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Classifying knowledge used in complementary medicine consultations: a qualitative systematic review.BMC Complementary Medicine and Therapies Aug 2022Complementary Medicine (CM) is widely used internationally but there is limited understanding of the forms of knowledge CM practitioners use in their clinical practice...
BACKGROUND
Complementary Medicine (CM) is widely used internationally but there is limited understanding of the forms of knowledge CM practitioners use in their clinical practice and how they use this knowledge in interactions with patients. This review aims to synthesise the existing evidence on the forms of knowledge that are mobilised, and the role of this knowledge in the interactions between practitioners and patients during CM consultations. It considered a diverse range of CM practice areas to develop a classification of CM practitioners' knowledge use in consultations.
METHODS
Systematic searches of health and sociology databases were conducted using core concepts, including complementary and alternative medicine, practitioners, and knowledge. Articles were included where they reported on data from recorded CM practitioner and patient consultations and offered insights into the types and applications of knowledge used in these consultations. 16 unique studies were included in the review. Data were extracted, coded and analysed thematically.
RESULTS
Results demonstrate that diverse sources of knowledge were mobilised by practitioners, predominantly derived from the patients themselves -their bodies and their narratives. This reflected principles of patient-centredness. The use of discipline specific forms of knowledge and references to biomedical sources illustrated ongoing efforts towards legitimacy for CM practice.
CONCLUSION
CM practitioners are navigating tensions between what some might see as competing, others as complementary, forms of knowledge. The classification system provides a useful tool for promoting critically reflective practice by CM practitioners, particularly in relation to self-assessment of knowledge translation and patient interactions.
Topics: Complementary Therapies; Health Personnel; Humans; Longitudinal Studies; Referral and Consultation
PubMed: 35933449
DOI: 10.1186/s12906-022-03688-w -
BMJ Global Health Jul 2022Many low-income and middle-income country (LMIC) researchers have disadvantages when applying for research grants. Crowdfunding may help LMIC researchers to fund their...
BACKGROUND
Many low-income and middle-income country (LMIC) researchers have disadvantages when applying for research grants. Crowdfunding may help LMIC researchers to fund their research. Crowdfunding organises large groups of people to make small contributions to support a research study. This manuscript synthesises global qualitative evidence and describes a Special Programme for Research and Training in Tropical Diseases (TDR) crowdfunding pilot for LMIC researchers.
METHODS
Our global systematic review and qualitative evidence synthesis searched six databases for qualitative data. We used a thematic synthesis approach and assessed our findings using the GRADE-CERQual approach. Building on the review findings, we organised a crowdfunding pilot to support LMIC researchers and use crowdfunding. The pilot provided an opportunity to assess the feasibility of crowdfunding for infectious diseases of poverty research in resource-constrained settings.
RESULTS
Nine studies were included in the qualitative evidence synthesis. We identified seven findings which we organised into three broad domains: public engagement strategies, correlates of crowdfunding success and risks and mitigation strategies. Our pilot data suggest that crowdfunding is feasible in diverse LMIC settings. Three researchers launched crowdfunding campaigns, met their goals and received substantial monetary (raising a total of US$26 546 across all three campaigns) and non-monetary contributions. Two researchers are still preparing for the campaign launch due to COVID-19-related difficulties.
CONCLUSION
Public engagement provides a foundation for effective crowdfunding for health research. Our evidence synthesis and pilot data provide practical strategies for LMIC researchers to engage the public and use crowdfunding. A practical guide was created to facilitate these activities across multiple settings.
