have been infrequently studied and were without synergistic reactivation. Adverse events, where reported, were mostly low grade, yet occurred frequently. Seven studies had individuals who discontinued LRAs for related adverse events. The reservoir size was assessed by HIV-1 DNA in 80% of studies. A small decrease in reservoir was observed in three studies on immune checkpoint inhibitors and the histone deacetylase inhibitors romidepsin and chidamide. No clear effect of LRAs on ATI duration was observed.
CONCLUSION
This systematic review provides a summary of the reactivation of LRAs used in current clinical trials whilst highlighting the importance of pharmacovigilance. Highly heterogeneous study designs and underrepresentation of relevant patient groups are to be considered when interpreting these results. The observed reactivation did not lead to cure or a significant reduction in the size of the reservoir. Finding more effective LRAs by including well-designed studies are needed to define the required reactivation level to reduce the HIV-1 reservoir.
PubMed: 37663575
DOI: 10.1016/j.jve.2023.100342