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Prehospital and Disaster Medicine Dec 2016Introduction Disaster and humanitarian responders are at-risk of experiencing a wide range of physical and psychological health conditions, from minor injuries to... (Review)
Review
UNLABELLED
Introduction Disaster and humanitarian responders are at-risk of experiencing a wide range of physical and psychological health conditions, from minor injuries to chronic mental health problems and fatalities. This article reviews the current literature on the major health outcomes of responders to various disasters and conflicts in order to better inform individuals of the risks and to inform deploying agencies of the health care needs of responders.
METHODS
In March 2014, an EMBASE search was conducted using pre-defined search criteria. Two reviewers screened the resultant 2,849 abstracts and the 66 full-length manuscripts which are included in the review.
RESULTS
The majority of research on health outcomes of responders focused on mental health (57 of 66 articles). Posttraumatic stress disorder (PTSD) and depression were the most studied diagnoses with prevalence of PTSD ranging from 0%-34% and depression from 21%-53%. Physical health outcomes were much less well-studied and included a wide range of environmental, infectious, and traumatic conditions such as heat stroke, insect bites, dermatologic, gastrointestinal, and respiratory diseases, as well as burns, fractures, falls, and other traumatic injuries.
CONCLUSIONS
The prevalence of mental health disorders in responders may vary more and be higher than previously suggested. Overall health outcomes of responders are likely poorly monitored and under-reported. Improved surveillance systems and risk mitigation strategies should be employed in all disaster and conflict responses to better protect individual responders. Garbern SC , Ebbeling LG , Bartels SA . A systematic review of health outcomes among disaster and humanitarian responders. Prehosp Disaster Med. 2016;31(6):635-642.
Topics: Altruism; Disasters; Female; Humans; Male; Outcome Assessment, Health Care; Volunteers
PubMed: 27641075
DOI: 10.1017/S1049023X16000832 -
Early Intervention in Psychiatry Dec 2017The aim of this study was to analyse the effect of age at onset on the long-term clinical, social and global outcomes of schizophrenia through a systematic review and a... (Meta-Analysis)
Meta-Analysis Review
The aim of this study was to analyse the effect of age at onset on the long-term clinical, social and global outcomes of schizophrenia through a systematic review and a meta-analysis. Original studies were searched from Web of Science, PsycINFO, Pubmed and Scopus, as well as manually. Naturalistic studies with at least a 2-year follow-up were included. Of the 3509 search results, 81 articles fulfilled the inclusion criteria. The meta-analysis was performed in Stata as a random-effect analysis with correlation coefficients between age at onset and the outcomes (categorized into remission, relapse, hospitalization, positive symptoms, negative symptoms, total symptoms, general clinical outcome, employment, social/occupational functioning and global outcome). There was a statistically significant (P < .05) correlation between younger age at onset and more hospitalizations (number of studies, n = 9; correlation, r = 0.17; 95% confidence interval, CI 0.09-0.25), more negative symptoms (n = 7; r = 0.14; 95% CI 0.01-0.27), more relapses (n = 3; r = 0.11; 95% CI 0.02-0.20), poorer social/occupational functioning (n = 12; r = 0.15; 95% CI 0.05-0.25) and poorer global outcome (n = 13; r = 0.14; 95% CI 0.07-0.22). Other relationships were not significant. This was the first systematic review of the effects of age at onset on the long-term outcomes of schizophrenia. The results show that age at onset has a small, but significant impact on some of the outcomes of schizophrenia.
Topics: Age of Onset; Humans; Outcome Assessment, Health Care; Schizophrenia
PubMed: 28449199
DOI: 10.1111/eip.12412 -
Patient Education and Counseling Jun 2016The management of type 2 diabetes (T2D) requires complex behavior changes and treatment regimens to achieve optimal outcomes. Interventions including motivational... (Review)
Review
OBJECTIVES
The management of type 2 diabetes (T2D) requires complex behavior changes and treatment regimens to achieve optimal outcomes. Interventions including motivational interviewing (MI) have been explored to help patients achieve behavior change and outcomes; this study aimed to explore evidence and gaps in the literature for MI interventions and outcomes in adults with T2D.
METHODS
A modified Cochrane method structured the search strategy among databases including MEDLINE, CINAHL, PsycINFO, and others. Inclusion criteria included randomized controlled trials that assessed the effects of MI on behavior changeoutcomes and resultant clinical outcomes in adults with T2D.
RESULTS
Of the initial 159 studies identified, 14 were eligible for retention. Behavior targets in the retained studies included dietary changes, physical activity, smoking cessation, and alcohol reduction. MI had significant impact on some dietary behaviors and on weight loss. MI intervention structures were heterogeneous across studies; fidelity assessment was infrequent.
CONCLUSION
The effects of MI interventions on outcomes in T2D showed promising results for dietary behaviors. Clinical change outcomes from MI-based interventions were most favorable for weight management in T2D.
