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Population Health Management Jun 2019Emergency medical services (EMS) in the United States are frequently used for nonurgent medical needs. Use of 911 and the emergency department (ED) for primary...
Emergency medical services (EMS) in the United States are frequently used for nonurgent medical needs. Use of 911 and the emergency department (ED) for primary care-treatable conditions is expensive, inefficient, and undesirable for patients and providers. The objective is to describe the outcomes from community paramedicine (CP) and mobile integrated health care (MIH) interventions related to the Quadruple Aim. Three electronic databases were searched for peer-review literature on CP-MIH interventions in the United States. Eight articles reporting data from 7 interventions were included. Four studies reported high levels of patient satisfaction, and only 3 measured health outcomes. No study reported provider satisfaction measures. Reducing ED and inpatient utilization were the most common study outcomes, and programs generally were successful at reducing utilization. With reduced utilization, costs should be reduced; however, most studies did not quantify savings. Future studies should conduct economic analyses that not only compare the intervention to traditional EMS services, but also measure potential cost savings to the EMS agencies running the intervention. Most cost savings from reduced utilization will be to insurance companies and patients, but more efficient use of EMS agencies' resources could lead to cost savings that could offset intervention implementation costs. The other 3 aims (health, patient satisfaction, and provider satisfaction) were reported inconsistently in these studies and need to be addressed further. Given the small number of heterogeneous studies reviewed, the potential for CP-MIH interventions to comprehensively address the Quadruple Aim is still unclear, and more research on these programs is needed.
Topics: Delivery of Health Care, Integrated; Emergency Medical Services; Humans; Mobile Health Units; Patient Satisfaction; United States
PubMed: 30614761
DOI: 10.1089/pop.2018.0114 -
Journal of Applied Research in... Mar 2021Microenterprises are very small businesses requiring little capital and can be an employment pathway for people with intellectual disabilities. This systematic review... (Review)
Review
BACKGROUND
Microenterprises are very small businesses requiring little capital and can be an employment pathway for people with intellectual disabilities. This systematic review aims to identify the facilitators, barriers and outcomes from microenterprise.
METHOD
Web of Science, Scopus, EconLit, PsycINFO and ProQuest were searched to identify peer-reviewed studies on microenterprises owned by people with intellectual disability published up to and including 1 October 2019.
RESULTS
A total of 1080 papers were independently screened by two reviewers. Six papers met the inclusion criteria. Barriers included lack of access to business expertise and resources, and the tension between growing microenterprises and maintaining eligibility for welfare payments. Formal and informal supports were key facilitators. Outcomes experienced included additional income, skills development, increased confidence and engagement in meaningful activities.
CONCLUSION
Additional research is required to develop an evidence base which may support investment in this employment pathway, making microenterprise more accessible to people with intellectual disabilities.
Topics: Delivery of Health Care; Employment; Humans; Intellectual Disability; Peer Review
PubMed: 33280214
DOI: 10.1111/jar.12836 -
The Journal of Nutrition, Health & Aging Feb 2016Early intervention with nutritional support has been found to stop weight loss in older people malnourished or at risk of malnutrition. Enriched food could be a more... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Early intervention with nutritional support has been found to stop weight loss in older people malnourished or at risk of malnutrition. Enriched food could be a more attractive alternative to improve meals, than conventional oral nutritional supplements.
AIMS
To determine the effectiveness of food-based fortification to prevent risk of malnutrition in elderly patients in community or institutionalized elderly patients.
METHODS
A systematic review was conducted of randomized controlled trials, quasi-experimental, and interrupted time series including a longitudinal analysis.
PARTICIPANTS
Elderly patients who are institutionalized, hospitalized or community-dwelling, with a minimum average age of 65 years. All type of patient groups, with the exception of people in critical care, or those who were recovering from cancer treatment, were included.
INTERVENTION
Studies had to compare food-based fortification against alternatives. Studies that used oral nutritional supplementation such as commercial sip feeds, vitamin or mineral supplements were excluded. The search was conducted in Cochrane, CINAHL, PubMed, EMBASE, LILACS, and Cuiden. An independent peer review was carried out.
RESULTS
From 1011 studies obtained, 7 were included for the systematic review, with 588 participants. It was possible to perform meta-analysis of four studies that provided results on caloric and protein intake. Food-based fortification yielded positive results in the total amount of ingested calories and protein. Nevertheless, due to the small number of participants and the poor quality of some studies, further high quality studies are required to provide reliable evidence.
IMPLICATIONS FOR PRACTICE
Despite the limited evidence, due to their simplicity, low cost, and positive results in protein and calories intake, simple dietary interventions based on the food-based fortification or densification with protein or energy of the standard diet could be considered in patients at risk of malnutrition.
