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Patient Preference and Adherence 2020Compared to men, women have lower treatment rates for cardiovascular disease (CVD), are at higher risk for medication non-adherence and have different reasons for being... (Review)
Review
BACKGROUND
Compared to men, women have lower treatment rates for cardiovascular disease (CVD), are at higher risk for medication non-adherence and have different reasons for being non-adherent. The aim of this study was to synthesize and evaluate gender-specific adherence-promoting interventions for cardiovascular medication and gender-specific effects of gender-neutral interventions.
METHODS
A systematic literature search was performed in PubMed, Embase, PsycINFO, CINAHL and Cochrane Library from January 2007 to October 2019. Intervention studies (with control group) aimed at improving cardiovascular medication adherence with minimally 14 weeks follow-up were included. Two reviewers independently screened titles and abstracts. Full text was obtained for selected abstracts and screened for final inclusion. Data extraction included gender-specific targeting or analysis.
RESULTS
The search identified 6502 citations. After screening title and abstract, full text was obtained from 127 potentially eligible articles. Ultimately, 11 articles were included that analyzed gender differences in gender-neutral interventions. Two reported a gender-specific intervention effect. Using an electronic reminder device, one study increased statin adherence in women. The other found a larger increase in adherence to CVD medication following telephone counseling for men than women. Nine studies did not identify a gender-specific effect.
CONCLUSION
Despite differences in levels of and reasons for non-adherence, most studies addressing adherence did not analyze potential differences in effect by gender. Moreover, none of the identified studies used gender-specific adherence promoting interventions. Increasing awareness about gender differences in adherence might lead to better tailoring of interventions to gender-specific needs and better results in improving adherence.
PubMed: 33154630
DOI: 10.2147/PPA.S260562 -
The Journal of Antimicrobial... May 2014Extended-spectrum β-lactamases (ESBLs) have become widespread around the world. We sought to evaluate the proportion of ESBL-producing isolates among Enterobacteriaceae... (Review)
Review
OBJECTIVES
Extended-spectrum β-lactamases (ESBLs) have become widespread around the world. We sought to evaluate the proportion of ESBL-producing isolates among Enterobacteriaceae in Africa.
METHODS
A systematic search in the PubMed and Scopus databases was performed in order to identify studies providing the proportion of ESBL-producing isolates among patients either infected or colonized with Enterobacteriaceae. In an effort to incorporate contemporary data, only studies published from 2005 onwards and, among them, only those including isolates that were recovered from 2000 onwards were eligible.
RESULTS
Twenty-six studies (409 ,215 isolates) from 13 African countries met the inclusion criteria. The proportion of ESBL-producing isolates among 13 studies reporting on isolates from a urinary source varied from 1.5% to 22.8%. Four other studies evaluated various clinical samples from different hospitals, showing that the proportion varied from 12.8% to 21.1%. Last, the proportions were 0.7%, 14%, 15.2% and 75.8%, respectively, in four studies evaluating patients with bloodstream infection. In particular, the proportion was 0.7% in a study from Malawi where ceftriaxone was the only available cephalosporin and was 75.8% in a study from Egypt that included only patients from intensive care units. In total, the proportion of ESBL-producing isolates was <15% in 16 out of 26 studies.
CONCLUSIONS
Data originating from a small number of African countries suggest that the proportion of ESBL-producing isolates among Enterobacteriaceae may not be high in Africa, but is certainly not negligible. Further studies are needed from countries where no or limited relevant data are available.
Topics: Africa; Enterobacteriaceae; Enterobacteriaceae Infections; Humans; Prevalence; beta-Lactamases
PubMed: 24398340
DOI: 10.1093/jac/dkt500 -
BMC Research Notes Aug 2018In this systematic review, we present the molecular epidemiology and knowledge gaps of the carbapenem resistance in East Africa as well as the future probable research...
OBJECTIVE
In this systematic review, we present the molecular epidemiology and knowledge gaps of the carbapenem resistance in East Africa as well as the future probable research interventions that can be used to address the emergence of carbapenem resistance in the region.