PRACTICE IMPLICATIONS
Behavior-specific MI interventions may positively influence study outcomes. Assessment of MI intervention fidelity will enhance treatment integrity and claims for validity.
Topics: Behavior Therapy; Diabetes Mellitus, Type 2; Humans; Motivational Interviewing; Outcome Assessment, Health Care; Randomized Controlled Trials as Topic
PubMed: 26699083
DOI: 10.1016/j.pec.2015.11.022 -
Headache Feb 2021To review the acute migraine clinical trial literature and provide a summary of the endpoints and outcomes used in such trials.
BACKGROUND/OBJECTIVE
To review the acute migraine clinical trial literature and provide a summary of the endpoints and outcomes used in such trials.
METHOD
A systematic literature review, following a prespecified (but unregistered) protocol developed to adhere to recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, was conducted to understand endpoints and outcomes used in acute migraine clinical trials. Predefined terms were searched in PubMed to locate clinical trials assessing acute migraine treatments. Final database search was conducted on October 28, 2019. Identified publications were reviewed against established inclusion and exclusion criteria to determine eligibility. Data related to general trial design characteristics, sample characteristics, and outcomes and endpoints reported in each publication were extracted from eligible publications. Descriptive summaries of design features, sample characteristics, and the endpoints and outcomes employed across publications were constructed. Outcomes are presented within four broad categories: (a) pain-related outcomes (pain relief, pain freedom, etc.), (b) associated symptoms (nausea, photophobia, etc.), (c) disability/impairment/impact, (d) patient-reported outcome measures (PROMs, general health and migraine/headache-specific). Endpoint types were categorized within three broad categories: (a) change from baseline, (b) fixed timepoint, and (c) responder definitions (e.g., 50% reduction). This review focuses on a subset of recent (1998 or later) randomized and blinded publications evaluating drugs or medical devices.
RESULTS
Of 1567 publications found through the initial search and reference section reviews, 705 met criteria and were included for data extraction. Inter-rater agreement kappas for the descriptive variables extracted had an average kappa estimate of 0.86. The more recent, randomized and blinded pharmaceutical and medical device article subset includes 451 publications (451/705, 63.9%). The outcomes and endpoints varied substantially across trials, ranging from pain relief or freedom, freedom from or relief of migraine-associated symptoms, use of acute or rescue medication, and various other PROMs, including measures of satisfaction and quality of life. Within the recent randomized and blinded article subset, most articles examined ≥1 pain-related outcome (430/451, 95.3%). Of the publications that examined pain, outcomes most often used were pain relief (310/430, 72.1%), pain freedom (279/430, 64.9%), and headache recurrence (202/43,051, 47.0%) or rescue medication use (278/430, 64.9%). Associated symptoms such as nausea, photophobia, and phonophobia were more frequently measured (299/451, 66.3%) compared to most bothersome associated symptom (16/451, 3.5%), as it is a new addition to regulatory guidance. Over one-third of eligible publications examined disability/impairment (186/451, 41.2%) or ≥1 PROM (159/451, 35.3%). The definition of the endpoints used (e.g., change from baseline, fixed timepoint comparisons, categorization of "responders" to treatment based on wide variety of "responder definitions") also differed substantially across publications.
CONCLUSION
Acute migraine clinical trials exhibit a large amount of variability in outcomes and endpoints used, in addition to the variability in how outcomes and endpoints were used from trial-to-trial. There were some common elements across trials that align with guidance from the International Headache Society, the Food and Drug Administration and other regulatory agencies (e.g., assessing pain and associated symptoms, 2-hour post-treatment). Other aspects of acute migraine clinical trial design did not follow guidance. For example, multi-item PROMs intended to measure constructs (e.g., scales) are rarely used, the use of pain-related outcomes is inconsistent, some associated symptom assessments are idiosyncratic, and the timing of the assessment of primary endpoints is variable. The development of a core set of outcomes and endpoints for acute migraine clinical trials that are patient-centered and statistically robust could improve the conduct of individual trials, facilitate cross-trial comparisons, and better support informed treatment decisions by healthcare professionals and patients.
Topics: Acute Disease; Clinical Trials as Topic; Humans; Migraine Disorders; Outcome Assessment, Health Care
PubMed: 33611818
DOI: 10.1111/head.14067 -
BMC Palliative Care May 2017As in other areas of health delivery, there is a need to ensure that end-of-life care is guided by patient centred research. A systematic review was undertaken to... (Review)
Review
BACKGROUND
As in other areas of health delivery, there is a need to ensure that end-of-life care is guided by patient centred research. A systematic review was undertaken to examine the quantity and quality of data-based research aimed at improving the (a) processes and (b) outcomes associated with delivering end-of-life care in hospital settings.