Topics: Aged; Aged, 80 and over; Dietary Proteins; Dietary Supplements; Energy Intake; Female; Food, Fortified; Health Services for the Aged; Humans; Male; Malnutrition; Nutritional Status
PubMed: 26812514
DOI: 10.1007/s12603-015-0591-z -
BMJ Open Jul 2014Venous thromboembolism (VTE) is a major disease associated with short-term and long-term morbidity and mortality. Patients with a VTE provoked by surgery or... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Venous thromboembolism (VTE) is a major disease associated with short-term and long-term morbidity and mortality. Patients with a VTE provoked by surgery or immobilisation are at low risk of recurrence and do not require long-term anticoagulation; those with a VTE and metastatic cancer are at high risk of recurrence and require lifetime thromboprophylaxis. In those at intermediate risk of recurrence, it remains controversial whether prolonging anticoagulation and thus incurring treatment burden and bleeding risk is warranted.
METHODS AND ANALYSIS
We will conduct a systematic review and meta-analysis of randomised controlled trials enrolling patients with VTE at intermediate risk of recurrence and evaluating short-term anticoagulation (12 weeks to 9 months initial therapy) versus longer term anticoagulation (at least 6 months additional anticoagulation beyond the course of treatment in the shorter arm). Anticoagulation could consist of vitamin K antagonists or new oral anticoagulants. Outcomes of interest include recurrent non-fatal thrombosis (deep venous thrombosis and pulmonary embolism), major non-fatal bleeding and mortality. We will systematically search CINAHL, EMBASE, MEDLINE and the Cochrane Central Registry of Controlled Trials. Teams of two reviewers will, independently and in duplicate, screen titles and abstracts and complete full text reviews to determine eligibility, and subsequently abstract data and assess risk of bias in eligible trials. We will conduct meta-analyses to establish the effect of short-term versus long-term anticoagulation on the outcomes of interest and evaluate confidence in estimates (quality of evidence) using the GRADE (grading of recommendations, assessment, development and evaluation) approach.
ETHICS AND DISSEMINATION
Our review will facilitate evidence-based management of patients with unprovoked or recurrent VTE. For purposes of privacy and confidentiality, the systematic review will be limited to studies with deidentified data. The study will be disseminated by peer-review publication and conference presentation.
TRIAL REGISTRATION NUMBER
PROSPERO (CRD42014007620).
Topics: Anticoagulants; Humans; Recurrence; Time Factors; Venous Thromboembolism
PubMed: 24996916
DOI: 10.1136/bmjopen-2014-005674 -
International Journal of Molecular... Oct 2022Environmental Enrichment (EE) is based on the promotion of socio-environmental stimuli, which mimic favorable environmental conditions for the practice of physical... (Review)
Review
Environmental Enrichment (EE) is based on the promotion of socio-environmental stimuli, which mimic favorable environmental conditions for the practice of physical activity and health. The objective of the present systematic review was to evaluate the influence of EE on pro-and anti-inflammatory immune parameters, but also in cell activation related to the innate and acquired immune responses in the brain and peripheral tissues in rodents. Three databases [PubMed (2209 articles), Scopus (1154 articles), and Science Direct (1040 articles)] were researched. After applying the eligibility criteria, articles were selected for peer review, independently, as they were identified by September 2021. The protocol for this systematic review was registered in the PROSPERO. Of the 4417 articles found, 16 were selected for this systematic review. In the brain, EE promoted a reduction in proinflammatory cytokines and chemokines. In the blood, EE promoted a higher percentage of leukocytes, an increase in CD19+ B lymphocytes, and the proliferation of Natura Killer (NK cells). In the bone marrow, there was an increase in the number of CD27- and CD11b+ mature NK cells and a reduction in CD27- and CD11b+ immature Natural Killer cells. In conclusion, EE can be an immune modulation approach and plays a key role in the prevention of numerous chronic diseases, including cancer, that have a pro-inflammatory response and immunosuppressive condition as part of their pathophysiology.
Topics: Animals; Bone Marrow; Cytokines; Killer Cells, Natural; Rodentia
PubMed: 36233282
DOI: 10.3390/ijms231911986 -
Burns : Journal of the International... Mar 2018Randomized controlled clinical trials (CTs) are gold standard tools for assessing interventions. Although burn CTs have improved care, their status, publication...
BACKGROUND
Randomized controlled clinical trials (CTs) are gold standard tools for assessing interventions. Although burn CTs have improved care, their status, publication frequency, and publication quality are not known.
OBJECTIVES
(1) Characterize burn CTs by analyzing location, completion status, temporal trend, and funding sources. (2) Assess quality of trial reporting.