RESULTS
The 17 articles which presented concrete information about the prevalence of carbapenem resistance in East Africa were reviewed. Tanzania exhibited the highest level of carbapenem resistance at 35% while DRC had the lowest level at 0.96%. Uganda was the only country with studies documenting CR obtained amongst hospital environment isolates with incidence ranging from 21% in Pseudomonas aeruginosa to 55% in Acinetobacter baumannii. Carbapenem resistance was more exhibited in A. baumannii (23%), followed by P. aeruginosa (17%), Klebsiella pneumoniae (15%), Proteus mirabilis (14%) and Escherichia coli (12%) mainly isolated from respiratory tract, blood, urine and wound/pus. The regional genetic determinants of carbapenem resistance detected were blaIMP, blaVIM-1 blaSPM-l, blaNDM-1, blaOXA-23 blaOXA-24, blaOXA-58 and blaKPC.
Topics: Acinetobacter baumannii; Africa, Eastern; Anti-Bacterial Agents; Carbapenems; Drug Resistance, Bacterial; Escherichia coli; Humans; Microbial Sensitivity Tests; beta-Lactamases
PubMed: 30170613
DOI: 10.1186/s13104-018-3738-2 -
International Urogynecology Journal Jun 2024The aim of this article is to present a systematic literature review focused on microbiome diversity in women experiencing pelvic floor dysfunction. (Review)
Review
INTRODUCTION AND HYPOTHESIS
The aim of this article is to present a systematic literature review focused on microbiome diversity in women experiencing pelvic floor dysfunction.
METHODS
Utilizing PubMed/MedLine and Scopus, 25 pertinent studies were meticulously selected for this review.
RESULTS
A key theme identified is the potential of microbiomes as diagnostic tools. The findings consistently highlight Lactobacillus as recurrent microbiota. Additionally, Gardnerella, Streptococcus, Prevotella, Aerococcus, Staphylococcus, Proteus, and Bifidobacterium species were frequently observed. This suggests the influential role of these microorganisms in shaping female urological and reproductive health. A deeper understanding of these predominant bacterial genera could offer invaluable insights into healthy physiological states and various disorders. The complex relationship between microbial compositions and diverse health conditions paves the way for novel diagnostic and therapeutic approaches. As we further explore the complexities of microbiomes, their role becomes increasingly crucial in transforming women's health care.
CONCLUSIONS
These findings emphasize the need for personalized care, integrating the microbiome into a comprehensive health assessment and treatment framework. This review lays the groundwork for future medical strategies where the microbiome is a pivotal element in both preventive and therapeutic care.
PubMed: 38861007
DOI: 10.1007/s00192-024-05821-4 -
Games For Health Journal Apr 2020A systematic review of health interventions using avatars ( = 18) was conducted to provide comprehensive knowledge of the effectiveness of using avatars to promote...
A systematic review of health interventions using avatars ( = 18) was conducted to provide comprehensive knowledge of the effectiveness of using avatars to promote healthy behaviors, specifically in relationship to healthy eating and exercising. Two researchers identified field or laboratory studies that had quantified study results, which were published in peer-reviewed journals in English from January 2000 to March 2019. Databases (PsychInfo, PubMed, and Web of Science), forward reference, and manual searches were used to identify the studies. Search terms included avatar, the Proteus effect, exercise, and diet, among others. Two field interventions and 16 laboratory studies were identified. Information on sample characteristics, technologies used, study design and conditions pertaining to avatars, outcome measures, results, and conclusion were extracted. Six different avatar characteristics used to elicit health outcomes were identified, which are the similarity with the user, avatar body size, self-domain (e.g., ideal-self), customizability, body transformation, and avatar's behaviors. Only a few studies had a no-avatar control group; thus, it was not possible to conclude whether employing avatars in health interventions increases the effectiveness of the interventions in comparison to not using an avatar. The results indicate that using an avatar that is physically active, fit, and similar-looking (to the user) is effective in eliciting healthy behaviors.