METHODS
Medline, EMBASE and Cochrane databases were searched between 1995 and 2015 for data-based papers. Eligible papers were classified as descriptive, measurement or intervention studies. Intervention studies were categorised according to whether the primary aim was to improve: (a) end of life processes (i.e. end-of-life documentation and discussions, referrals); or (b) end-of-life outcomes (i.e. perceived quality of life, health status, health care use, costs). Intervention studies were assessed against the Effective Practice and Organisation of Care methodological criteria for research design, and their effectiveness examined.
RESULTS
A total of 416 papers met eligibility criteria. The number increased by 13% each year (p < 0.001). Most studies were descriptive (n = 351, 85%), with fewer measurement (n = 17) and intervention studies (n = 48; 10%). Only 18 intervention studies (4%) met EPOC design criteria. Most reported benefits for end-of-life processes including end-of-life discussions and documentation (9/11). Impact on end-of-life outcomes was mixed, with some benefit for psychosocial distress, satisfaction and concordance in care (3/7).
CONCLUSION
More methodologically robust studies are needed to evaluate the impact of interventions on end-of-life processes, including whether changes in processes translate to improved end-of-life outcomes. Interventions which target both the patient and substitute decision maker in an effort to achieve these changes would be beneficial.
Topics: Humans; Outcome Assessment, Health Care; Program Evaluation; Quality of Health Care; Research; Terminal Care
PubMed: 28526095
DOI: 10.1186/s12904-017-0204-1 -
Social Psychiatry and Psychiatric... Sep 2018To conduct a systematic review and meta-analysis to examine the strength of associations between social network size and clinical and functional outcomes in... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To conduct a systematic review and meta-analysis to examine the strength of associations between social network size and clinical and functional outcomes in schizophrenia.
METHOD
Studies were identified from a systematic search of electronic databases (EMBASE, Medline, PsycINFO, and Web of Science) from January 1970 to June 2016. Eligible studies included peer-reviewed English language articles that examined associations between a quantitative measure of network size and symptomatic and/or functional outcome in schizophrenia-spectrum diagnoses.
RESULTS
Our search yielded 16 studies with 1,929 participants. Meta-analyses using random effects models to calculate pooled effect sizes (Hedge's g) found that smaller social network size was moderately associated with more severe overall psychiatric symptoms (N = 5, n = 467, g = - 0.53, 95% confidence interval (CI) = - 0.875, - 0.184, p = 0.003) and negative symptoms (N = 8, n = 577, g = - 0.75, 95% CI = - 0.997, - 0.512, p = 0.000). Statistical heterogeneity was observed I = 63.04%; I = 35.75%,) which could not be explained by low-quality network measures or sample heterogeneity in sensitivity analyses. There was no effect for positive symptoms (N = 7, n = 405, g = - 0.19, 95% CI = 0.494, 0.110, p = 0.213) or social functioning (N = 3, n = 209, g = 0.36, 95% CI = - 0.078, 0.801, p = 0.107). Narrative synthesis suggested that larger network size was associated with improved global functioning, but findings for affective symptoms and quality of life were mixed.
CONCLUSION
Psychosocial interventions which support individuals to build and maintain social networks may improve outcomes in schizophrenia. The review findings are cross-sectional and thus causal direction cannot be inferred. Further research is required to examine temporal associations between network characteristics and outcomes in schizophrenia and to test theoretical models relating to explanatory or mediating mechanisms.
Topics: Humans; Outcome Assessment, Health Care; Psychotherapy; Psychotic Disorders; Schizophrenia; Social Support
PubMed: 29951929
DOI: 10.1007/s00127-018-1552-8 -
Neuropsychological Rehabilitation Oct 2006A systematic review of the evidence on substance misuse prevalence in patients with traumatic brain injury (TBI) and outcomes associated with this population is... (Review)
Review
A systematic review of the evidence on substance misuse prevalence in patients with traumatic brain injury (TBI) and outcomes associated with this population is presented. Building upon an earlier review of the area by Corigan (1995), this review is limited to research published between 1994 and 2004. Psycinfo and Medline abstract databases were searched for English-language publications citing research from Western countries on the epidemiology and outcomes of adult TBI patients (aged 15 years or older). The majority of reviewed studies were undertaken in the USA and the investigation foci and methods used were multifarious, constraining the generalisation of the review findings. Prevalence for alcohol intoxication at time of injury in the review was found to be almost identical to that in Corrigan's review: 37-51% and 36-51%, respectively. Pre-TBI history of alcohol misuse was found to be less prevalent in the present as opposed to Corrigan's review: 37-51% and 55-66%, respectively. Outcome findings were mixed (also found by Corrigan), but mainly in the expected direction of poorer outcomes (neurological, medical, neuropsychological, and functional) in patients with pre-TBI substance misuse. Further research and implications for services are outlined.