Topics: Fund Raising; Humans; Pilot Projects; Research Support as Topic
PubMed: 35896184
DOI: 10.1136/bmjgh-2022-009110 -
Cureus Jun 2022Neurosurgery is one of the cornerstones corresponding to a large scope of clinical pathologies and is a highly-regarded surgical specialty. However, there has been a... (Review)
Review
Neurosurgery is one of the cornerstones corresponding to a large scope of clinical pathologies and is a highly-regarded surgical specialty. However, there has been a decline in recruits into the neurosurgical residency due to many factors derailing the interest of medical students with an ambition to become neurosurgeons. Some of these issues encompass little or lack of early exposure to neurosurgery, lack of quality mentorship programs, and institutional curriculum entailing prolonged periods of training and study in neurosurgery. Therefore, this systematic review and meta-analysis aim to establish some strategic methodologies for increasing the recruitment to neurological surgery. Neurosurgery is an interestingly exciting specialty that integrates cutting-edge technology allowing for diversified subspecialization with an exceptional degree of variety. Nevertheless, several factors such as the duration of the required training, the kind of lifestyle, lack of early exposure to neurosurgery, and lack of mentors to a vast of medical students across the globe have curtailed the recruitment to neurological surgery. Despite an increased number of female representations in medical surgery, there has been a reported increase in students matching into neurosurgery, although the number is relatively below the expectation due to the factors highlighted earlier. As a result, many studies and surveys have been conducted to identify ways of improving neurosurgical recruitment. Five electronic databases, including PubMed, Science Direct, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar, MEDLINE, and Cochrane Library, were searched to provide pertinent information to the topic of study in strict compliance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis) guidelines. Meta-analysis was then conducted on the included studies to determine their correlations based on the individual outcomes of each study. A total of 2,134 search results were obtained, screened, and reviewed against the exclusion and inclusion criteria to remain with 12 included studies detailing improving the recruitment to neurosurgical residency. The 12 studies were retrieved for their study characteristics based on the PICO (predetermined patient, intervention, control, and outcome) standards. Most of the studies were surveys (n = 8), retrospective and prospective studies (n = 2), and pilot and multifocal studies making up for the rest (n = 2). Several neurosurgery aspects need consideration to improve the recruitment of medical students to neurosurgical fields. Medical institutions, specialists, and other stakeholders should consider reconstructing the neurosurgical curriculum to ease the prolonged study time as well as to create and encourage structural programs aimed at acquainting medical students in neurosurgery and involving the students in conducting other research projects. In addition, mentorship programs and early exposure of medical students to neurological surgery play a key role in influencing the medical students' interest in choosing neurosurgical career paths.
PubMed: 35891848
DOI: 10.7759/cureus.26212 -
The International Journal of Social... Nov 2022While employment programs were not created with the intent to improve common mental disorders (CMDs), they may have a positive impact on the prevalence, incidence, and... (Review)
Review
BACKGROUND
While employment programs were not created with the intent to improve common mental disorders (CMDs), they may have a positive impact on the prevalence, incidence, and severity of CMD by reducing poverty and increasing access to economic mobility.
AIM
To examine and synthesize the available quantitative evidence of the impact of employment programs on outcomes of CMD.
METHODS
Embase, Econlit, Global Health, MEDLINE, APA PsychINFO, and Social Policy and Practice were searched for experimental and quasi-experimental studies which investigated the impact of employment programs on primary and secondary outcomes of a CMD. A narrative synthesis according to Popay was conducted. The methodological quality of studies was assessed with the Cochrane Risk of Bias tool and the Newcastle-Ottawa Assessment Scale.
RESULTS
Of the 1,327 studies retrieved, two randomized controlled trials, one retrospective cohort, one pilot study with a non-randomized experimental design, and one randomized field experiment were included in the final review. Employment programs generally included multiple components such as skills-based training, and hands-on placements. Depression and anxiety were the CMDs measured as primary or secondary outcomes within included studies. Findings regarding the impact of employment programs on CMD were mixed with two studies reporting significantly positive effects, two reporting no effects, and one reporting mixed effects. The quality among included studies was good overall with some concerns regarding internal validity.
CONCLUSION
Employment programs may support a decrease in the prevalence, incidence, and severity of CMDs. However, there is high heterogeneity among study effects, designs, and contexts. More research is needed to gain further insight into the nature of this association and the mechanisms of impact. This review highlights the potential for employment programs and other poverty-reduction interventions to be utilized and integrated into the wider care, prevention, and treatment of common-mental disorders.