Topics: Health Behavior; Healthy Lifestyle; Humans; Video Games
PubMed: 31724888
DOI: 10.1089/g4h.2018.0134 -
Journal of Managed Care & Specialty... Jul 2021The prevalence of financial medication assistance (FMA), including patient assistance programs, coupons/copayment cards, vouchers, discount cards, and programs/pharmacy...
The prevalence of financial medication assistance (FMA), including patient assistance programs, coupons/copayment cards, vouchers, discount cards, and programs/pharmacy services that help patients apply for such programs, has increased. The impact of FMA on medication adherence and persistence has not been synthesized. The primary objective of this study was to review published studies evaluating the impact of FMA on the three phases of medication adherence (initiation [or primary adherence], implementation [or secondary adherence], and discontinuation) and persistence. Among these studies, the secondary objective was to report the impact of FMA on patient out-of-pocket costs and clinical outcomes. A systematic review was performed using MEDLINE and Web of Science. Of 656 articles identified, eight studies met all inclusion criteria. Seven studies examined FMA for medications treating cardiovascular diseases, while one study assessed FMA for cancer medications. Among included studies, FMA had a positive impact on medication adherence or persistence, and most measured this impact over one year or less. Of the three phases of medication adherence, implementation (5 of 8) was most commonly reported, followed by discontinuation (3 of 8), and then initiation (1 of 8). Regarding implementation, users of FMA had a higher mean medication possession ratio (MPR) than nonusers, ranging from 7 to 18 percentage points higher. The percentage of patients who discontinued medication was 7 percentage points lower in users of FMA versus nonusers for cardiovascular disease states. In one cancer study, FMA had a larger impact on initiation than discontinuation, ie, compared to nonusers, users of FMA were less likely to abandon an initial prescription (risk ratio= 0.12, 95% confidence interval [CI]: 0.08-0.18), and this effect was larger than the decreased likelihood of discontinuing the medication (hazard ratio = 0.76, 95% CI: 0.66-0.88). In 3 of 8 studies reporting on medication persistence, FMA increased the odds of medication persistence for one year ranged from 11% to 47%, depending on the study. In addition to adherence, half of the studies reported on FMA impacts on patient out-of-pocket costs and 3 of 8 studies reported on clinical outcomes. Impacts on patient out-of-pocket costs were mixed; two studies reported that out-of-pocket costs were higher for users of a coupon or a voucher versus nonusers, one study reported the opposite, and one study reported null effects. Impacts on clinical outcomes were either positive or null. We found that FMA has positive impacts on all phases of medication adherence as well as medication persistence over one year. Future studies should assess whether FMA has differential impacts based on phase of medication adherence and report on its longer-term (ie, beyond one year) impacts on medication adherence. This work was sponsored by a grant from Pharmaceutical Research and Manufacturers of America (PhRMA). PhRMA had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Hung reports past employment by Blue Cross Blue Shield Association and CVS Health and a grant from PhRMA outside of the submitted work. Zullig reports research funding from Proteus Digital Health and the PhRMA Foundation. consulting fees from Novartis. Reed reports receiving research support from Abbott Vascular, AstraZeneca, Janssen Research & Development, Monteris, PhRMA Foundation, and TESARO and consulting fees from Sanofi/Regeneron, NovoNordisk, SVC Systems, and Minomic International, Inc. Bosworth reports research grants from the PhRMA Foundation, Proteus Digital Health, Otsuka, Novo Nordisk, Sanofi, Improved Patient Outcomes, Boehinger Ingelheim, NIH, and VA, as well as consulting fees from Sanofi, Novartis, Otsuka, Abbott, Xcenda, Preventric Diagnostics, and the Medicines Company. The other authors have nothing to report. This work was presented as a poster presentation at the ESPACOMP Annual Meeting in November 2020.
Topics: Fees, Pharmaceutical; Humans; Medical Assistance; Medication Adherence; Retrospective Studies
PubMed: 34185554
DOI: 10.18553/jmcp.2021.27.7.924 -
Journal of General Internal Medicine Mar 2022A culture of improvement is an important feature of high-quality health care systems. However, health care teams often need support to translate quality improvement (QI)...