Topics: Brain Injuries; Databases as Topic; Disability Evaluation; Humans; Neuropsychological Tests; Outcome Assessment, Health Care; Prevalence; Research; Substance-Related Disorders
PubMed: 16952892
DOI: 10.1080/09602010500231875 -
Inquiry : a Journal of Medical Care... 2019The aim of this systematic scoping review was to identify and analyze indicators that address implementation quality or success in health care services and to deduce...
The aim of this systematic scoping review was to identify and analyze indicators that address implementation quality or success in health care services and to deduce recommendations for further indicator development. This review was conducted according to the Joanna Briggs Manual and the PRISMA Statement. CINAHL, EMBASE, MEDLINE, and PsycINFO were searched. Studies or reviews published between August 2008 and 2018 that reported monitoring of the quality or the implementation success in health care services by using indicators based on continuous variables and proportion-based, ratio-based, standardized ratio-based, or rate-based variables or indices were included. The records were screened by title and abstract, and the full-text articles were also independently double-screened by 3 reviewers for eligibility. In total, 4376 records were identified that resulted in 10 eligible studies, including 67 implementation indicators. There was heterogeneity regarding the theoretical backgrounds, designs, objectives, settings, and implementation indicators among the publications. None of the indicators addressed the implementation outcomes of appropriateness or sustainability. was identified as an additional outcome. Achieving consensus in framing implementation outcomes and indicators will be a new challenge in health services research. Considering the new debates regarding health care complexity, the further development of indicators based on complementary qualitative and quantitative approaches is needed.
Topics: Delivery of Health Care; Health Services; Health Services Research; Humans; Outcome Assessment, Health Care; Qualitative Research
PubMed: 31347418
DOI: 10.1177/0046958019861257 -
International Journal of Nursing... Jan 2020Nursing classification systems are used to report nursing practices and maintain a unified documentation language. Nursing interventions classification (NIC) and nursing...
BACKGROUND
Nursing classification systems are used to report nursing practices and maintain a unified documentation language. Nursing interventions classification (NIC) and nursing outcomes classification (NOC) are among the recognized terminology systems.
AIM
To examine the extent of reporting NIC/NOC in nursing research.
DESIGN
A systematic review following PRISMA guidelines.
DATA SOURCES
A literature search in three electronic databases was performed.
RESULTS
A total of (18) articles were included. Nine studies were conducted to describe the commonly used NIC/NOC, six studies validated the effectiveness of classification systems, and two studies compared different nursing classification systems.
CONCLUSION
The available evidence is limited by the quality of the studies. We recommend examining the use of NIC/NOC in nursing documentation using an experimental design.
Topics: Nursing Records; Nursing Research; Outcome Assessment, Health Care; Standardized Nursing Terminology
PubMed: 31743604
DOI: 10.1111/2047-3095.12265 -
International Journal of Nursing Studies May 2019Despite growing recognition of person-centered care as an essential component of quality care, little is known about how person-centered care can be implemented in the...
BACKGROUND
Despite growing recognition of person-centered care as an essential component of quality care, little is known about how person-centered care can be implemented in the provision of care services and how it is empirically related to outcomes in the rehabilitation settings.
OBJECTIVES
To investigate the extent of implementation of the person-centered care in rehabilitation practices, as well as its effects on relevant outcomes.
DESIGN
Systematic literature review.
DATA SOURCES
Six electronic databases (PubMed, Web of Science, CINAHL, Scopus, PsycARTICLES, and Cochrane library) were searched for articles published between January 2000 and January 2018.
METHODS
Based on the inclusion criteria, quantitative studies that examined person-centered rehabilitation interventions and relevant outcomes were included. Study quality assessment, data extraction, and synthesis were performed.
RESULTS
For this systematic review, 17 eligible studies were included and most studies were rated as low-quality. The selected studies were varied concerning the use of the term person-centered care, research design, target population, sample size, setting, intervention, and outcome measures. The most examined interventions in this review were focused on goal setting and shared-decision making processes based on the client-centered approach. The implementation of those interventions varied considerably. Results showed mixed relationships between person-centered care and the outcomes examined in the studies although there was strong evidence regarding the positive effects of person-centered care on occupational performance and rehabilitation satisfaction.
CONCLUSIONS
Person-centered care has been increasingly advocated in rehabilitation settings. However, we found that true person-centered care was not fully implemented in rehabilitation practices. Moreover, it appears that person-centered care could positively affect rehabilitation outcomes, such as significant improvements in functional performance and quality of life, however, evidence about these positive effects of person-centered care is not sufficient. More research with rigorous designs is needed.
Topics: Humans; Outcome Assessment, Health Care; Patient-Centered Care; Quality of Health Care; Rehabilitation; Treatment Outcome
PubMed: 30870614
DOI: 10.1016/j.ijnurstu.2019.02.012