Topics: Humans; Employment; Mental Disorders; Pilot Projects; Poverty; Randomized Controlled Trials as Topic; Retrospective Studies
PubMed: 35796434
DOI: 10.1177/00207640221104684 -
JPMA. the Journal of the Pakistan... Jun 2022To build a consensus on portfolio framework for master's in health professional education students and document programme learning outcomes, tasks for students related...
OBJECTIVE
To build a consensus on portfolio framework for master's in health professional education students and document programme learning outcomes, tasks for students related to each outcome, and the pieces of evidence regarding the completion of each task.
METHODS
The modified Delphi study was conducted from February to July 2020 at Riphah International University, Islamabad, Pakistan, and comprised a three-round electronic-based survey of faculty members associated with the master's in health professional education programme, alumni, and current students as well as portfolio experts. The panellists had to choose from 10 programme learning outcomes, 75 tasks for students to achieve those outcomes, and 510 pieces of evidence to confirm that the tasks had been done to achieve the outcomes. A consensus cut-off of ≥80% was decided to select the item.
RESULTS
Of the 45 stakeholders approached, 41(91.5%) responded in round 1. Of them, 31(75.6%) responded in round 2, while round 3 comprised responses from 31(96.7%) subjects. The draft template was originally derived from the master's in health professional education programme guide, expert opinions, and systematic literature review available for portfolios of other higher education degrees. The list of items was refined through a pilot study. The final template was approved by the expert panel after 3 iterations. The final list of items included 59 (78.6%) tasks and 105(21%) pieces of evidence related to all the 10 programme learning outcomes.
CONCLUSIONS
The important programme learning outcomes, their related tasks, and the required pieces of evidence to be added in the e-portfolio of master's in health professional education programme students were identified, and recommendations for the format of implementation and assessment were given.
Topics: Humans; Consensus; Delphi Technique; Pilot Projects; Students; Education, Professional
PubMed: 35751318
DOI: 10.47391/JPMA.3242 -
Nutrients May 2022To assess the relationship between fat mass percentage (FMP) and glucose metabolism in children aged 0−18 years we performed a systematic review of the literature on... (Meta-Analysis)
Meta-Analysis Review
To assess the relationship between fat mass percentage (FMP) and glucose metabolism in children aged 0−18 years we performed a systematic review of the literature on Medline/PubMed, SinoMed, Embase and Cochrane Library using the PRISMA 2020 guidelines up to 12 October 2021 for observational studies that assessed the relationship of FMP and glucose metabolism. Twenty studies with 18,576 individuals were included in the meta-analysis. The results showed that FMP was significantly associated with fasting plasma glucose (FPG) (r = 0.08, 95% confidence interval (CI): 0.04−0.13, p < 0.001), fasting plasma insulin (INS) (r = 0.48, 95% CI: 0.37−0.57, p < 0.001), and homeostasis model assessment (HOMA)- insulin resistance (IR) (r = 0.44, 95% CI: 0.33−0.53, p < 0.001). The subgroup analysis according to country or overweight and obesity indicated that these associations remained significant between FMP and INS or HOMA-IR. Our results demonstrated that there is a positive relationship between FMP and FPG. Moreover, subgroup analysis according to country or overweight and obesity indicated that FMP is significantly associated with INS and HOMA-IR. This is the first known systematic review and meta-analysis to determine the associations of FMP with glucose metabolism in children and adolescents.
Topics: Adolescent; Blood Glucose; Child; Glucose; Humans; Insulin; Insulin Resistance; Obesity; Overweight
PubMed: 35684072
DOI: 10.3390/nu14112272 -
JAMA Network Open May 2022Phase 3 trials for patients with metastatic colorectal cancer (mCRC) have been conducted with varying designs and often with surrogate end points for overall survival...
Overall Survival in Phase 3 Clinical Trials and the Surveillance, Epidemiology, and End Results Database in Patients With Metastatic Colorectal Cancer, 1986-2016: A Systematic Review.
IMPORTANCE
Phase 3 trials for patients with metastatic colorectal cancer (mCRC) have been conducted with varying designs and often with surrogate end points for overall survival (OS).
OBJECTIVES
To critically examine the factors associated with clinically relevant improvement in OS (defined as ≥2 months) in these trials and to evaluate their association with outcomes reflected in Surveillance, Epidemiology, and End Results (SEER) registry data.