BACKGROUND
A culture of improvement is an important feature of high-quality health care systems. However, health care teams often need support to translate quality improvement (QI) activities into practice. One method of support is consultation from a QI coach. The literature suggests that coaching interventions have a positive impact on clinical outcomes. However, the impact of coaching on specific process outcomes, like adoption of clinical care activities, is unknown. Identifying the process outcomes for which QI coaching is most effective could provide specific guidance on when to employ this strategy.
METHODS
We searched multiple databases from inception through July 2021. Studies that addressed the effects of QI coaching on process of care outcomes were included. Two reviewers independently extracted study characteristics and assessed risk of bias. Certainty of evidence was assessed using GRADE.
RESULTS
We identified 1983 articles, of which 23 cluster-randomized trials met eligibility criteria. All but two took place in a primary care setting. Overall, interventions typically targeted multiple simultaneous processes of care activities. We found that coaching probably has a beneficial effect on composite process of care outcomes (n = 9) and ordering of labs and vital signs (n = 6), and possibly has a beneficial effect on changes in organizational process of care (n = 5), appropriate documentation (n = 5), and delivery of appropriate counseling (n = 3). We did not perform meta-analyses because of conceptual heterogeneity around intervention design and outcomes; rather, we synthesized the data narratively. Due to imprecision, inconsistency, and high risk of bias of the included studies, we judged the certainty of these results as low or very low.
CONCLUSION
QI coaching interventions may affect certain processes of care activities such as ordering of labs and vital signs. Future research that advances the identification of when QI coaching is most beneficial for health care teams seeking to implement improvement processes in pursuit of high-quality care will support efficient use of QI resources.
PROTOCOL REGISTRATION
This study was registered and followed a published protocol (PROSPERO: CRD42020165069).
Topics: Delivery of Health Care; Health Services; Humans; Mentoring; Quality Improvement; Quality of Health Care
PubMed: 34981354
DOI: 10.1007/s11606-021-07217-2 -
Archives of Dermatological Research May 2024Hand infection is a rare complication in patients with diabetes. Its clinical outcomes depend on the severity of hand infection caused by bacteria, but the difference in... (Comparative Study)
Comparative Study
Hand infection is a rare complication in patients with diabetes. Its clinical outcomes depend on the severity of hand infection caused by bacteria, but the difference in bacterial species in the regional disparity is unknown. The purpose of this study was to explore the influence of tropical and nontropical regions on bacterial species and clinical outcomes for diabetic hand. A systematic literature review was conducted using PubMed, EMBASE, Web of Science, and Google Scholar. Moreover, the bacterial species and clinical outcomes were analyzed with respect to multicenter wound care in China (nontropical regions). Both mixed bacteria (31.2% vs. 16.6%, p = 0.014) and fungi (7.5% vs. 0.8%, p = 0.017) in the nontropical region were significantly more prevalent than those in the tropical region. Staphylococcus and Streptococcus spp. were dominant in gram-positive bacteria, and Klebsiella, Escherichia coli, Proteus and Pseudomonas in gram-negative bacteria occupied the next majority in the two regions. The rate of surgical treatment in the patients was 31.2% in the nontropical region, which was significantly higher than the 11.4% in the tropical region (p = 0.001). Although the overall mortality was not significantly different, there was a tendency to be increased in tropical regions (6.3%) compared with nontropical regions (0.9%). However, amputation (32.9% vs. 31.3%, p = 0.762) and disability (6.3% vs. 12.2%, p = 0.138) were not significantly different between the two regions. Similar numbers of cases were reported, and the most common bacteria were similar in tropical and nontropical regions in patients with diabetic hand. There were more species of bacteria in the nontropical region, and their distribution was basically similar, except for fungi, which had differences between the two regions. The present study also showed that surgical treatment and mortality were inversely correlated because delays in debridement and surgery can deteriorate deep infections, eventually leading to amputation and even death.
Topics: Humans; Amputation, Surgical; Bacteria; Bacterial Infections; China; Diabetes Complications; Hand; Treatment Outcome; Tropical Climate
PubMed: 38695894
DOI: 10.1007/s00403-024-02856-x