DATA SOURCES
CT records were obtained from ClinicalTrials.gov and WHO's CT Registry (searched May 2017). Publications were obtained from PubMed, Google Scholar, OVID MEDLINE, and ClinicalTrials.gov (searched June 2017).
PUBLICATION APPRAISAL
23-item rubric adapted from CONSORT and ICH E3 guidelines.
RESULTS
738 burn CTs were identified globally, of which majority were publically-funded (77%), ongoing (52%), and assessed behavioral, pharmacological, device-based, dietary-based, and biological/procedural interventions. Amongst the ended trials, 69 (28%) published their findings. Significantly fewer industry-funded trials published findings (14% vs 33% publically-funded). Quality of reporting was suboptimal, and most underreported categories were trial phase, severity, and sample size estimation.
LIMITATIONS
Incomplete, outdated, and non-registered CTs which are difficult to track.
CONCLUSIONS
Burn trials are proliferating in number, location, and interventions assessed. Only a small proportion are published and quality of reporting is suboptimal.
IMPLICATIONS OF KEY FINDINGS
Burn researchers should aim to register and report on all clinical trials regardless of outcome. Superior a priori design can reduce precocious termination and mandatory reporting of data fields can improve quality of reporting. Systematic review registration number: CRD42017068549.
Topics: Burns; Clinical Trials as Topic; Humans; Peer Review, Research; Periodicals as Topic; Registries; Research Report
PubMed: 29169699
DOI: 10.1016/j.burns.2017.11.001 -
Prenatal Diagnosis Sep 2017To systematically review clinical validation studies of massive parallel sequencing (MPS) technology in prenatal screening for trisomy 21 and to explore the potential... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To systematically review clinical validation studies of massive parallel sequencing (MPS) technology in prenatal screening for trisomy 21 and to explore the potential implementation strategies in China compared with those in developing countries.
METHODS
Searches of the Cochrane Library, Medline, EMBASE, Web of Science, Biosis Previews, and three major Chinese databases were performed to identify all the peer-reviewed articles published between 1 January 2011 and 15 October 2016. We also reviewed and discussed the potential challenges and risks in the future promotion of MPS technology in China compared with those in developing countries.
RESULTS
The weighted pooled sensitivity and specificity of MPS technology for the prenatal detection of trisomy 21 were 99.7% (95% CI 98.3-99.9%) and 100.0% (95% CI 99.9-100.0%), respectively, based on a meta-analysis of 44 included studies. An additional meta-analysis was conducted based on the 25 included studies that were performed in medical/genetic sequencing institutions in mainland China, showing a weighted pooled sensitivity and specificity of MPS technology as 99.5% (95% CI 98.7-99.8%) and 100% (95% CI 99.9-100%), respectively.
CONCLUSION
MPS technology offers effective screening performance for trisomy 21 but should be cautiously promoted due to its clinical limitations and challenges that stem from the ethics and business aspects. © 2017 John Wiley & Sons, Ltd.
Topics: China; DNA; Down Syndrome; Female; High-Throughput Nucleotide Sequencing; Humans; Peer Review; Pregnancy; Prenatal Diagnosis; Sensitivity and Specificity; Sequence Analysis, DNA
PubMed: 28686807
DOI: 10.1002/pd.5111 -
Journal of Palliative Medicine May 2019The state of palliative care research is closely linked to the development of palliative care services in a country or region. To systematically review the current...
The state of palliative care research is closely linked to the development of palliative care services in a country or region. To systematically review the current state of palliative care research in the Asia Pacific region and analyze its relationship with the performance of each country in the region on the Economist Intelligence Unit's 2015 Quality of Death Index. Systematic review and bibliographic analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol 2015 (PRISMA-P). The PubMed/MEDLINE, EMBASE, SCOPUS, CINAHL, and PsychiNFO databases were searched on February 4, 2018. One thousand six hundred sixty-seven articles were reviewed. Eighteen out of 32 countries in the region published research. Around 74.15% (1236) of the articles were produced by high-income countries. Research output (articles per 1 m population) was closely linked to country performance on the Economist Intelligence Unit's 2015 Quality of Death Index (adjusted 0.85). Palliative care research in the region is overwhelmingly focused on cancer (80.13% of articles reviewed). The most common themes of research were "palliative care service (24.45%)" and "clinical" (15.38%). Palliative care research in the region is growing but remains largely centered on the high-income countries, with many low- and middle-income countries having little published research output. Much work is required to drive research in these countries to generate the evidence required for the development of palliative care services. The emphasis on cancer in research also indicates that the needs of patients suffering from noncancer-related diseases may be neglected.