EVIDENCE REVIEW
Medline, EMBASE, Cochrane, Web of Science, ClinicalTrials.gov, EU Clinical Trials Register, and the International Clinical Trials Registry Platform were searched for phase 3 trials of systemic therapy for patients with mCRC by decade (1986-1996, 1997-2006, and 2007-2016), excluding early or pilot studies, studies that did not involve an anticancer drug, studies on cancer screening and prevention, reports of pooled data from multiple trials, and studies with nonpharmaceutical approaches. The association of drug development with OS outside the clinical trial setting was evaluated using data from the SEER registry, including adult patients with a primary cancer site in the colon or rectum, including adenocarcinoma, mucinous adenocarcinoma, or signet ring cell carcinoma; a distant stage; and receipt of chemotherapy as first-line therapy. Kaplan-Meier curves and log-rank tests were used to assess OS.
FINDINGS
The literature search identified 150 phase III clinical trials with 77 494 total enrollments, and 67 126 patients with mCRC were identified from the SEER database. Significant increases in survival were noted over time, best reflected in the experimental arm of first-line therapy (OS increased by 5.7 months per 10 years; 95% CI, 4.7-6.6 months; progression-free survival increased by 1.4 months per 10 years; 95% CI, 0.7-2.1 months). Although 69 of 148 trials (46.6%) met their predefined primary end point (including 20 of 44 trials [45.5%] with OS as the primary end point), only 35 of 132 trials (26.5%) resulted in improvement in OS by 2 months or more (including 13 of 42 trials [31.0%] with OS as the primary end point). Multivariable logistic regression showed that third-line therapies or later (odds ratio, 0.57; 95% CI, 0.51-0.63) and funding by pharmaceutical companies (odds ratio, 0.57; 95% CI, 0.54-0.60) were less often associated with improvement in OS. Furthermore, there was a decrease in the novelty of targets and agents over time, with trials that evaluated regimens composed entirely of previously approved drugs for mCRC increasing from 28% to 50%. Data from the SEER database showed that median OS increased from 12 months (95% CI, 12-13 months) (1986-1996) to 21 months (95% CI, 21-22 months) (2007-2015) (P < .001), but the 5-year OS continued to be low at 12.2% in 2011.
CONCLUSIONS AND RELEVANCE
In this systematic review, OS for patients with mCRC appeared to improve significantly in trials, translating into meaningful benefits outside the clinical trial setting; however, these advances, although significant cumulatively, are largely incremental individually. These data should be a call to aim for larger gains from future trials with novel drugs, building on the increasing understanding of the biology of mCRC and sophisticated translational research tools.
Topics: Adult; Antineoplastic Agents; Colorectal Neoplasms; Databases, Factual; Humans; Progression-Free Survival
PubMed: 35608860
DOI: 10.1001/jamanetworkopen.2022.13588 -
Frontiers in Genetics 2022infects millions and kills thousands of people annually the world over. With the emergence of artemisinin and/or multidrug resistant strains of the pathogen, it has...
infects millions and kills thousands of people annually the world over. With the emergence of artemisinin and/or multidrug resistant strains of the pathogen, it has become even more challenging to control and eliminate the disease. Multiomics studies of the parasite have started to provide a glimpse into the confounding genetics and mechanisms of artemisinin resistance and identified mutations in Kelch13 (K13) as a molecular marker of resistance. Over the years, thousands of genomes and transcriptomes of artemisinin-resistant/sensitive isolates have been documented, supplementing the search for new genes/pathways to target artemisinin-resistant isolates. This meta-analysis seeks to recap the genetic landscape and the transcriptional deregulation that demarcate artemisinin resistance in the field. To explore the genetic territory of artemisinin resistance, we use genomic single-nucleotide polymorphism (SNP) datasets from 2,517 isolates from 15 countries from the MalariaGEN Network (The Pf3K project, pilot data release 4, 2015) to dissect the prevalence, geographical distribution, and co-existing patterns of genetic markers associated with/enabling artemisinin resistance. We have identified several mutations which co-exist with the established markers of artemisinin resistance. Interestingly, K13-resistant parasites harbor α-ß hydrolase and putative HECT domain-containing protein genes with the maximum number of SNPs. We have also explored the multiple, publicly available transcriptomic datasets to identify genes from key biological pathways whose consistent deregulation may be contributing to the biology of resistant parasites. Surprisingly, glycolytic and pentose phosphate pathways were consistently downregulated in artemisinin-resistant parasites. Thus, this meta-analysis highlights the genetic and transcriptomic features of resistant parasites to propel further exploratory studies in the community to tackle artemisinin resistance.
PubMed: 35464842
DOI: 10.3389/fgene.2022.824483 -
International Journal of Environmental... Apr 2022Resilience is a key factor that reflects a teacher's ability to utilize their emotional resources and working skills to provide high-quality teaching to children....
Resilience is a key factor that reflects a teacher's ability to utilize their emotional resources and working skills to provide high-quality teaching to children. Resilience-building interventions aim to promote positive psychological functioning and well-being. However, there is lack of evidence on whether these interventions improve the well-being or mental health of teachers in early childhood education (ECE) settings. This review examined the overall effectiveness of resilience-building interventions conducted on teachers working in the ECE field. A systematic approach is used to identify relevant studies that focus on resilience-building in countering work stress among early childhood educators. Findings from this review observed a preference of group approaches and varying durations of interventions. This review highlights the challenges of the group approach which can lead to lengthy interventions and attrition amongst participants. In addition to the concerns regarding response bias from self-report questionnaires, there is also a lack of physiological measures used to evaluate effects on mental health. The large efforts by 11 studies to integrate multiple centres into their intervention and the centre-based assessment performed by four studies highlight the need for a centre-focused approach to build resilience among teachers from various ECE centres. A pilot study is conducted to evaluate the feasibility of an integrated electroencephalography-virtual reality (EEG-VR) approach in building resilience in teachers, where the frontal brain activity can be monitored during a virtual classroom task. Overall, the findings of this review propose the integration of physiological measures to monitor changes in mental health throughout the resilience-building intervention and the use of VR as a tool to design a unique virtual environment.
Topics: Child; Child, Preschool; Electroencephalography; Humans; Mental Health; Pilot Projects; Surveys and Questionnaires; Virtual Reality
PubMed: 35410097
DOI: 10.3390/ijerph19074413 -
Value in Health : the Journal of the... Apr 2022Indication-based pricing (IBP) has received growing attention because of the expected increase in the number of new medicines with multiple indications. In our... (Review)
Review
OBJECTIVES
Indication-based pricing (IBP) has received growing attention because of the expected increase in the number of new medicines with multiple indications. In our systematic review, we assess the potential benefits, barriers, current experiences, and future perspectives of different IBP mechanisms.
METHODS
We searched publications in English, Spanish, or French assessing the impact, international experience, and future context of IBP systems on PubMed, Scopus, Cochrane, EconLit, American Society of Clinical Oncology, and National Institute for Health Research Health Technology Assessment from 2000 to 2020. This was complemented by a gray literature search in Google Scholar.
RESULTS
A total of 29 publications that specifically addressed the topic of IBP were retained. The most commonly reported benefits of IBP were a better alignment of medicines' value and price, optimization of research and development incentives and increase of competition, and improvement of patients' access to treatments. Data collection and proper infrastructures, and the risk of high administrative burden and associated costs, were seen as the main barriers for proper IBP implementation. International experience lacks concrete examples of IBP. A single weighted average price according to volume, value, or a combination of both, appears to be the most used methodology, followed by different confidential net prices per indication. Different brands with distinct price per indication are less common, although it is considered a pure IBP system.
CONCLUSIONS
Evidence of IBP impact is still scarce, and there is a need for pilot projects and experiences to monitor its real consequences. An appropriate price and reimbursement model for multi-indication medicines should be a priority, but political will and proper data collection systems remain crucial.
Topics: Costs and Cost Analysis; Drug Costs; Humans; Policy
PubMed: 35227598
DOI: 10.1016/j.jval.2021.11.1376