Topics: Asia; Bibliometrics; Biomedical Research; Developing Countries; Hospice and Palliative Care Nursing; Humans; Pacific Ocean; Palliative Care; Peer Review, Research; Publications
PubMed: 30570416
DOI: 10.1089/jpm.2018.0447 -
Journal of the American College of... Nov 2015As the US health care system transitions toward value-based reimbursement, there is an increasing need for metrics to quantify health care quality. Within radiology,... (Review)
Review
PURPOSE
As the US health care system transitions toward value-based reimbursement, there is an increasing need for metrics to quantify health care quality. Within radiology, many quality metrics are in use, and still more have been proposed, but there have been limited attempts to systematically inventory these measures and classify them using a standard framework. The purpose of this study was to develop an exhaustive inventory of public and private sector imaging quality metrics classified according to the classic Donabedian framework (structure, process, and outcome).
METHODS
A systematic review was performed in which eligibility criteria included published articles (from 2000 onward) from multiple databases. Studies were double-read, with discrepancies resolved by consensus. For the radiology benefit management group (RBM) survey, the six known companies nationally were surveyed. Outcome measures were organized on the basis of standard categories (structure, process, and outcome) and reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
RESULTS
The search strategy yielded 1,816 citations; review yielded 110 reports (29 included for final analysis). Three of six RBMs (50%) responded to the survey; the websites of the other RBMs were searched for additional metrics. Seventy-five unique metrics were reported: 35 structure (46%), 20 outcome (27%), and 20 process (27%) metrics. For RBMs, 35 metrics were reported: 27 structure (77%), 4 process (11%), and 4 outcome (11%) metrics. The most commonly cited structure, process, and outcome metrics included ACR accreditation (37%), ACR Appropriateness Criteria (85%), and peer review (95%), respectively.
CONCLUSIONS
Imaging quality metrics are more likely to be structural (46%) than process (27%) or outcome (27%) based (P < .05). As national value-based reimbursement programs increasingly emphasize outcome-based metrics, radiologists must keep pace by developing the data infrastructure required to collect outcome-based quality metrics.
Topics: Cost-Benefit Analysis; Diagnostic Imaging; Education, Medical, Continuing; Female; Humans; Male; Outcome Assessment, Health Care; Quality Assurance, Health Care; Radiology; Surveys and Questionnaires; United States
PubMed: 26372621
DOI: 10.1016/j.jacr.2015.06.038 -
Archives of Physical Medicine and... Feb 2017To systematically review (1) psychometric properties of criterion isokinetic dynamometry testing of muscle strength in persons with poststroke hemiplegia (PPSH); and (2)... (Review)
Review
OBJECTIVES
To systematically review (1) psychometric properties of criterion isokinetic dynamometry testing of muscle strength in persons with poststroke hemiplegia (PPSH); and (2) literature that compares muscle strength in patients poststroke with that in healthy controls assessed by criterion isokinetic dynamometry.
DATA SOURCES
A systematic literature search of 7 databases was performed.
STUDY SELECTION
Included studies (1) enrolled participants with definite poststroke hemiplegia according to defined criteria; (2) assessed muscle strength or power by criterion isokinetic dynamometry; (3) had undergone peer review; and (4) were available in English or Danish.
DATA EXTRACTION
The psychometric properties of isokinetic dynamometry were reviewed with respect to reliability, validity, and responsiveness. Furthermore, comparisons of strength between paretic, nonparetic, and comparable healthy muscles were reviewed.
DATA SYNTHESIS
Twenty studies covering 316 PPSH were included. High intraclass correlation coefficient (ICC) inter- and intrasession reliability was reported for isokinetic dynamometry, which was independent of the tested muscle group, contraction mode, and contraction velocity. Slightly higher ICC values were found for the nonparetic extremity. Standard error of the mean (SEM) values showed that a change of 7% to 20% was required for a real group change to take place for most muscle groups, with the knee extensors showing the smallest SEM% values. The muscle strength of paretic muscles showed deficits when compared with both healthy and nonparetic muscles, independent of muscle group, contraction mode, and contraction velocity. Nonparetic muscles only showed minor strength impairments when compared with healthy muscles.
CONCLUSIONS
Criterion isokinetic dynamometry is a reliable test in persons with stroke, generally showing marked reductions in muscle strength of paretic and, to a lesser degree, nonparetic muscles when compared with healthy controls, independent of muscle group, contraction mode, and contraction velocity.
Topics: Hemiplegia; Humans; Muscle Contraction; Muscle Strength; Muscle Strength Dynamometer; Muscle, Skeletal; Psychometrics; Reproducibility of Results; Stroke Rehabilitation
PubMed: 27372002
DOI: 10.1016/j.apmr.2016.05.023